title: Comparison of medication safety systems in critical access hospitals: Combined analysis of two studies.
abstract: OBJECTIVE
  The role of pharmacist transcription, onsite pharmacist dispensing, use of automated dispensing cabinets (ADCs), nurse-nurse double checks, or barcode-assisted medication administration (BCMA) in reducing medication error rates in critical access hospitals (CAHs) was evaluated.
  
  
  METHODS
  Investigators used the practice-based evidence methodology to identify predictors of medication errors in 12 Nebraska CAHs. Detailed information about each medication administered was recorded through direct observation. Errors were identified by comparing the observed medication administered with the physician's order. Chi-square analysis and Fisher's exact test were used to measure differences between groups of medication-dispensing procedures.
  
  
  RESULTS
  Nurses observed 6497 medications being administered to 1374 patients. The overall error rate was 1.2%. The transcription error rates for orders transcribed by an onsite pharmacist were slightly lower than for orders transcribed by a telepharmacy service (0.10% and 0.33%, respectively). Fewer dispensing errors occurred when medications were dispensed by an onsite pharmacist versus any other method of medication acquisition (0.10% versus 0.44%, p = 0.0085). The rates of dispensing errors for medications that were retrieved from a single-cell ADC (0.19%), a multicell ADC (0.45%), or a drug closet or general supply (0.77%) did not differ significantly. BCMA was associated with a higher proportion of dispensing and administration errors intercepted before reaching the patient (66.7%) compared with either manual double checks (10%) or no BCMA or double check (30.4%) of the medication before administration (p = 0.0167).
  
  
  CONCLUSIONS
  Onsite pharmacist dispensing and BCMA were associated with fewer medication errors and are important components of a medication safety strategy in CAHs.
authors.affiliation: Department of Pharmacy Practice, University of Nebraska Medical Center, Omaha, NE. glcochran@unmc.edu.
authors.forename: Gary L
authors.initials: GL
authors.lastname: Cochran
authors.affiliation: Institute for Clinical Outcomes Research, International Severity Information Systems, Salt Lake City, UT.
authors.forename: Ryan S
authors.initials: RS
authors.lastname: Barrett
authors.affiliation: Institute for Clinical Outcomes Research, International Severity Information Systems, Salt Lake City, UTDepartment of Population Health Sciences, School of Medicine, University of Utah, Salt Lake City, UT.
authors.forename: Susan D
authors.initials: SD
authors.lastname: Horn
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003422:Critical Care / Q000379:methods / Q000592:standards*; D001330:Electronic Data Processing / Q000379:methods / Q000592:standards; D005260:Female; D006801:Humans; D008297:Male; D008508:Medication Errors / Q000517:prevention & control*; D008510:Medication Systems, Hospital / Q000592:standards*; D008875:Middle Aged; D009329:Nebraska; D024802:Nurse's Role; D004364:Pharmaceutical Preparations; D010595:Pharmacists / Q000592:standards*; D010607:Pharmacy Service, Hospital / Q000379:methods / Q000592:standards*
chemical_list: D004364:Pharmaceutical Preparations