Pharmacy World & Science

, Volume 30, Issue 6, pp 823–833 | Cite as

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

  • Tuula TeiniläEmail author
  • Virpi Grönroos
  • Marja Airaksinen
Research Article


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.


Community pharmacy Dispensing error Finland Medication error Medication safety Pharmacist opinion Pharmacist perception System approach 



The authors thank Kirsi Kaunisvesi, M.Sc.(Pharm.), Kirsikka Kaila, M.Sc.(Pharm.) and other pharmacists for their help in developing the survey instrument as well as all pharmacy owners and managing pharmacists participating in the survey. The authors also thank Jaana Kovalainen and the Association of Finnish Pharmacies for help and support in mailing the survey questionnaires, and Simon Bell, Ph.D., B.Pharm.(Hons.) for assistance in the preparation of the manuscript.

Conflicts of Interests

The authors declare they have no conflicts of interest relevant to the contents of this manuscript.


  1. 1.
    Cohen MR, editor. Medication Errors. Washington, DC: American Pharmaceutical Association; 1999. ISBN 0-917330-89-7.Google Scholar
  2. 2.
    Council of Europe, Expert Group on Safe Medication Practices. Creation of a better medication safety culture in Europe: Building up safe medication practices [Internet]. Council of Europe. 2006. Available from: Accessed 26 May 2008.
  3. 3.
    National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP). What is a Medication Error? [Internet]. NCC MERP; Available from: Accessed 26 May 2008.
  4. 4.
    Leape LL. Error in medicine. JAMA. 1994;272:1851–7. doi: 10.1001/jama.272.23.1851.PubMedCrossRefGoogle Scholar
  5. 5.
    Reason J. Human error: models and management. BMJ. 2000;320:768–70. doi: 10.1136/bmj.320.7237.768.PubMedCrossRefGoogle Scholar
  6. 6.
    Department of Health. An organisation with a memory. Report of an expert group on learning from adverse events in the NHS. London: The Stationery Office; 2000. ISBN 0-11-322441-9.Google Scholar
  7. 7.
    Institute of Medicine. Crossing the quality chasm: a new health system for the 21st century. Washington, DC: National Academy Press; 2001. ISBN 0-309-07280-8.Google Scholar
  8. 8.
    Kohn LT, Corrigan JM, Donaldson SM, editors. (Institute of Medicine). To err is human: building a safer health system. Washington DC: National Academy Press; 2000. ISBN 0-309-06837-1.Google Scholar
  9. 9.
    Australian Council for Safety and Quality in Health Care. Second National Report on Patient Safety. Improving Medication Safety [Internet]. Australian Council for Safety and Quality in Health Care. 2002 Jul. Available from:$File/med_saf_rept.pdf Accessed 26 May 2008.
  10. 10.
    World Health Organization (WHO). World Alliance for Patient Safety. Forward Programme 2005 [Internet]. WHO. 2004 Oct. Available from: Accessed 26 May 2008.
  11. 11.
    European Commission. DG Health and Consumer Protection. Patient Safety - Making it Happen! Luxembourg Declaration on Patient Safety [Internet]. Luxembourg. 2005 Apr. Available from: Accessed 26 May 2008.
  12. 12.
    SIMPATIE Project. Final Report. Safety Improvement for Patients in Europe [Internet]. 2007 May. Available from: Accessed 26 May 2008.
  13. 13.
    Dean B. Learning from prescribing errors. Qual Saf Health Care. 2002;11:258–60. doi: 10.1136/qhc.11.3.258.PubMedCrossRefGoogle Scholar
  14. 14.
    Stelfox HT, Palmisani S, Scurlock C, Orav EJ, Bates DW. The “To Err is Human” report and the patient safety literature. Qual Saf Health Care. 2006;15:174–8. doi: 10.1136/qshc.2006.017947.PubMedCrossRefGoogle Scholar
  15. 15.
    Allan EL, Barker KN, Malloy MJ, Heller WM. Dispensing errors and counseling in community practice. Am Pharm. 1995;NS35:25–33.PubMedGoogle Scholar
  16. 16.
    Chua SS, Wong ICK, Edmondson H, Allen C, Chow J, Peacham J, et al. A feasibility study for recording of dispensing errors and ‘Near Misses’ in four UK primary care pharmacies. Drug Saf. 2003;26:803–13. doi: 10.2165/00002018-200326110-00005.PubMedCrossRefGoogle Scholar
  17. 17.
    Ashcroft DM, Quinlan P, Blenkinsopp A. Prospective study of the incidence, nature and causes of dispensing errors in community pharmacies. Pharmacoepidemiol Drug Saf. 2005;14:327–32. doi: 10.1002/pds.1012.PubMedCrossRefGoogle Scholar
  18. 18.
    Flynn EA, Barker KN, Carnahan BJ. National observational study of prescription dispensing accuracy and safety in 50 pharmacies. J Am Pharm Assoc. 2003;43:91–200.Google Scholar
  19. 19.
    Guernsey BG, Ingrim NB, Hokanson JA, Doutré WH, Bryant SG, Blair CW, et al. Pharmacists’ dispensing accuracy in a high-volume outpatient pharmacy service: focus on risk management. Drug Intell Clin Pharm. 1983;17:742–6.PubMedGoogle Scholar
  20. 20.
    Buchanan TL, Barker KN, Gibson JT, Jiang BC, Pearson RE. Illumination and errors in dispensing. Am J Hosp Pharm. 1991;48:2137–45.PubMedGoogle Scholar
  21. 21.
    Spencer MG, Smith AP. A multicentre study of dispensing errors in British hospitals. Int J Pharm Pract. 1993;2:142–6.Google Scholar
  22. 22.
    Kistner UA, Keith MR, Sergeant KA, Hokanson JA. Accuracy of dispensing in a high-volume, hospital-based outpatient pharmacy. Am J Hosp Pharm. 1994;51:2793–7.PubMedGoogle Scholar
  23. 23.
    Beso A, Franklin BD, Barber N. The frequency and potential causes of dispensing errors in a hospital pharmacy. Pharm World Sci. 2005;27:182–90. doi: 10.1007/s11096-004-2270-8.PubMedCrossRefGoogle Scholar
  24. 24.
    Reason J. Human error. New York: Cambridge University Press; 1990. ISBN 0–521-31419-4.Google Scholar
  25. 25.
    Feinberg JL, editor. Med Pass Survey. A Continuous Quality Improvement Approach. Alexandria VA: American Society of Consultant Pharmacists; 1993.Google Scholar
  26. 26.
    Bell JS, Väänänen M, Ovaskainen H, Närhi U, Airaksinen MS. Providing patient care in community pharmacies: practice and research in Finland. Ann Pharmacother. 2007;41:1039–46. doi: 10.1345/aph.1H638.PubMedCrossRefGoogle Scholar
  27. 27.
    National Agency for Medicines. Labelling and package leaflets for medicinal products [Internet]. National Agency for Medicines. 2005 Nov. Available from: Accessed 26 May 2008.
  28. 28.
    Directive 2001/83/EC of the European Parliament and of the Council of 6 November 2001 on the Community code relating to medicinal products for human use, Official Journal L 311, 28/11/2001 P.0067 – 0128.Google Scholar
  29. 29.
    The Association of Finnish Pharmacies. Annual review 2004 [Internet]. Helsinki: The Association of Finnish Pharmacies. 2005. Available from: Accessed 26 May 2008.
  30. 30.
    Tuomi J, Sarajärvi A. Laadullinen tutkimus ja sisällönanalyysi [Qualitative research and content analysis]. Jyväskylä, Finland: Gummerus Kirjapaino Oy; 2004. Finnish; ISBN 951-26-4856-3.Google Scholar
  31. 31.
    Peterson GM, Wu MSH, Bergin JK. Pharmacists’ attitudes towards dispensing errors: their causes and prevention. J Clin Pharm Ther. 1999;24:57–71. doi: 10.1046/j.1365-2710.1999.00199.x.PubMedCrossRefGoogle Scholar
  32. 32.
    Dean B, Schachter M, Vincent C, Barber N. Causes of prescribing errors in hospital inpatients: a prospective study. Lancet. 2002;359:1373–8. doi: 10.1016/S0140-6736(02)08350-2.PubMedCrossRefGoogle Scholar
  33. 33.
    Santell JP, Hicks RW, McMeekin J, Cousins DD. Medication errors: experience of the United States Pharmacopeia (USP) MEDMARX reporting system. J Clin Pharmacol. 2003;43:760–7.PubMedGoogle Scholar
  34. 34.
    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;16:285–90. doi: 10.1136/qshc.2006.022053.PubMedCrossRefGoogle Scholar
  35. 35.
    Ashcroft DM, Morecroft C, Parker D, Noyce PR. Likelihood of reporting adverse events in community pharmacy: an experimental study. Qual Saf Health Care. 2006;15:48–52. doi: 10.1136/qshc.2005.014639.PubMedCrossRefGoogle Scholar
  36. 36.
    Kivijärvi A. Laatutietoisuus ja laatutyö Suomen apteekeissa [master’s thesis] [Quality consciousness and management in Finnish community pharmacies]. [Helsinki]: University of Helsinki; 2004.Google Scholar
  37. 37.
    Institute for Safe Medication Practices (ISMP). Medication Safety Self Assessment for Community/Ambulatory Pharmacy [Internet]. ISMP; 2001. Available from: Accessed 26 May 2008.
  38. 38.
    Ashcroft DM, Morecroft C, Parker D, Noyce PR. Safety culture assessment in community pharmacy: development, face validity, and feasibility of the Manchester Patient Safety Assessment Framework. Qual Saf Health Care. 2005;14:417–21. doi: 10.1136/qshc.2005.014332.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2008

Authors and Affiliations

  • Tuula Teinilä
    • 1
    Email author
  • Virpi Grönroos
    • 1
  • Marja Airaksinen
    • 1
  1. 1.Division of Social Pharmacy, Faculty of PharmacyUniversity of HelsinkiHelsinkiFinland

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