What’s In the Box?! Decreasing Medication Errors in the Last Mile

Medication safety has traditionally focused on clinical checks and dispensing accuracy inside the pharmacy, but the risks don’t stop there. The last mile of delivery has become an increased point of vulnerability, especially as therapies grow more complex and shipping networks remain strained. Packing errors, temperature excursions and delivery delays can directly affect patient safety, satisfaction and outcomes.

While regulatory bodies have defined “distribution errors” to set a compliance baseline, pharmacies can benefit from considering a broader view. A distribution error is any preventable, unplanned or unwelcome event in the shipping or delivery process. These incidents are rising quickly – specialty pharmacies now report six times more distribution errors than dispensing errors. (1)

During our recent webinar hosted by Becker’s Hospital Review, Amanda Awe, PharmD, and Marc Chouquette, PharmD, MBA with Saint Luke’s Health System, explored how pharmacies can decrease medication errors in the last mile. Here are four key takeaways.

1. Reframe Medication Safety for Distribution

Pharmacies can apply the same principles that safeguard dispensing to the last mile. Tools like barcode scanning, digital grouping and automation are powerful when adapted for shipping workflows, while physical grouping can provide a reliable fallback when technology falls short. Simplifying processes after verification reduces the number of decisions staff must make, which in turn lowers the risk of mistakes. By tracking data beyond compliance, pharmacies can gain actionable insights into delivery performance and use them to determine the most effective delivery method.

2. Build a Just Culture to Encourage Reporting

Safety isn’t only about technology and process – it’s also about culture. A punitive environment discourages staff from reporting errors, leaving problems hidden and morale strained. On the other hand, a just culture creates a safe environment for reporting mistakes and near misses, allowing the organization to learn and continuously improve. The Institute for Safe Medication Practices (ISMP) suggests that just culture can help reduce error rates and staff burnout, while increasing engagement and trust.

3. Leverage Technology for the Last Mile

Technology is most powerful in the last mile when it creates a seamless bridge between dispensing, shipping and tracking. By automating address workflows and using decision logic, pharmacies can reduce manual errors and ensure delivery choices are consistent. When these workflows are standardized and integrated, tracking data flows back into the pharmacy system, supporting audits, documentation and quality improvement while also lowering overall shipping costs.

4. Applying Data-Driven Risk Reduction Strategies

Finally, risk reduction in the last mile requires a proactive approach. Avoiding practices like post-dating labels ensures scan accuracy, while standardized packouts reduce variability and free up staff to focus on oversight. Historical shipping data can reveal patterns and help predict potential points of failure. By turning those insights into monitoring dashboards or triage plans for in-transit packages, pharmacies can act before an error becomes a disruption.

The last mile is no longer just a logistical challenge – it is a central component of medication safety. By reframing safety practices for distribution, cultivating a just culture, embracing technology and adopting data-driven risk reduction strategies, pharmacies can minimize errors, protect patients and strengthen trust across the care journey.

(1) Source: URAC Aggregate Performance Reports​