Medication safety practices used in two government pharmacy settings for the development of a medication safety practice package for pharmacists in Sri Lanka

Abstract

Introduction: Pharmacists play an important role in ensuring medication safety. This study assessed medication safety practices used by pharmacists in two Teaching Hospitals in Colombo to develop a medication safety practice package for pharmacists. Methods: An observational cross sectional, quantitative study was done among pharmacists on application of medication safety practices using an interviewer-administered questionnaire. Implementation of medication safety audit lists for pharmacists were assessed using a Likert scale of 1-5 (5 being highest). Descriptive statistics were used in analysis. Results: Data from 100 pharmacists showed 47% dispensed >300 prescriptions/day and 16% dispensed 200-300/day. Mean score was 1.92 for labelling with large fonts among medicines prone to errors, (51% not implementing); 1.13 for Tall-Man-Lettering among Look Alike Sound Alike (LASA) drugs (89% not implementing); 2.7 for storing LASA drugs separately (only 53% adhering); 4.22 for storing high alert medicines (HAM) separately (implemented by 57%). Pharmacists identified 126 LASA combinations, 103 HAMs and 58 error prone abbreviations. Mean score for correct identification of HAM out of 20 was 16.83, (range 5-20). All agreed that no protocols were available to handle HAM, 61% agreeing that the layout is not designed to minimize mix-ups and 86% premises had inadequate drug storage space. Checking on OTC (33%) and Ayurveda medicines (17%) and polypharmacy (27%) was poor. Only 25% pharmacists had training on medication errors and 27% had no competence in responding to errors. Commonly identified barriers were overcrowded patients (93%), inadequate pharmacists (86%) and lack of time for counselling (80%) and resources (64%). Conclusion: Medication safety practices adopted by pharmacists need improvement. There were no protocols to handle HAM in hospitals. Development of a medication safety practice package for pharmacists with protocols to handle HAM, LASA drugs, storage of medicine and prevent errors are some key areas to be addressed.