Background Safety is a priority in the medication use process.

Purpose To prepare a risk map to identify the risks to safety in a Pharmacy Service and prioritise the risks found.

Materials and Methods Formation of a multidisciplinary working group.

1. Description of the different processes linked to the healthcare area which included the clinical pharmacy unit sited in the Hospital and primary health care pharmacies.

2. Identify the risks linked to the processes by the FMEA or Failure Mode and Effect Analysis: (mode of failure, cause of failure, effect of failure).

3. Rank risks by a risk matrix (vertical axis: likelihood and horizontal axis: consequence). The matrix uses a colour code.

4. Prioritize the risks by the modified Hanlon method. Once the risks have been identified, rate each risk on the following criteria: size of the risk (A), magnitude of the risk (B), feasibility of possible interventions (C) and effectiveness of potential interventions (D). Then, calculate priority scores using the following formula: (A+B)C × D.

Results In the unit clinical hospital pharmacy, eleven processes were identified: 1) Drug acquisitions; 2) Pharmacy stores; 3) Drug stock management; 4) Automatic dispensing systems; 5) Traditional drug-dispensing systems; 6) Out-patient pharmacy; 7) Patient education; 8) Centralized cytotoxic preparation; 9) Pharmacy production; 10) Intravenous admixture preparation; 11) Clinical trials. The process with the highest risk score was the centralised cytotoxic preparation.

In primary health care pharmacies, eight processes were identified: 1) Methadone treatment programme; 2) Drug stock management; 3) Pharmacy stores; 4) Vaccination dispensing and storage; 5) Management of off-label drug use; 6) Drug prescription validation; 7) Health education; 8) Rational use of drugs. The process with the highest risk score was vaccination storage and dispensing.

Conclusions Preparing a risks map is a useful tool to identify risks to safety. Prioritization of the risks allows us to identify the most unsafe practises and provides a starting point for implementing measures to improve safety in the work environment.

No conflict of interest.