Error-provoking conditions in the medication use process: the case of a government hospital in Ghana.

Objective: This study aimed to explore error-provoking factors prevalent in hospitals that have the potential to cause medication errors and to create awareness of the existence of medication errors.

Methods: A total of 200 medical folders of in-patients in the health facility were randomly selected and assessed based on a checklist to record potential medication errors. The medication use process and working environment as well as drug packages and labels in the pharmacy were observed, and potential medication errors were documented.

Findings: Of the 162 valid in-patient folders studied, 60.5% of the patients did not receive the actual quantity of drugs they were supposed to. Illegible handwriting on medication orders and prescription were common observations in the folders studied. Look-alike medicine packages and labeling were found. The working space in the dispensary was congested, and distractions (e.g., ringing personal telephones, being called from one task to attend to another, and unnecessary conversation between personnel) were common.

Conclusions: This study has highlighted the vulnerability of the medication use process in the study site to medication errors. The findings may just be a tip of the iceberg; therefore, the researchers plan undertaking a multicenter study. In the absence of that, however, there is a need for a national policy on patient safety, and a national policy on incident reporting would help in determining the incidence, types, and potential causes of medication errors to improve patient safety.