Methods of Avoiding the Errors in the first place

[DavidS]

Many times dispensary staff have presented me with boxes of medicines with incorrect quantities when they were meant to add or subtract an amount.

Well, you are right, me too, and yet I still don't habitually open complete packs to check they are. My reason is that the wrong quantity is not going to seriously harm a patient, and I can leave that to the patient to check.

However, with split packs, I am much more likely to check, as I have had plenty of experience of bits of the wrong strip being stuffed into another box. This is why I personally prefer that odd 2s are not cut off, but say 28 plavix or 30 prednisolone are prepared from the already open packs, so that we don't end up with a box of bits which can be difficult to identify.

Its nice to see that this thread is still current and considered useful: I started the thread with my first post on here. Its been fun!

[howe928]

it has been a habit for me to open boxes and make sure the quantity is right (more than better than less than until they decided to change to original pack dispensing), always you can find they either generous (eg prescribed 60 co-codamol and 100 given) or counting error (there is always 1 missing somewhere), this prevented a customer claiming did not receive enough sleeping tablets (how confident are you if a customer comes back to say you have not given them enough tablets? if you did the check then you know you are right).

Techniques that i use
- to feel how heavy is the box, if it is lighter than you thought then something missing, if it is heavier than you thought then it is too much
- listen to the sounds and feel it when you shake that carton box lightly, you will find out if it is too much or too little
- endorsing quantity checked off by you by hand so you know exactly how much you gave to customers

To be honest, checking quantity dispensed this way drains a lot of energy (also sore dry hand) but prevented a lot of potential quantity queries or challenges. If the company has strict clinical governance policy, you may get quite a few dispensing error reports. Dunno if these reports would be part of the evidences when the statutory committee investigates let's say a dispensing error brought to their attention.

[medical6969]

Cutting down on distractions is vital to reduce the mental load on our poor little brains, when were checking the box of tablets in front of us (I know its obvious, but how many of us tell staff not to disturb us while were checking medication?).

When your attention is focused on something else, you are less likely to notice it's propranolol in your hand rather than prednisolone.

Check out this experimental video:
Click

[DavidS]

Check out this experimental video:
Click

Absolutely terrific!

[medical6969]

Hi David,
so to put it into our context, I guess each basket ball pass is one or more of the following 'Mrs Jones has run out of medicines', 'Marks here for his methadone', and 'There's someone on the phone that wants to talk to the pharmacist'... etc... etc
...and the gorilla passing through the scene is equivalent to the box of propranolol passing through our hands into the bag (instead of prednisolone)... with us being totally unaware (i.e. blind).

With so many distractions on the screen, we never stood a chance of seeing the gorilla.
If however, there was just one team of players, and only 2 people on the team, we would have probably spotted the gorilla... i.e. cut down on the distractions as much as possible.

[Asterix]

The best method of checking I have observed is a locum pharmacist who would circle the name of the drug on the box itself after looking at the rx and then circle the strength on the box. Surely in this way 'marking' help prevent mistakes.

[medical6969]

If I were a manager at a particular branch (rather than a locum) I would play one of the videos below to my staff to show them why I should be disturbed as little as possible.
Not because I'm lazy, but to ensure a high level of safety.
Obviously you would need to train your staff so they can deal with most queries themselves, and not just dump them in the deep end.

1. The original experiment done by Daniel Simons click

2. One for those old enough to remember the 'danger mouse' cartoons click

3. With some academic type explaining a bit about the phenomenon click

4. For those of you who are by now 'gorilla spotting' experts click (starts at 55seconds)

[bleepholder]

My reason is that the wrong quantity is not going to seriously harm a patient, and I can leave that to the patient to check.

I'll ahvje to disagree with you on that one..... in some cases incorrect quantities "can" affect a patient..you don't give them enough steroids to complete a reducing course, patient is none the wiser. Most of the time they are under the impression they take the tablets until they are all gone...so hypothetically someone is on 40mg od for 7/7 and they are to reduce by 5mg each week to a maintenance dose of 5mg. we supply them enough to get down to say 20mg, then they run out..patient stops taking them. surely some harm is done to the patient

same goes for antibiotics...patient prescribed 10 day course. we give them a 5 day course because we think the box is full or has extra doses in...patient finishes cousre 5 days earlier than the dr intended..surely that is some harm to a patient??

[medical6969]

1. Lloyds pharmacies have an in-store radio show, which plays music throughout the day.
Apart from being unprofessional (having Robbie Williams latest hit playing while you are handing out medication it totally bizarre) it is also distracting, which may increase the risk of dispensing errors (need to find some evidence of this though).

2. The level of competence of pharmacy support staff can be horrific. Many really don't seem to care about ensuring that the right medication is put in front of the pharmacist for checking. Yes they are not paid much, but they should still be able to do the job to a certain standard.
Compare this to someone putting cans of food on the shelves at a Tesco store. Do you think they would continue to be employed if they kept putting the cans on the wrong shelf? They care enough about their job to do the job properly. They don't think 'I'll put it roughly in the right spot, but it's no big deal if I get it wrong, the manager will spot any mistakes. And anyway, I don't get paid enough to try to make sure it's 100% correct.'

However the attitude of dispensery staff is to just haphazadly put the basket of medication together. And, if it's wrong the pharmacist will be able to spot it.
Totally ridiculous attitude. And its the regular pharmacy manager at that pharmacy that is to blame for allowing this culture to continue. Train your staff up, or move them 'on' if they have this sort of attitude.

[tinx25388]

However the attitude of dispensery staff is to just haphazadly put the basket of medication together. And, if it's wrong the pharmacist will be able to spot it. Totally ridiculous attitude. And its the regular pharmacy manager at that pharmacy that is to blame for allowing this culture to continue. Train your staff up, or move them 'on' if they have this sort of attitude.

In the Pharmacy where I work (as a dispenser) there is an ongoing battle between two dispensers and the Pharmacy Manager. One who takes longer to dispense, but rarely makes a mistake, and one who churns out scripts at ridiculous pace, and never seems bothered if she makes an error. Recently one reached the patient, with the patient taking completely the wrong medication for a month before noticing that "she wasnt feeling quite right and wondered if it was because the tablets looked a bit different"

I am struggling to understand why it is the slow, accurate one who is getting told to work faster, and the faster one is not questioned by the Manager (only our other regular Pharmacist!)