Abstract
BACKGROUND: Medication errors constitute a major contributor to patient harm, driving up health care costs and representing a preventable cause of medical incidents. Over the past decade, many hospitals have integrated various medication-related technologies into their pharmacy operations. However, real-world evidence of the impact of these advanced systems on clinical prescription dispensing error rates remains limited. OBJECTIVE: This study aims to prospectively detect and record the categories and rates of dispensing errors to illustrate how medication-related technologies, such as automated dispensing cabinet (ADC), barcode medication administration (BCMA), and smart dispensing counter (SDC), can be used to minimize dispensing errors. METHODS: This study used a before-and-after design at a 2202-bed academic medical center in Taiwan to assess the impact of implementing medication-related technologies (ADC, BCMA, and SDC) on patient medication safety. Dispensing error rates were analyzed from January 1, 2017, to December 31, 2023, using data from the China Medical University Hospital Patient Safety Database. The study periods were defined as stage 0 (preintervention, January to November 2017), stage 1 (post-ADC intervention, December 2017 to June 2018), stage 2 (post-BCMA intervention, July 2018 to October 2020), and stage 3 (post-SDC intervention, November 2020 to December 2023). Medication errors were defined according to the National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP). Chi-square or Fisher exact tests were used to analyze differences between intervention periods, with Bonferroni correction for multiple comparisons. Statistical significance was set at P<.05. RESULTS: Following the introduction of medication-related technologies, the average dispensing error incidence rate significantly decreased by 39.68%, 44.44%, and 77.78%, from 0.0063% in stage 0 to 0.0038%, 0.0035%, and 0.0014% in stages 1, 2, and 3, respectively (P<.001). The frequency of "wrong drug" errors, the most common error type in stage 0, significantly decreased by 51.15%, 56.85%, and 81.26% in stages 1, 2, and 3, respectively. All error types, except for "wrong dosage form," "wrong strength," "wrong time," and "others," demonstrated statistically significant differences (P<.001). The majority of harm severities were categorized as "A" (no error; 97%-98.8%) and "B-D" (error, no harm; 1.2%-3%) according to the NCC MERP classification. The severity of "no error" (category A) significantly decreased at each stage (P<.001). Statistically significant differences in dispensing error rates were observed between all stages (P<.001), except between stages 2 and 1 (P>.99). CONCLUSIONS: This study provides significant evidence that the implementation of medication-related technologies, including ADC, BCMA, and SDC, effectively reduces dispensing errors in a hospital pharmacy setting. Specifically, we observed a substantial decrease in the average dispensing error rate across 3 stages of technology implementation. Importantly, this study appears to be the first to investigate the combined impact of these 3 specific technologies on dispensing error rates within a hospital pharmacy.