Objectives To determine the common stages and strategies involved in the dispensing accuracy-checking process used by pharmacy staff and to determine the training activities used by these staff to gain the knowledge and skills for accuracy checking. Method Face-to-face tape-recorded ethnographic interviews (n = 28) were undertaken in 2009-2010 at two large teaching hospitals with a purposive sample of pharmacists and accredited checking technicians qualified to undertake the final accuracy check on dispensed medicines. Participants described their accuracy-checking process, strategies used to aid checking using anonymised prescriptions and accurate dispensing of medicines to aid discussion. The range of training activities undertaken to develop this skill were discussed. Qualitative data were analysed in accordance with the principles of grounded theory to identify themes. Key findings The accuracy-checking process was described as a cognitive and systematic process. The order in which accuracy checking was executed was found to follow two pathways, with all participants checking the prescription first before verifying either the label or dispensed product. Various physical and sensory aids were used to assist in this verification process. There were inconsistencies in the level of accuracy-checking training received by pharmacists and accredited checking technicians, with many pharmacists reporting no training. Conclusion Although an important medication-error prevention strategy, until this study little was known about the process used by pharmacy staff when verifying the accuracy of dispensed medicines. Accuracy checking is a complex cognitive task involving verification of the product and label with the prescription. Strategies obtained during past experience and in training were used to aid checking. The study highlighted that pharmacy staff training to undertake this task was variable. Application of strategies identified in this study may allow individuals to adopt further safeguards to improve patient safety.