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ABSTRACT
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1. INTRODUCTION only, as this is a specific angle. This literature review

Medication safety is a key issue in the quality and
patient safety movement. Medication delivery is
complex in all areas of health care however, presents
additional challenges and opportunities for error [1].
Medication errors are significant global concern and can
serious medical consequences for patients [2]. There are
a lot of different approaches to classifying medication
errors [3]. One approach is to base the classification on
the stage in the sequence of medication use process,
such as prescribing, transcribing, dispensing,
administration or monitoring [3].
Dispensing medication is a complex process that
involves more than simply taking medicines from a
pharmacy shelf, sticking a label on a pack, and giving
this to the patient after containing it [4]. Dispensing
errors are one of the main types of medication errors.
They are defined as discrepancies between prescribed
medicines and the medicines that the pharmacy delivers
to the patient, including dispensing of medicines with
inferior pharmaceutical of informal quality [5]. (collect
data dispen error around the word terupdate).
Despite the frequency of dispensing errors in
community, there are limited number of studies that
have reported on dispensing errors in community and
hospital pharmacies. One of the review studies about
that was conducted in 2009 [6]. The present review
focuses on dispensing errors in community pharmacy
therefore aims to classification of error types and
incidence, reported incidence of dispensing errors,
reported types of dispensing errors, and cause of
dispensing errors.
1.1.1. Third Level Heading (Head 3)
1.1.1.2. Fourth Level Heading
2. METHOD
2.2. Literature Search
A comprehensive search of electronic bibliographic
databases was undertaken: Medline (2009-2021) and
Google Scholar (2009-2021). In the search, we included
all publication types but excluded veterinary citations.
The keywords used to search for the relevant studies
were as follow: Dispens* errors, Dispensing Errors,
Inciden*, Incident, Near-miss*, Near-miss, Med*,
Medication, Prescri*, Prescription, Drug, Pharm*,
Pharmacy, Community*, Community Pharmacy,
Outpatients. Besides that, we also used the ‘related
articles’ feature in the electronic database that provide
this. The time period 2009-2021 was chosen to ensure
the review would be as up to date as possible and
describe the dispensing errors in community pharmacy
that occurred in the past one decade.
2.3. Inclusion/exclusion criteria 11. Indication of any assumptions made
12. Ethical approval obtained
The publications were included in this review if they
fulfilled the inclusion criteria (Table 1) and any relevant 2.5. Definition
in information was extracted from papers about
dispensing errors in community pharmacy. We only use 3. RESULT
the full research paper for this review. The dispensing
errors in hospital (Table 2) was excluded in this review 3.1.
due to specified the dispensing errors cases in
community pharmacy. Scalar variables and physical constants should be
italicized, and a bold (non-italics) font should be used

Table 1. Inclusion/exclusion criteria

Inclusion Criteria Exclusion Criteria

International, primary quantitative and/or qualitative research Extemporaneous and aseptic dispensing errors
investigation about incidence, type, and cause of medication errors
Hospital pharmacies (inpatients, ambulatory care)
Dispensing errors (errors arising during the process of dispensing
medication) that detected before medication has left from pharmacy
or/and detected after medication has left from pharmacy with or
without patient’s awareness

Community pharmacies:
1. Pharmacy type
a. Independent
b. Chain/multiple
c. Supermarket
d. Mass merchant
e. Mail-service
f. Outpatients
2. Prescription type
a. Individually dispensed item for patients
b. Original prescription
c. Repeat prescription
3. Dispensing system
a. Manual dispensing (unit dose, original pack, or compliance
pack)

for vectors and matrices. Do not italicize subscripts

2.4. Data Extraction
unless they are variables. Equations should be either
The inclusion criteria were applied and the quality of display (with a number in parentheses) or inline. Use the
retrieved papers was assessed using 12 criteria outline built-in Equation Editor or MathType to insert complex
by Allan and Barker [7] and modified by Aldhwaihi [4] equations.
in order to apply to any type of medication error study. Display equations should be flush left and numbered
The definition of what constitutes a medication error consecutively, with equation numbers in parentheses
was changed to a definition of what constitutes a and flush right. First, use the equation editor to create
dispensing error. The selected studies had to satisfy a
the equation. Then, select the equation, and set the
minimum of six criteria from the following list:
“Equation” Style. Press the tab key and type the
1. Aims/objective of the study clearly stated
equation number in parentheses.
2. Definition of what constitutes a dispensing error
3. Error categories specified
4. Error categories defined  b  b 2  4ac
5. Presence of a clearly defined denominator 2a (1)
6. Data collection method described clearly
7. Setting in which study conducted described
n!
8. Sampling and calculation of sample size described r! n  r  ! (2)
9. Reliability and validity measures applied
10. Limitations of study listed
 Be sure the symbols in your equation have been
defined before the equation appears or immediately
following. Please refer to “Equation (1),” not “Eq. (1)”
or “equation (1).”
4. FIGURES AND TABLES
Figures and tables should be placed either at the top
or bottom of the page and close to the text referring to
them if possible.
Figure 1 Caption content. The title “Figure” and the
label should be in bold.
For small tables, please place it within a column and
bigger table be placed in a text frame spanning to both
columns. Use the Table facility available within the
MSWord. The font in the row header should be bold and
you can use the style available from the style palette.
AUTHORS’ CONTRIBUTIONS
The title "AUTHORS’ CONTRIBUTIONS" should
be in all caps.
ACKNOWLEDGMENTS
The title "ACKNOWLEDGMENTS" should be in
all caps and should be placed above the references. The
references should be consistent within the article and
follow the same style. List all the references with full
details.
REFERENCES
[1] K. Sears, A. Ross-White, C. G.-J. E. Synthesis,
and undefined 2012, “The incidence,
prevalence and contributing factors associated
with the occurrence of medication errors for
children and adults in the community setting: A
systematic,” journals.lww.com, 2012, Accessed:
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https://journals.lww.com/jbisrir/Fulltext/2012/1
0350/The_incidence,_prevalence_and_contribut
ing_factors.1.aspx.
[2] Z. Alsulami, S. Conroy, and I. Choonara,
“Medication errors in the Middle East countries:
A systematic review of the literature,” doi:
10.1007/s00228-012-1435-y.
[3] R. E. Ferner and J. K. Aronson, “Clarification of
Terminology in Medication Errors Definitions
and Classification,” Drug Saf., vol. 29, no. 11,
pp. 1011–1022, 2006.
[4] K. Aldhwaihi, N. Umaru, C. Pezzolesi, and F.
Schifano, “A systematic review of the nature of
dispensing errors in hospital pharmacies,”
Integr. Pharm. Res. Pract., vol. 5, p. 1, Jan.
2016, doi: 10.2147/IPRP.S95733.
[5] P. A. G. M. De Smet, K. C. Cheung, and M. L.
Bouvy, “Medication errors: The importance of
safe dispensing,” Br. J. Clin. Pharmacol., vol.
67, no. 6, pp. 676–680, Jun. 2009, doi:
10.1111/J.1365-2125.2009.03428.X.
[6] K. L. James, D. Barlow, R. McArtney, S. Hiom,
D. Roberts, and C. Whittlesea, “Incidence, type
and causes of dispensing errors: a review of the
literature,” Int. J. Pharm. Pract., vol. 17, no. 1,
pp. 9–30, Jan. 2009, doi:
10.1211/ijpp/17.1.0004.
[7] E. L. Allan and K. N. Barker, “Fundamentals of
medication error research,” Am. J. Hosp.
Pharm., vol. 47, no. 3, pp. 555–571, Mar. 1990,
doi: 10.1093/AJHP/47.3.555.
[8] D. H. Abdel-Qader, A. Z. Al Meslamani, P. J.
Lewis, and S. Hamadi, “Incidence, nature,
severity, and causes of dispensing errors in
community pharmacies in Jordan.,” Int. J. Clin.
Pharm., vol. 43, no. 1, pp. 165–173, Feb. 2021,
doi: 10.1007/s11096-020-01126-w.
[9] K. Adie, R. Fois, … A. M.-B. J. of, and
undefined 2021, “The nature, severity and
causes of medication incidents from an
Australian community pharmacy incident
reporting system: the QUMwatch study,” Wiley
Online Libr., Accessed: Nov. 13, 2021.
[Online]. Available:
https://bpspubs.onlinelibrary.wiley.com/doi/abs/
10.1111/bcp.14924.
[10] Y. M. Al-Worafi, “DISPENSING ERRORS
OBSERVED BY COMMUNITY PHARMACY
DISPENSERS IN IBB - YEMEN,” Asian J.
Pharm. Clin. Res., vol. 11, no. 11, pp. 478–481,
Nov. 2018, doi:
10.22159/AJPCR.2018.V11I11.28382.
[11] A. de Las Mercedes Martínez Sánchez,
“Medication errors in a Spanish community
pharmacy: nature, frequency and potential
causes.,” Int. J. Clin. Pharm., vol. 35, no. 2, pp.
185–189, Apr. 2013, doi: 10.1007/s11096-012-
9741-0.
[12] A. Boucher et al., “Quality-related events
reported by community pharmacies in Nova
Scotia over a 7-year period: a descriptive
analysis.,” C. open, vol. 6, no. 4, pp. E651–
E656, 2018, doi: 10.9778/cmajo.20180090.
[13] L. Soubra and S. Karout, “Dispensing errors in
 Lebanese community pharmacies: incidence,
types, underlying causes, and associated
factors.,” Pharm. Pract. (Granada)., vol. 19, no.
1, p. 2170, Mar. 2021, doi:
10.18549/PharmPract.2021.1.2170.
[14] E. Gogazeh, “Dispensing errors and self-
medication practice observed by community
pharmacists in Jordan,” Saudi Pharm. J., vol.
28, no. 3, pp. 233–237, Mar. 2020, doi:
10.1016/J.JSPS.2020.01.001.
[15] O. M. Ibrahim, R. M. Ibrahim, A. Z. Al
Meslamani, and N. Al Mazrouei, “Dispensing
errors in community pharmacies in the United
Arab Emirates: investigating incidence, types,
severity, and causes.,” Pharm. Pract.
(Granada)., vol. 18, no. 4, p. 2111, Oct. 2020,
doi: 10.18549/PharmPract.2020.4.2111.
[16] E. A. Flynn, K. N. Barker, B. A. Berger, K. B.
Lloyd, and P. D. Brackett, “Dispensing errors
and counseling quality in 100 pharmacies,” J.
Am. Pharm. Assoc. (2003)., vol. 49, no. 2, pp.
171–182, 2009, doi:
10.1331/JAPHA.2009.08130.
 Study Country Types of Study Duration Setting Outcomes

Abdel et al [8] Jordan Prospective Over 5 months Community pharmacy all 12 The total number of dispensing errors was 37,009 (24,6%) intercepted in 150,442 dispensed
(October 2019 to regions of Jordan medications, that included 17,352 prescription-related errors or PREs (11,5%) and 19,657 pharmacist
February 2020) counselling errors or PCEs (13,1%). The most common types of PREs were wrong quantity (37,9%),
wrong strength (26,6%), wrong dosage form (13,0%), instruction error (1,1%). The most common
types of PCEs were wrong drug (41,9%), wrong strength (20,7%), wrong dosage form (17,9%), and
wrong quantity errors (10,8%), and label error (0,4%). The most common cause of dispensing errors
was poor handwriting (30,7%) and heavy workload (17,3%)

Adie et al [9] Australia Reporting incident Over 30 months Thirty community pharmacies Total of incidents were reported over 30 months were 1013 incidents, that 831 incidents near misses
system in metropolitan Sydney were and 165 involved patient harms. The most incidents involved errors during prescribing stage (61,1%),
recruited from March 2010 to followed by dispensing errors (25,7%) and administration errors (23,5%), while some errors occurred
June 2011 at multiple stages (17,9%).

Al-Worafi [10] Yemen Prospective Over 4 months (March Community pharmacies located 35 (0,80%) dispensing errors were detected from 4325 prescriptions. The most common types
1 to End June 2016) within the city of Ibb (30 dispensing errors were wrong dosage form (45,7%). Prescription poor handwriting (48,6%) were the
community pharmacies were most causes of dispensing errors then wrong quantity (37,1%), wrong strength (14,3%), wrong drug
invited but only 7 were (2,9%).
participated)

Sanchez [11] Spanish Prospective Over 13 months A community pharmacy in 2,117 medication errors were collected from 42,000 prescriptions; there were 1,127 prescribing errors,
Madrid (2 pharmacists and 2 216 dispensing errors, and 774 near misses. Prescriptions with incompletely specified dosages or
(February 2010 to pharmacy technicians were frequency (17,8%) were the most frequent types of dispensing errors or near misses, followed by
March 2011) participated) missing or wrong patient identification (12,6%).

Boucher et al [12] Nova Scotia Retrospective analysis October 1, 2010 to 301 community pharmacies in 131,031 events reported, of these events 98,097 were reported as quality related events (QREs) with
June 30,2017 Nova Novia 29,3% dispensing errors and 38,1% harm to patient in dispensing errors case. Incorrect dose or
frequency (58,7%) were the most frequently types of dispensing errors.

Soubra [13] Lebanese Prospective July and August 2017 Community pharmacies in 376 dispensing errors were reported from 12860 prescription that divided into “dispensing near-miss”
Observational Beirut city and four Lebanese (67,1%, n=252) and “dispensing” errors (32,9%, n=124). Several types of DEs were giving
governorates incomplete/incorrect use instructions (40,9%, n=154), omission of wring (23,6%, n=89), wrong dose
(12%, n=45), wrong drug (11,4%, n=43). The causes of DEs were work overloads/time pressures
reported (55%, n=206), illegible handwriting (23,13%, n=87), distractions/interruptions (15,15%,
n=57), and confusions due to similar drug naming/packaging (LASA) (7%, n=26).

Gogazeh [14] Jordan Cross sectional survey More than 2 months 300 registered community The major factor that associated in increasing of dispensing errors were poor handwritten prescription
pharmacists all over the regions (3,78 of 5), followed by similar or confusing drugs name (3,48 of 5), high workload and lack of time
of Jordan for patient counselling (3,27 of 5), pharmacy dispensary area design (3,20 of 5), pharmacy fatigue
(2,85 of 5), interruptions (2,75 of 5), pharmacy assistants (2,5 of 5)

Ibrahim et al [15] United Arab Prospective Over 6 months All community pharmacies Total number of dispensing errors was 30912 divided into 12274 pharmacist counselling errors and
Emirates (November 2019 to across 7 regions of UAE 18638 prescription related errors. The most common types of dispensing errors were wrong drug
April 2020) (divided into 3 geographical (n=7,618), following by wrong strength (n=5829). Medicine replaced into another medicine near
regions) expired date was the major cause of dispensing errors.

Study Country Types of Study Duration Setting Outcomes

Flyn et al [16] Finland Cross-sectional study January and February Community chain pharmacies 22 prescriptions were identified into dispensing errors from 100 prescriptions. The types of dispensing
2007 in large metropolitan areas of errors that detected were wrong instruction errors (73%, n=16), wrong quantity errors (23%, n=5),
Florida (community chain other errors (4%, n=1). Of these total errors cause by busy pharmacies (24%).
pharmacies and trained
shoppers)
Rajah

Incidence of dispensing errors

Reference [8] [9] [10] [11] [12] [13] [14] [15] [16]

Research method observation observation form

Setting 350 pharmacies 350 pharmacies 100 community
pharmacies chain
Dispensing system Unspecified Unspecified Unspecified
Unprevented (U)/Prevented U U U
(P) dispensing incidents
Incidence (%) 24,6% 6,7% 22%
Types of dispensing error
Reference [8] [9] [10] [11] [12] [13] [15] [16]

Preparation Error X
Content errors
Wrong drug dispensed X X
Wrong medicine strength X X
dispensed
Improper dose dispensed X
Wrong quantity dispensed X X X
Expired drug
Dose medicine omission X X
Wrong dosage form X X
Other content errors X X
Labelling error
Wrong patient name on label
Wrong drug name on label
Wrong drug strength
Wrong frequency
Wrong dosage form
Wrong date
Wrong instructions X X X
Incomplete information
Completely wrong label X X
Other labelling errors
Other errors X
Other content errors (Deteriorated drug error)

Factors that cause of dispensing errors

Reference [8] [9] [10] [11] [12] [13] [14] [15] [16]

Environment
Heavy workload X X
Interruption X X
Low staff X X
Busy X
Dispensary design X
Day of the week X
Medicine
LASA X X
Packaging looks a like
Poor labelling
Out of stock X
Team
Staff inexperienced X
Lack of communication
Fatigue/lack of concentration X
 Poor training X
Task
Complex prescription X
Poor handwriting prescription X
Low of checking
Low of knowledge
Ambiguous task

Poor training (off-label use without counselling)