Photo by Christine Sandu on Unsplash
Medication Safety update presenting our analysis of patient safety incidents reported during the second quarter of 2021 (Q3) – access the full report here.
In the NPA Q3 2021 medication safety update:
- Analysis of patient safety incidents reported during Q3 2021
- Look-alike sound-alike (LASA) errors analysis
- Original Pack Dispensing and supply of medicines containing sodium valproate open consultation
- Elvanse capsules vs Elvanse Adult capsules
- Pharmacy Quality Scheme (PQS) 2021/22
- Valproate reminder
- The professional duty of Candour
Number of patient safety incidents during Q3 of 2021
Overall, there was a 5% increase in the number of incidents reported during Q3 2021, compared to Q2 2021. Please continue to report, investigate and analyse patient safety incidents, and share learnings from them within your pharmacy teams.
Summary of key findings from analysis of patient safety incidents reported during Q3 2021
- Overall, there was a 5% increase in the number of incidents reported during Q3 2021, compared to Q2 2021.
- 95% of incidents reported originated from the pharmacy
- 3% of errors reported were prescribing errors – this remained the same compared to those reported during Q2 2021
- The most common type of incident reported during Q3 was ‘dispensing error’, which accounted for 89% of all reported incidents
- Delivery/collection errors accounted for 7% of the incidents reported; which is a 2% decrease compared to Q2 2021
- The main categories of errors reported were those involving medication errors such as wrong drug/medicine, strength or formulation, these accounted for 69% of errors reported – this is a 1% decrease from Q2 2021
- The degree of harm caused to patients reported as ‘none’ (61%) and ‘near miss’ (23%) continues to make up the majority of the reports.
- There was a 3% decrease in the incidents involving self-checking compared to Q2 2021. This accounted for 6% of errors reported
- The main contributing factor continues to be ‘work and environment factors’ (43%) and LASA (17%).
- LASA errors — 2% of all reported LASA errors involved gabapentin and pregabalin
NPA patient safety resources
The full range of the NPA patient safety resources can be accessed on the NPA website: https://www.npa.co.uk/services-and-support/patientsafety
Contact the Pharmacy Services team for further advice and support:
- Telephone: 01727891800 (Mon-Fri 9am to 6pm, Sat 9am to 1pm)
- Email: [email protected]