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Patient compliance has long been recognized to be a problem associated with drug treatment. Dosettes constitute a compliance aid; their aim is to maintain patient independence, while facilitating patient compliance. However, those patients most in need of such devices are the least likely to be able to manage them. It was therefore decided to examine incidents in which problems involving dosettes had been identified; 52 such incidents were found. Half the incidents involved filling errors, and most of these involved nurses; some incidents were potentially dangerous systematic errors. A second type of incident involved a problem with use, mainly caused by hurried or confused patients; these sporadic errors were less dangerous than filling errors. The remainder of the incidents involved patients taking medication in addition to the medication in the dosette. Recommendations include objectively assessing that a dosette is appropriate for the individual patient, and education about the need for compliance, meticulous care and checking when filling, and regular checks to confirm correct use.

Problems that arise from health-care management, rather than from a disease process, are now recognized as making a substantial contribution to patient morbidity and mortality and to the cost of health care. However, most classifications of these problems do not provide sufficient detail to allow comparisons or to develop better strategies for the prevention, detection and management of these problems. A 'Generic Occurrence Classification' was developed to record their salient features, place them in context and elicit any system or human error-based contributing factors. This was done by an iterative process in which 'natural categories', identified from over 2000 incidents and 800 adverse events, were placed in a hierarchical structure created using software written in Microsoft Visual Basic; data were stored in a Microsoft Access database. This was shown to be a valid and reliable way to compare incidents and accidents from different sources and to allow sufficient detail to be retrieved to develop preventive strategies.