Medication errors were common (nearly 1 of every 5 doses in the typical hospital and skilled nursing facility). The percentage of errors rated potentially harmful was 7%, or more than 40 per day in a typical 300-patient facility. The problem of defective medication administration systems, although varied, is widespread.

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This trial suggests that use of dedicated medication nurses does not reduce medication error rates. However, subgroup analysis indicates that medication nurses might be useful in some settings. The differences in findings at the 2 hospitals and their differences in medication-use processes reinforce the concept that medication errors are usually related to systems design issues.

Associations between ambient sounds and accuracy of pharmacists' prescription-filling performance in a pharmacy was studied. Pharmacists were videotaped as they filled prescriptions each workday for 23 days. Each filled prescription was inspected by the investigator. Deviations from the physician's written order were considered errors. Videotape analysis was used to detect unpredictable, predictable, uncontrollable, and controllable sounds. A within-subjects case control study design was employed to determine whether the frequency of ambient sounds was significantly different when prescriptions with errors, compared with those without errors, were filled. Loudness, in terms of equivalent sound levels (Leq) for each half hour, was analyzed for a relationship to dispensing error rate. A mean dispensing error rate of 3.23% was found. Unpredictable sounds, controllable sounds, and noise had a significant effect on pharmacists which resulted in a decreased dispensing error rate. These results suggest that the quality of pharmacists' performance is not adversely affected by ambient sound. As equivalent sound levels increased, the error rate increased to a point, then decreased.

Implementation of BCMA-eMAR in two hospitals was associated with significant increases in total medication accuracy rates in most study units and did not introduce new types of error into the medication administration process. Accuracy rates further improved when wrong-time errors were excluded from analysis. The frequency of errors preventable by BCMA-eMAR decreased significantly in both hospitals after implementation of that technology. BCMA-eMAR and direct observation were more effective than voluntary reporting programs at intercepting and recording errors and preventing them from reaching patients.