|Year : 2018 | Volume
| Issue : 2 | Page : 83-87
Medication errors, pharmacological knowledge and interventions amongst employed pharmacy technicians in qom drugstores, Iran: A cross-sectional study
Abolfazl Mohammadbeigi1, Salman Khazaei2, Parisa Nobakht3, Esmail Moshiri4, Sima Afrashteh5, Hamid Oureie3, Seyed Mohammad Millani3, Hossein Ansari6
1 Department of Epidemiology and Biostatistics, Health Policy and Promotion Research Center, Qom University of Medical Sciences, Hamadan, Iran
2 Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
3 Department of Food and Drug Vice Chancellor, Qom University of Medical Sciences, Qom, Iran
4 Department of Anesthesiology and Critical Care, Arak University of Medical Sciences, Arak, Iran
5 MSc of Epidemiology, Bushehr University of Medical Sciences, Bushehr, Iran
6 Department of Epidemiology and Biostatistics, Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
|Date of Web Publication||8-May-2018|
Department of Anesthesiology and Critical Care, Arak University of Medical Sciences, Arak
Source of Support: None, Conflict of Interest: None
Introduction: Different factors are effective in medication errors, but some dispensing errors may occur by the pharmacy technicians due to the expanded responsibilities of them and lack of standardised training. This study aimed to assess the pharmacy technician awareness in different dimensions including pharmacological knowledge, interventions and medication errors in employed technicians of Qom pharmacies. Methods: A cross-sectional study was conducted in all 101 employed pharmacy technicians in medical pharmacies of Qom, Iran, in 2017. The data collection conducted by a standard researcher-made questionnaire. The questionnaire was including demographic characteristics, pharmacological knowledge, intervention and medication errors. Data were analysed by t-test, analysis of variance and Pearson's correlation coefficient tests in SPSS. Results: The mean score in pharmacological knowledge, interventions and medication errors was 5.72 ± 2.35, 1.05 ± 0.744 and 6.68 ± 2.26, respectively. Moreover, the total score of pharmacological awareness was 13.45 ± 3.96. Only 12% of the pharmacy technicians in Qom educated in medical field, 45% were diploma and lower and 61% of participants reported that they have not passed any educational pharmacological courses. The mean score of pharmacological knowledge (P = 0.010) and errors (P = 0.026) and the total score of pharmacological awareness (P = 0.005) were significantly lower in 23 years' age group and higher in 23-year-old pharmacological technicians. Moreover, week-work is directly associated with medication errors. Gender, job history and educational field are related factors in pharmacological knowledge of pharmacy technicians. Conclusion: The mean score of pharmacological knowledge, intervention and medication errors of pharmacy technicians was moderate. Nevertheless, there was some main challenge in Iranian pharmacy staffs including irrelevant education of pharmacy technicians, low educational level and low experience job in drugstores.
Keywords: Drugstore, Iran, medication error, pharmacological knowledge, pharmacy technicians
|How to cite this article:|
Mohammadbeigi A, Khazaei S, Nobakht P, Moshiri E, Afrashteh S, Oureie H, Millani SM, Ansari H. Medication errors, pharmacological knowledge and interventions amongst employed pharmacy technicians in qom drugstores, Iran: A cross-sectional study. Adv Hum Biol 2018;8:83-7
|How to cite this URL:|
Mohammadbeigi A, Khazaei S, Nobakht P, Moshiri E, Afrashteh S, Oureie H, Millani SM, Ansari H. Medication errors, pharmacological knowledge and interventions amongst employed pharmacy technicians in qom drugstores, Iran: A cross-sectional study. Adv Hum Biol [serial online] 2018 [cited 2019 Oct 22];8:83-7. Available from: http://www.aihbonline.com/text.asp?2018/8/2/83/232021
| Introduction|| |
Todays, medication errors are considered as an epidemic health problem., It is defined as a preventable event that may create by unsuitable medication and could lead to patient harm. Medication errors are the most common types of medical errors, and it is defined as misuse and inappropriate of the drug that is preventable.
In medication errors, the properly dosage, time of medication and the administration method of the drug does not adhere., It can lead to serious adverse consequences such as increased death, increased duration of hospitalisation, disability, increased medical expenses and also physical and psychological harm which affect millions of patients every year., It is showed that the medication errors may prolong hospital stay by 2 days and caused to increase catastrophic cost and charge by 2000–2500$ per patient for additional treatment costs., Consequently, a portion of patients who affected by the health system errors experience mortality or severe damages. It is estimated that the system errors caused between 44,000 and 9800 deaths in Americans hospitals annually.
There were a number of studies that are estimated the medical errors to higher 70% but different based on the area.,,, The medication errors include all errors that occur in administration of treatment including errors in name, dosage form, dose and measuring unit, administration route and intervals of administration. It is reported that near 25% of patients experience the medical errors affecting to severe consequence. Several studies in Iran reported the prescribing error of 10.5% and transcribing error of 29.9%,, although these errors reported to 70% in some studies.,,
Pharmacy in Iran is a crucial position in healthcare system that is responsible for dispensing medicines to the patients, directly that the face-to-face education for drug consumption to clients and patients is being carried out in these units. Pharmacist in drugstores is responsible for delivering required information and to provide healthcare needs and advice to the patients based on the physician treatment. However, because easy accessibility and friendly approach, pharmacists are conveniently placed at the first point of contact in the healthcare system., The pharmacy technician helps to the pharmacist in prescription entry, third-party insurance management, staff/patient scheduling and inventory control.
Different factors are effective in medication errors,,, but some dispensing errors may occur by the pharmacy technicians due to the expanded responsibilities of them and lack of standardised training. Currently, the number of medical prescriptions increased and the pharmacy staffs is limited, and this could increase the medication errors if the drug knowledge is questionable. In addition, pharmacy technicians in pharmacies have an important role in health of people because the most advices and drug consultation are provided by them who have face-to-face education with customers and patients. However, the Iranian pharmaceutical system is faced to many limitation, problems and dysfunctions. These existing challenges in the pharmaceutical system showed that assessing the knowledge and ability of pharmacy technicians in Iran is necessary. Therefore, the current study aimed to assess the pharmacy technician awareness in different dimensions including pharmacological knowledge, interventions and medication errors in employed technicians of Qom pharmacies.
| Methods|| |
A cross-sectional study was conducted in all employed pharmacy technicians including 101 participants in medical pharmacies of Qom, Iran, in winter 2017. Sample size calculation conducted based on the per cent of inadequate information in pharmacy technicians 68% and type 1 error 5% and precision 0.1. Based on these data, the minimum sample size for this study calculated as 89 participants and we gathered the data of 101 pharmacy technicians. The participants work in more than thirty drugstores in Qom city and work in three work shifts. All of them invited for participating in the study, and after taking informed consents, the eligible participants recruited for the study.
The data collection conducted by a standard researcher-made questionnaire. The questionnaire was including four parts: A – demographic characteristics (age, sex, marital status, educational field, educational degree, work time, job history and pharmacological and English knowledge), B – pharmacological knowledge (11 questions), C – pharmacological errors (11 questions) and D – pharmacological intervention (2 questions). The scores of true responses were 0 and 1 for false responses, respectively. The sum of three scopes of questionnaire computed and the maximum score for B, C and D section of questionnaire was 11, 11 and 2, respectively. Moreover, the total score of pharmacological awareness in participants was calculated by summing of three different sessions of questionnaire and was ranged since 0–24. Medical experts were assessed the validity and reliability of the questionnaire, and statistical methods were used in a pilot study for approving it. All pharmacy technicians who work in Qom drugstores including daily and boarding in three work shifts completed the questionnaires. Data were analysed by t-test, analysis of variance and Pearson's correlation coefficient tests. The information of participants was secret, and the study protocol was approved by the Ethical Committee of Qom University of Medical Sciences.
| Results|| |
The mean score in pharmacological knowledge, interventions and medication errors was 5.72 ± 2.35, 1.05 ± 0.744 and 6.68 ± 2.26, respectively. Moreover, the total score of pharmacological awareness was 13.45 ± 3.96. The pharmacological and English knowledge of participants is depicted in [Figure 1] based on self-report. [Table 1] shows that only 12% of the pharmacy technicians in Qom educated in medical field and 45% were diploma and lower while 31% were bachelor or higher. The training question showed that only 39% of pharmacy technicians were trained for pharmacological work academically in pharmacologist association (11%) and red crescent (28%). Furthermore, 61% of participants reported that they have not passed any educational pharmacological courses and his/her knowledge in pharmacological information acquired based on their experiment.
|Figure 1: The per cent of frequency of pharmacy technicians regarding to the English and pharmacological knowledge.|
Click here to view
|Table 1: Demographic characteristics of studied pharmacological technicians|
Click here to view
[Table 2] showed that based on analysis of variance test, there was a significant difference amongst different age groups based on the mean score of pharmacological knowledge and errors and the total score of pharmacological awareness (P< 0.05), while the mean score of pharmacological interventions was not significant amongst three age groups (P< 0.05). The Tukey test for post hoc analysis showed that the mean score of pharmacological knowledge (P = 0.010) and errors (P = 0.026) and the total score of pharmacological awareness (P = 0.005) were significantly lower in 23 years' age group and higher in 23-year-old pharmacological technicians.
|Table 2: Comparing the mean score of pharmacological knowledge, interventions and medication errors and the total score of pharmacological awareness based on the age groups in pharmacological technicians|
Click here to view
Independent sample t-test [Table 3] showed that there was a significant difference between males and females regarding the mean score of medication errors (P = 0.046), while there was no significant difference in the mean score of pharmacological knowledge and interventions and the total score of pharmacological awareness in male versus female technicians (P > 0.05). A significant difference was observed in pharmacological interventions (P = 0.032) and medication errors (P = 0.017) in studied technicians based on their job history, but the mean score of pharmacological knowledge and the total score of pharmacological awareness were not statistically significant (P > 0.05). T-tests showed that pharmacological knowledge (P = 0.046), drug errors (P = 0.002) and the total score of pharmacological awareness (P = 0.006) were significantly different between participants based on marital status, while the pharmacological intervention score was not significant (P > 0.05). Moreover, there was no significant difference in pharmacological knowledge, interventions and drug errors amongst the participants based on the educational field, although participants with college degree had reached the highest pharmacological intervention score. The Pearson's correlation coefficient test showed [Table 4] that daily and weekly time work is correlated with pharmacological knowledge directly. Moreover, week-work is directly associated with medication errors.
|Table 3: Comparing the mean score of pharmacological knowledge, interventions and errors and the total score of pharmacological awareness based on the gender and job history of pharmacological technicians|
Click here to view
|Table 4: Correlations of scores in pharmacological knowledge, interventions and medication errors with age, time work and job history of pharmacological technicians|
Click here to view
| Discussion|| |
The mean score in pharmacological knowledge, interventions and medication errors and the total score of pharmacological awareness were higher than moderate. In addition, the pharmacological and English knowledge of pharmacy technicians estimated in moderate level. The poor knowledge amongst physicians and medical students as well as health workers is showed in different parts of the Ministry of Health in Iran., The poor knowledge in healthcare workers is important because of severe consequences on health outcomes.,,
Currently, there were many problems and dysfunctions in Iranian pharmaceutical system. Some of the most limitations are related to health workers and pharmacist coworkers including regular shortages of some medicines in the market, irrational prescribing by physicians, self-medication by patients, selling medicines by pharmacies without prescription and inefficient structure of current supply chain. In Iran, most of the pharmacy technicians received their knowledge-based on-the-job training without any educational courses, and in this study, we found this phenomenon as 61%. However, formal training in educational courses only occurred in 39% and may relate to improvement in increasing true knowledge, staff retention and job satisfaction of pharmacy technicians which can also confer a good sense of vocational identity., Moreover, it is could increase the complexity of state regulations, variation between state requirements and record keeping. A recent study in Isfahan, Iran, showed that 73% of prescribing orders were incomplete and did not have all six parameters. Moreover, transcribing errors were 15% and the dispensing errors varied between 1.4% and 2.2%. In another Iranian study in emergency care technicians, 68% of participants were unable to response to the questions of pharmacological knowledge and only 3.6% had a good drug knowledge. In another study in Intensive Care Unit nurses, 74.4% committed to medication errors. Similar studies in European and America showed that 5%–10% of patients experience degrees of adverse effects of treatment during the hospitalisation time. Moreover, Cheragi et al. study showed that 64.5% of nurses reported medication errors and 31.37% of them reported to be on the verge of a medication error. Prescribing errors occur in 50% of all hospital admissions, and incomplete medication histories are responsible for more than 25% of prescribing errors occurring in hospital admissions.,
Our results showed that 45% of pharmacy technicians were diploma and only 39% of pharmacy technicians were trained for pharmacological work academically and 88% of pharmacy technicians graduated in irrelevant academic education. Lack of pharmacological knowledge, incorrect drug calculation, failure in following the planned protocols, bad line in doctors' orders and same naming of drugs are related factors of medication errors in drug deliveries by the pharmacy technicians.,, Although participants with higher education have highest pharmacological intervention score.
Our results showed that female technicians have lower medication errors than male. In addition, the mean score of pharmacological knowledge and errors and the total score of pharmacological awareness were significantly lower in pharmacological technicians who were younger than 23 years. Medical errors are related to some lacks in technical and knowledge issues including inadequate knowledge of the prescribed medication or the patients' medical history, lack of knowledge about the insurance system in pharmacies, lack of training or experience, high workload and work pressure for the prescriber and inadequate communication between healthcare professionals.,, Moreover, we showed that workload was related with medication errors directly, and pharmacological interventions and medication errors were lower in participants who have more job history. However, it is demonstrated that fatigue, inadequate staff, absence or lack of furniture are indirect effective factors in medication errors. Furthermore, pharmacists who have collaborated with pharmacy technicians and service providers to patients gain the most clinical outcomes and the lowest negative output. Moreover, beside the experiences of computer techniques, the participation of pharmacists in the medication prescribing programmes has produced a large reduction in the number of prescribing errors. Furthermore, there was no difference in pharmacy technicians based on medical or non-medical education regarding to pharmacological knowledge, interventions and drug errors amongst the participants.
However, medication errors are one of the most prevalent health errors that threaten patients' safety, and patient safety is one of the main concepts in the field of healthcare provision and has a key role in managing and improving the quality of healthcare services. In the current study, we cannot conduct subgroup analysis for pharmacy technicians based on those have secondary work. Moreover, shift working of pharmacy technicians caused to some participants was inaccessible.
| Conclusion|| |
According to our results, the mean score of pharmacological knowledge, intervention and medication errors of pharmacy technicians was moderate. Nevertheless, there was some main challenge in Iranian pharmacy staffs. The most important challenge is irrelevant education of pharmacy technicians besides their low educational level. Moreover, most of the pharmacy technicians are without experience in job in drugstores as part-time. Therefore, a national interventional programme for education, planning, management and policy-making for pharmacy staffs is necessary.
The authors are very grateful for Research Vice Chancellor of Qom University of Medical Sciences as well as all participants who participate in the study.
Financial support and sponsorship
This study was financially supported by Qom University of Medical Sciences.
Conflicts of interest
There are no conflicts of interest.
| References|| |
Saghafi F, Zargarzadeh AH. Medication error detection in two major teaching hospitals: What are the types of errors? J Res Med Sci 2014;19:617-23.
Buck TC, Gronkjaer LS, Duckert ML, Rosholm JU, Aagaard L. Medication reconciliation and prescribing reviews by pharmacy technicians in a geriatric ward. J Res Pharm Pract 2013;2:145-50.
] [Full text]
Malhotra K, Goyal M, Walia R, Aslam S. Medication errors: A preventable problem. Indian Journal of Clinical Practice 2012;23:17-21.
Nasab M. Analyzing the knowledge and attitude of nurses regarding medication error and its prophylactic ways in educational and therapeutic hospitals of Khorramabad. Yafteh 2009;10:55-63.
Hanafi S, Poormalek F, Torkamandi H, Hajimiri M, Esmaeili M, Khooie S, et al
. Evaluation of community pharmacists' knowledge, attitude and practice towards good pharmacy practice in Iran. J Pharm Care 2015;1:19-24.
Cheragi MA, Manoocheri H, Mohammadnejad E, Ehsani SR. Types and causes of medication errors from nurse's viewpoint. Iran J Nurs Midwifery Res 2013;18:228-31.
Kavosi Z, Mohammadbeigi A, Ramezani-Doroh V, Hatam N, Jafari A, Firoozjahantighi A, et al.
Horizontal inequity in access to outpatient services among Shiraz city residents, Iran. J Res Health Sci 2015;15:37-41.
Anbari Z, Mohammadbeigi A, Mohammadsalehi N, Ebrazeh A. Health expenditure and catastrophic costs for inpatient- and out-patient care in Iran. Int J Prev Med 2014;5:1023-8.
Fahimi F, Ariapanah P, Faizi M, Shafaghi B, Namdar R, Ardakani MT, et al.
Errors in preparation and administration of intravenous medications in the Intensive Care Unit of a teaching hospital: An observational study. Aust Crit Care 2008;21:110-6.
Fahimi F, Abbasi Nazari M, Abrishami R, Sistanizad M, Mazidi T, Faghihi T, et al.
Transcription errors observed in a teaching hospital. Arch Iran Med 2009;12:173-5.
Vessal G. Detection of prescription errors by a unit-based clinical pharmacist in a nephrology ward. Pharm World Sci 2010;32:59-65.
Koohestani HR, Baghcheghi N, Khosravi S. Frequency, type and causes of medication errors in student nurses. Iran J Nurs 2008;21:17-27.
Mohammadzadeh M. The study of profitability of drugstores in Iran's pharmaceutical system. Iran J Pharm Sci 2010;6:209-16.
Zaboli P, Hashemi-Meshkini A, Varmaghani M, Gholami H, Vazirian I, Zekri HS, et al.
Pharmaceutical laws and regulations in Iran: An overview. J Res Pharm Pract 2016;5:155-61.
] [Full text]
Alkhateeb FM, Shields KM, Broedel-Zaugg K, Bryan A, Snell J. Credentialing of pharmacy technicians in the USA. Int J Pharm Pract 2011;19:219-27.
Carlton G, Blegen MA. Medication-related errors: A literature review of incidence and antecedents. Annu Rev Nurs Res 2006;24:19-38.
Ahmadi A, Ershad M, Givzadeh H, Mohammad-Beigi A. General physicians' knowledge about nutrition in Shiraz, Iran. Pak J Biol Sci 2009;12:981-5.
Abbasi K, Hazrati M, Mohammadbeigi A, Ansari J, Sajadi M, Hosseinnazzhad A, et al.
Protection behaviors for cytotoxic drugs in oncology nurses of chemotherapy centers in Shiraz hospitals, South of Iran. Indian J Med Paediatr Oncol 2016;37:227-31.
] [Full text]
Moshfeghi K, Mohammadbeigi A. Comparison the effects of two educational methods on knowledge, attitude and practices of arak physicians about breast cancer. Pak J Biol Sci 2010;13:901-5.
Rafii F, Sajadi Hezaveh M, Naiemeh Seyedfatemi N. Concept analysis of transition from nursing studentship to working life: A hybrid model. J Hayat 2014;20:59-73.
Aghababaeian H, Maghami M, Saadati M, Araghi AL. Investigation of the capability of pharmaceutical calculation in the staff and technicians of emergency medical centers of northern Khuzestan in 2014. Sadra Med Sci J 2014;2:151-60. [Full text in Persian].
Cheraghi MA, Nasabadi N, Reza A, Mohammad Nejad E, Salari A, Kheyli EK, et al
. Medication errors among nurses in Intensive Care Units (ICU). J Mazandaran Univ Med Sci 2012;21:115-9.
Tully MP, Ashcroft DM, Dornan T, Lewis PJ, Taylor D, Wass V, et al.
The causes of and factors associated with prescribing errors in hospital inpatients: A systematic review. Drug Saf 2009;32:819-36.
Garjani A, Rahbar M, Ghafourian T, Maleki N, Garjani A, Salimnejad M, et al.
Relationship of pharmacist interaction with patient knowledge of dispensed drugs and patient satisfaction. East Mediterr Health J 2009;15:934-43.
Brennan TA, Leape LL, Laird NM, Hebert L, Localio AR, Lawthers AG, et al.
Incidence of adverse events and negligence in hospitalized patients: Results of the harvard medical practice study I 1991. Qual Saf Health Care 2004;13:145-51.
[Table 1], [Table 2], [Table 3], [Table 4]