A system approach to dispensing errors: a national study on perceptions of the Finnish community pharmacists

Objective To examine pharmacists’ perceptions and opinions on the potential causes of dispensing errors and the ways to prevent them in community pharmacies, and to assess whether pharmacists’ perceptions reflect the system approach. Method A survey instrument was mailed to privately owned Finnish community pharmacies (n = 599) in March 2005. The survey included two open-ended questions to assess the pharmacists’ perceptions on potential causes and prevention of dispensing errors. Furthermore, the questionnaire contained 20 structured, Likert-type, statements of dispensing errors and their management. The survey was addressed to the owner or operational manager of the pharmacy. The emphasis in the analysis of the study was on the open-ended questions which were analysed using the content analysis method. All quantitative data was analysed using the SPSS for Windows. Main outcome measure: The community pharmacists’ perceptions and opinions on the potential causes and preventive factors of dispensing errors. Results A total of 340 responses were entered in the study (response rate 57%). The content analysis revealed that factors related to organization and those related to individual professionals were the most frequently mentioned as the potential causes of dispensing errors (37% and 30% of all potential causes given, respectively; number of respondents n = 326; total number of given items n = 967). The organizational factors (46% of all the preventive factors given), and factors related to individual professionals (41%) were also the most frequently considered as preventive (number of respondents n = 323; total number of given items n = 916). The analysis of the structured statements revealed that discussion about the dispensing errors with pharmacy staff and changes in working routines based on the dispensing error incidents were considered to be the most important factors in error prevention. A heavy workload and the similarity of drug packages were considered as the most important potential causes of the dispensing errors in the structured statements. Conclusion Finnish community pharmacists still, to some extent, have the person-centred approach to medication safety although signs of the system approach were also evident. Attitudinal changes still have to take place, as well as changes to the practice environment, in order to get the system approach fully implemented in the Finnish community pharmacies.