Health Care and Rx Errors

No one likes making mistakes; and even more so, no one likes to admit they have made mistakes. This is especially true in the health care arena, and errors made by health care providers, pharmacies, nurses, caretakers, and others responsible for administering medications to patients should be ever conscious about the necessity of handling prescription and non-prescription drugs.

Have you noticed the number of pharmacies opening in your area? As the Baby-Boom Generation continues to age, there is a marked increase in the number of prescriptions being filled each day, according to LawFirms.com. And the number will continue to increase, with no end in sight. Retail pharmacy is big business. It is not unheard of for a busy retail pharmacy to fill more than 1,000 prescriptions each day, with the pharmacist working a 12-hour shift. Mistakes are inevitable. A one percent margin of error in a pharmacy filling 1,000 prescriptions each day equates to ten people walking out of the pharmacy each day with a wrong prescription.

According to CNNHealth.com, every year in the United States, 30 million dispensing errors out of 3 billion prescriptions occur at outpatient pharmacies, according to the National Patient Safety Foundation. Some errors are minor. Some patients catch easily. But others can be serious. More health care is happening outside hospitals, putting more of a burden on outpatient pharmacists. Here, from experts, are ways to avoid becoming a victim:

1.) Don't get a prescription filled at the beginning of the month. Research shows that in the first few days of each month fatalities due to medication errors rise by as much as 25 percent above normal. The reason: Social Security checks come at the beginning of the month. Quite a number of people can't afford to get their medicines until the Social Security check comes in, so at the beginning of the month they turn up in abnormally large numbers and swamp the pharmacists. When pharmacists are busy, they make more mistakes. Of course, it's not always possible to wait a week or two to get a prescription, but do so if you can.

2.) Open the bottle at the pharmacy. Pharmacy errors aren't common, but that there are things patients can do to make sure the medicine inside a bottle is the right drug. Opening the bottle right at the pharmacy and showing the pills to the pharmacist is one safeguard. Another: If it looks different than the medicine you've taken before, or you have any questions, don't be afraid to ask the pharmacist according to the American Pharmacists Association.

3.) Don't be in a rush. patients should take the time to get detailed instructions about how to take a drug. Errors happen not just when the wrong medicine is dispensed, but when the right medicine is taken at the wrong dosage. Also, pharmacies can take additional steps, too. For example, many drug names look alike. The Institute for Safe Medication Practices suggests writing in capital letters the portions of drug names similar to other medications to make distinctions more clear and to prevent errors. The Institute also has suggestions for making abbreviations clearer, too. For example, when a doctor writes "q.o.d." on a prescription, that means the pharmacist should instruct the patient to take the medicine every other day. That abbreviation could be mistaken for "q.d.", which means daily. The solution: Physicians should write out "every day" or "every other day."

According to About.com, pharmacy errors may have serious consequences. Many pharmacy errors go unreported because they remain undetected or cause no obvious harm. Potential problems make it imperative for people taking prescription drugs to always check the medication they receive. Though pharmacy errors are unlikely occurrences, they do happen. A watchful eye can help rectify the mistake quickly. The consequences of pharmacy errors can range from harmless to fatal. Certain actions can help people who take prescription drugs ensure their own safety:
--Know the drug name, dosage, and prescribing instructions for every prescription medication you are filling at the pharmacy. Keep a record of this information by writing it down, keeping a medication diary on your computer, or photocopying the prescription.
--When you pick up your prescription from the pharmacy, compare the label on the prescription bottle to the information you have recorded for the drug.
--If you are picking up the drug for the first time, search on the Internet for the name of the drug and information imprinted on the pill. The photo of the medication online should match the medication you have in your possession.
--If you are picking up a refill, compare the pills in the new bottle to any remaining in the previous bottle. Look at the color, shape, and imprint on both sides on the pills (name of manufacturer and number). The new and old pills should be identical.
--Generic medications come in various shapes and colors because they have more than one manufacturer. It is still possible to check. If Drug IDentifier does not produce the desired results, search Google.
--Don't assume everything is without problem until you actually check. The hassle it takes to be sure you were dispensed the correct medication is minimal and may save you from much greater hassles. It may save your life.

According to the Agency for Healthcare Research and Quality (AHRQ), the more medications that community pharmacists dispense each day, the greater the likelihood of medication errors. Aside from the sheer volume of prescriptions they need to fill, community pharmacists are often interrupted by telephone calls from doctors or patients and questions from pharmacy support personnel or in-store customers, which may also influence medication errors. Indeed, higher pharmacist and pharmacy workload at community pharmacies does increase the risk of dispensing medications with the potential for drug-drug interactions (DDIs). Community pharmacies and pharmacists with a greater workload are more likely to dispense medications with potential DDIs (such as coprescribing the anticoagulant warfarin with nonsteroidal anti-inflammatory drugs). As pharmacists become busier, they have less time to evaluate DDI warnings or to act on those warnings. Pharmacies with automated telephone systems for prescription orders are also significantly more likely to dispense medications with potential DDIs.

According to LawFirms.com, your neighborhood pharmacists are probably competent and trustworthy people, but their jobs are not easy. They have to supervise technicians, counsel customers, service the drive-through window, deal with insurance companies, decipher doctors’ handwriting, take telephone calls and faxes from patients, doctors and other pharmacies, all while filling a large volume of prescriptions in a busy environment. Mistakes happen, and when they do, it often leads to someone not getting medicine they critically need, or someone ingesting a medication that does them harm. Always verify the medications you receive from the pharmacy. Ask questions. Do your pills look different than usual? Is there writing, numbers or markings on the pills, and if so are the markings the same as usual? If something does not look right, call the pharmacy or your doctor, or better yet, go back to the doctor or pharmacy to review your medicine. Take your prescriptions to your doctor and have your physician confirm that you are taking the correct medicine. If you discover that you have ingested the wrong medicine, or if you do not feel well after taking a newly-filled or refilled prescription, get medical attention at once and check things out. It may be that the medicine you are taking is not what the doctor ordered.

Also, according to HarvardScience.com, in the use of bar coding technology for storing and dispensing medication from hospital pharmacies, results found that the rates of medication dispensing errors and potential adverse drug events, which are dispensing errors that can harm patients, were substantially reduced when bar code scanning technology was used in the dispensing process. By comparing the error rates before and after the implementation of bar code technology, the researchers found that the rate of dispensing errors targeted for reduction by bar code technology fell by 85 percent. The rate of potential adverse drug events (or dispensing errors with the potential to harm patients) also fell by 63 percent. Bar coding has been found to be a very good way to reduce the number of incidents of mistakes.

More than 100,000 Americans die each year of adverse drug reactions, according to a landmark report in the Journal of the American Medical Association -- making such reactions one of the six leading causes of death in the U.S. No one knows how many of those deaths are the result of errors in dispensing drugs, but observers say pharmacy mistakes may play a role. Part of the burden comes from soaring demand for prescription drugs. In 1994, Americans bought more than 2 billion prescriptions. Today that number has grown to over 3.7 billion, according to the National Association of Chain Drug Stores (NACDS). Meanwhile, according to AHealthyMe.com, the paperwork involved in filling each prescription has become more complicated. Under managed care, for example, each insurer has its own formulary -- the list of drugs it offers under its plan. Before a pharmacist can substitute one drug for another, he must check back with the doctor and the patient for approval -- adding to the time pressure as other prescription orders pile up.

Pharmacists are also required by federal law to counsel customers about prescription drugs, according to AHealthyMe.com. Many, however, just don't have the time to spare. The obvious solution is to add more pharmacists and relieve a little of the pressure on them by giving them adequate breaks, say pharmacy groups. But as the number of prescriptions being written has soared, the number of pharmacists to fill them hasn't kept pace. NACDS estimates that between 2004 and 2010 the number of pharmacists will increase by almost 8 percent – however, prescription volume is expected to increase an estimated 27 percent. To cut costs and meet the increasing demand for prescription drugs, pharmacies are turning some duties over to pharmacy technicians or clerks, who often have little training and are paid only $6 to $12 an hour. In some states technicians -- who must always work under a pharmacist's direction -- are allowed to pull drugs off stock shelves and even fill prescription bottles. They also enter prescriptions into the computer and call doctors to authorize prescription refills. Retail pharmacies used to be required to have one pharmacist for every one pharmacy technician on duty. This is no longer true. In fact, some states allow up to four technicians for every pharmacist on duty.

Pharmacists are legally responsible if a mistake is made, and some have been sued for millions of dollars, according to AHealthyMe.com. But pharmacy technicians have no legal responsibility -- which means they may have less incentive to double check the prescriptions they're handing out. Of course, beyond the time crunch they face, pharmacists have plenty of other challenges. They have to decipher the almost illegible handwriting of many doctors. They must also keep track of a bewildering number of new drugs with complicated and often similar sounding names -- drugs like Cerebyx, Celexa, and Celebrex, each of which is prescribed to treat very different conditions. One in every four medication errors, studies show, is a name-confusion error. What can you do to make sure the prescription you pick up contains the right drug at the right dose? Take an active role. You should always ask, "What's this for? How do I take it and for how long? Can it interfere with anything else I'm taking? What if I miss a dose?" It's equally important for you to give your pharmacist all the information he or she needs. Make sure you understand exactly what you're taking and why, and tell the pharmacist what other drugs or supplements you're taking. It's up to you to keep track of the drugs you're prescribed.

According to USLaw.com, pharmacy errors and prescription misfills can be grounds for personal injury or wrongful death lawsuits if a patient is injured, becomes ill, or dies as a result. Long shifts and minimal breaks can lead to carelessness, fatigue, and inattention when filling prescriptions. Providing speedy customer service can sometimes take priority over carefully filling a prescription. There are few standards within the industry for determining how much volume is too much, according to USAToday.com. Prescription volume is rising nationwide. But the number of pharmacists — about 240,000 nationwide, including about 110,000 in chain drugstores — hasn't kept pace. Pharmacy chains say they've spent billions of dollars on safety technology and other improvements that have cut their prescription-error rates to a fraction of 1%. But that still has the potential to lead to well over three million mistakes per year.

Bottom line--check your meds. Make sure what you get from the pharmacy is what you have been subscribed. Talk with the pharmacist, and double check with your doctor what medication and dosage you are supposed to take. Let the pharmacist know if you are taking any other prescriptions and any over the counter medications, including any vitamins or supplements. It only takes a minute to consult with the pharmacy. Use your time wisely when verifying any medication. It's your life. Don't lose it because you are in a hurry or assume they have your back.

Until next time. Let me know what you think.