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Medication Errors among Healthcare Workers in a Major HIV Treatment Centre in Nigeria

Background: Medication errors are major challenging clinical incidents in health care settings that could jeopardize a patient’s life and well being. These errors could occur at any step of the medication use process from prescribing, prescription verification, dispensing, drug administration to monitoring. This study aims to assess and classify medication errors among doctors and pharmacists. 
Methods: A prospective observational study from July to September 2018. Randomly selected prescriptions were screened for errors before and after dispensing of drugs. Errors were assessed and classified according to the National Coordination Council for Medication Error Reporting and Prevention (NCCMERP) index to determine the level of harm it posed to the patient. 
Results: Out of 1529 prescriptions analyzed, 182(11.9%) medication errors were observed; 104(57.1%) and 78 (42.9%) among doctors and pharmacists respectively. Majority of the errors were for female patients, those on first line antiretroviral drug regimen, in the age group 41-50 years and according to the NCCMERP index of the error type D. The most common medication errors among the doctors were omission errors (36.5%) and errors in patient data (21.1%) while unsigned prescriptions (33.3%) and omitting prescribed drugs from dispensed drugs (28.2%) ranked highest among pharmacists’ errors. Doctors and pharmacists (53.3% and 75% respectively) with < 5years HIV care experience had higher error rates. 
Conclusion: Medication errors associated with cotrimoxazole therapy were most common for both categories of health workers and this has a potential for poor treatment outcome. There is need for continuous training of health workers in HIV management.