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Main conclusions

• Errors occur in 0.3% to 0.6% of prescriptions handled at the pharmacy
• Errors are made throughout the process of handling prescriptions at the pharmacy. The largest share of errors is seen in relation to writing the label and dispensing the drug
• The pharmacy intervenes in 1-4% of prescription handlings with interventions that have clinical relevance
• Medication errors are found to cause death in between 0.01% to 8.7% of cases
• The most common medication errors resulting in mortality are related to wrong dose, wrong drug and wrong method of administration
• Drugs related to mortality in particular: anti-inflammatory drugs including NSAIDs (non- steroid anti-inflammatory drugs), drugs that act on the central nervous system (CNS), drugs used in chemotherapy
• As causes of medication errors, product name similarity and communication failure are mentioned for all sectors
• System-related causes were given as: lack of knowledge, too busy, interruptions and lack of control procedures.

Full summary including references at the end of the summary