Dispensing errors in Lebanese community pharmacies: incidence, types, underlying causes, and associated factors

Main Article Content


Medication Errors, Drug Prescriptions, Pharmacies, Pharmacists, Professional Practice, Quality Assurance, Health Care, Multivariate Analysis, Cross-Sectional Studies, Lebanon


Objectives: To assess the incidence, types, the causes of as well as the factors associated with dispensing errors in community pharmacies in Lebanon.

Methods: An observational cross-sectional study was conducted in 286 pharmacies located all over Lebanon. Data were collected by senior pharmacy students during their experiential learning placement. Collected data included information on the types of dispensing errors, the underlying causes of errors, handling approaches, and used strategies for dispensing error prevention. Data were analyzed using multiple logistic regression to determine factors that were associated with dispensing errors.

Results: In the twelve thousand eight hundred sixty dispensed medications, there were 376 dispensing errors, yielding an error rate of 2.92%. Of these errors, 67.1% (252) corresponded to dispensing near-miss errors. The most common types of dispensing errors were giving incomplete/incorrect use instructions (40.9% (154)), followed by the omission of warning(s) (23.6% (89)). Work overloads/time pressures, illegible handwriting, distractions/interruptions, and similar drug naming/packaging were reported as the underlying causes in 55% (206), 23.13% (87), 15.15 % (57), and 7% (26) of the errors respectively. Besides, high prescription turnover volume, having one pharmacist working at a time, and extended working hours, were found to be independent factors that were significantly associated with dispensing errors occurrence (p<0.05).

Conclusions: This study sheds light on the need to establish national strategies for preventing dispensing errors in community pharmacies to maintain drug therapy safety, considering identified underlying causes and associated factors.


Download data is not yet available.
Abstract 518 | pdf Downloads 253


1. World Health Organization. Medication errors technical series on safer primary care medication errors. http://apps.who.int/iris/bitstream/10665/252274/1/9789241511643-eng.pdf?ua=1 (accessed Nov 5, 2019)
2. Koper D, Kamenski G, Flamm M, Böhmdorfer B, Sönnichsen A. Frequency of medication errors in primary care patients with polypharmacy. Fam Pract. 2013;30(3):313-319. https://doi.org/10.1093/fampra/cms070
3. Wittich CM, Burkle CM, Lanier WL. Medication errors: an overview for clinicians. Mayo Clin Proc. 2014;89(8):1116-1125. https://doi.org/10.1016/j.mayocp.2014.05.007
4. Assiri GA, Shebl NA, Mahmoud MA, et al. What is the epidemiology of medication errors, error-related adverse events and risk factors for errors in adults managed in community care contexts? A systematic review of the international literature. BMJ Open. 2018;8(5):e019101. https://doi.org/10.1136/bmjopen-2017-019101
5. Medication Errors and Adverse Drug Events . Agency for HealthCare Research and Quality. Available from: https://psnet.ahrq.gov/primer/medication-errors-and-adverse-drug-events (accessed Nov 5, 2019)
6. Lisby M, Nielsen LP, Brock B, Mainz J. How are medication errors defined? A systematic literature review of definitions and characteristics. Int J Qual Health Care. 2010;22(6):507-518. https://doi.org/10.1093/intqhc/mzq059
7. US Food and Drug Administration. Medication Errors. http://www.fda.gov/drugs/drugsafety/medicationerrors/ (accessed Dec 1, 2019).
8. Community pharmacy patient safety errors increase by 64%. http://www.pharmaceutical-journal.com/news-and-analysis/news/community-pharmacy-patient-safety-errors-increase-by-64/20205334.article (accessed Dec 1, 2019).
9. Zhou S, Kang H, Yao B, Gong Y. Analyzing Medication Error Reports in Clinical Settings: An Automated Pipeline Approach. AMIA Annu Symp Proc. 2018;2018:1611-1620.
10. Boehringer PA, Rylander J, Dizon DT, Peterson MW. Improving the quality of the order-writing process for inpatient orders in a teaching hospital. Qual Manag Health Care. 2007;16(3):215-218. https://doi.org/10.1097/01.qmh.0000281057.92305.57
11. Walsh EK, Hansen CR, Sahm LJ, Kearney PM, Doherty E, Bradley CP. Economic impact of medication error: a systematic review. Pharmacoepidemiol Drug Saf. 2017;26(5):481-497. https://doi.org/10.1002/pds.4188
12. Cheung KC, Bouvy ML, De Smet PA. Medication errors: the importance of safe dispensing. Br J Clin Pharmacol. 2009;67(6):676-680. https://doi.org/10.1111/j.1365-2125.2009.03428.x
13. Campbell PJ, Patel M, Martin JR, et al. Systematic review and meta-analysis of community pharmacy error rates in the USA: 1993-2015. BMJ Open Qual. 2018;7(4):e000193. https://doi.org/10.1136/bmjoq-2017-000193
14. Ibrahim OM, Ibrahim RM, Meslamani AZA, Mazrouei NA. Dispensing errors in community pharmacies in the United Arab Emirates: investigating incidence, types, severity, and causes. Pharm Pract (Granada). 2020;18(4):2111. https://doi.org/10.18549/pharmpract.2020.4.2111
15. Aldhwaihi K, Schifano F, Pezzolesi C, Umaru N. A systematic review of the nature of dispensing errors in hospital pharmacies. Integr Pharm Res Pract. 2016;5:1-10. https://doi.org/10.2147/iprp.s95733
16. Abdel-Qader DH, Al Meslamani AZ, Lewis PJ, Hamadi S. Incidence, nature, severity, and causes of dispensing errors in community pharmacies in Jordan. Int J Clin Pharm. 2021;43(1):165-173. https://doi.org/10.1007/s11096-020-01126-w
17. Cina JL, Gandhi TK, Churchill W, et al. How many hospital pharmacy medication dispensing errors go undetected?. Jt Comm J Qual Patient Saf. 2006;32(2):73-80. https://doi.org/10.1016/s1553-7250(06)32010-7
18. Pervanas HC, Revell N, Alotaibi AF. Evaluation of medication errors in community pharmacy settings: A retrospective report. J Pharm Technol. 2016;32(2):71-74. https://doi.org/10.1177/8755122515617199
19. de Las Mercedes Martínez Sánchez A. Medication errors in a Spanish community pharmacy: nature, frequency and potential causes. Int J Clin Pharm. 2013;35(2):185-189. https://doi.org/10.1007/s11096-012-9741-0
20. Darbishire PL, Zhao JC, Sodhi A, Anderson CM. Student observations of medication error reporting practices in community pharmacy settings. Res Social Adm Pharm. 2019;15(7):902-906. https://doi.org/10.1016/j.sapharm.2019.02.009
21. Ashcroft DM, Quinlan P, Blenkinsopp A. Prospective study of the incidence, nature and causes of dispensing errors in community pharmacies. Pharmacoepidemiol Drug Saf. 2005;14(5):327-332. https://doi.org/10.1002/pds.1012
22. Asmelashe Gelayee D, Binega Mekonnen G. Perception of Community Pharmacists towards Dispensing Errors in Community Pharmacy Setting in Gondar Town, Northwest Ethiopia. Biomed Res Int. 2017;2017:2137981. https://doi.org/10.1155/2017/2137981
23. Al-Worafi YM, Alseragi WM, Seng LK, et al. Dispensing errors in community pharmacies: a prospective study in Sana'a, Yemen. Arch Pharm Pract. 2018;9(4):1-3.
24. World Health Organization. The role of the pharmacist in the health care system. Geneve: WHO; 1994.
25. Hassell K, Seston EM, Schafheutle EI, Wagner A, Eden M. Workload in community pharmacies in the UK and its impact on patient safety and pharmacists' well-being: a review of the evidence. Health Soc Care Community. 2011;19(6):561-575. https://doi.org/10.1111/j.1365-2524.2011.00997.x
26. Shao SC, Chan YY, Lin SJ, et al. Workload of pharmacists and the performance of pharmacy services. PLoS One. 2020;15(4):e0231482. https://doi.org/10.1371/journal.pone.0231482
27. Knudsen P, Herborg H, Mortensen AR, Knudsen M, Hellebek A. Preventing medication errors in community pharmacy: root-cause analysis of transcription errors. Qual Saf Health Care. 2007;16(4):285-290. https://doi.org/10.1136/qshc.2006.022053
28. Rajah R, Hanif AA, Tan SSA, et al. Contributing factors to outpatient pharmacy near miss errors: a Malaysian prospective multi-center study. Int J Clin Pharm. 2019;41(1):237-243. https://doi.org/10.1007/s11096-018-0762-1
29. James KL, Barlow D, McArtney R, Hiom S, Roberts D, Whittlesea C. Incidence, type and causes of dispensing errors: a review of the literature. Int J Pharm Pract. 2009;17(1):9-30. https://doi.org/10.1211/ijpp.17.1.0004
30. Albarrak AI, Al Rashidi EA, Fatani RK, Al Ageel SI, Mohammed R. Assessment of legibility and completeness of handwritten and electronic prescriptions. Saudi Pharm J. 2014;22(6):522-527. https://doi.org/10.1016/j.jsps.2014.02.013
31. Kenawy AS, Kett V. The impact of electronic prescription on reducing medication errors in an Egyptian outpatient clinic. Int J Med Inform. 2019;127:80-87. https://doi.org/10.1016/j.ijmedinf.2019.04.005
32. Bates DW, Slight SP. Medication errors: what is their impact?. Mayo Clin Proc. 2014;89(8):1027-1029. https://doi.org/10.1016/j.mayocp.2014.06.014
33. Hughes RG, Ortiz E. Medication errors: why they happen, and how they can be prevented. Am J Nurs. 2005;105(3 Suppl):14-51. https://doi.org/10.1097/00000446-200503001-00005
34. Campmans Z, van Rhijn A, Dull RM, Santen-Reestman J, Taxis K, Borgsteede SD. Preventing dispensing errors by alerting for drug confusions in the pharmacy information system-A survey of users. PLoS One. 2018;13(5):e0197469. https://doi.org/10.1371/journal.pone.0197469
35. Teinilä T, Grönroos V, Airaksinen M. A system approach to dispensing errors: a national study on perceptions of the Finnish community pharmacists. Pharm World Sci. 2008;30(6):823-833. https://doi.org/10.1007/s11096-008-9233-4
36. Aronson JK. Medication errors: what they are, how they happen, and how to avoid them. QJM. 2009;102(8):513-521. https://doi.org/10.1093/qjmed/hcp052
37. Nair R, Kappil D, Woods T. 10 strategies for minimizing dispensing errors. https://www.pharmacytimes.com/publications/issue/2010/january2010/p2pdispensingerrors-0110
38. ISMP. Improving Medication Safety in Community Pharmacy: Assessing Risk and Opportunities. https://www.ismp.org/sites/default/files/attachments/2018-02/ISMP_AROC_whole_document.pdf (accessed Sep 30, 2020)
39. Szeinbach S, Seoane-Vazquez E, Parekh A, Herderick M. Dispensing errors in community pharmacy: perceived influence of sociotechnical factors. Int J Qual Health Care. 2007;19(4):203-209. https://doi.org/10.1093/intqhc/mzm018
40. Salhotra R, Tyagi A. Medication errors: They continue. J Anaesthesiol Clin Pharmacol. 2019;35(1):1-2. https://doi.org/10.4103/joacp.joacp_88_19