Medication error prevention strategies: A focus on near-miss medication errors detected during prescription screening and counter-checking in inpatient pharmacy

Background Identifying patterns and factors of near-miss medication errors in high-risk settings is essential for medication safety. This study analysed near-miss medication errors and identified its risk factors at inpatient pharmacy of a tertiary hospital. Methods A cross-sectional study was conducted in a Malaysian hospital, including all new and repeat prescriptions received at inpatient pharmacy units between January 2021 and December 2024. Near-miss medication error detected during prescription screening and counter-checking were recorded using a validated form. The type and sub-type of near-miss medication errors were classified according to national guidelines, and descriptive analysis was performed. Chi-square test was performed to examine the relation between filling error and drug characteristics. Results Of the 2,262,201 prescriptions examined, near-miss medication errors occurred in 0.76% and 0.07% prescriptions during screening and counter-checking, respectively. The most common type and sub-type of near-miss medication error during prescription screening was inappropriate or incorrect regimen (6482/13,202; 49.1%) and inappropriate or incorrect dose (n = 3123/13,202; 23.66%), respectively. The most common type and sub-type of near-miss medication error during prescription counter-checking was filling error (n = 1087/1553; 69.99%) and unfilled drug (405/1553; 26.08%), respectively. A statistically significant relationship was found between near-miss filling errors and the availability of a drug in multiple strengths of the same dosage form, χ² (1, N = 1490) = 12.45, p < 0.001. Conclusions Near-miss medication errors frequently occur in inpatient pharmacy settings, particularly with drugs available in multiple strengths. Strengthening detection strategies and implementing collaborative interventions are essential to reducing medication errors and improving patient safety.