Prescription Errors on The Rise
Lyle Loughry, July 2008

Medical mistakes have become so commonplace that there is a virtual epidemic of them taking place in the US, today. iatrogenic deaths have risen to the point that some 750,000+ deaths occur, annually, as a result of mistakes by doctors and hospitals. For the complete story, go to the Featured Health Articles section on this website, and link onto the article entitled, Death by Friendly Fire.

The word iatrogenic comes from iatros, the Greek word for physician, and genic, meaning induced by. Combined, of course, they become iatrogenic, meaning physician-induced. Iatrogenic deaths, then, are deaths caused by a physician. The growing complexity of modern medicine has promoted the elasticity of language, so much so that, in common usage, iatrogenic death is now being applied to any death associated with any medical practitioner or treatment encountered in hospitals, clinics, nursing homes, or offices, or an ambulance on the way to those places.

Until recently, attention has been focused primarily on those that occur in hospitals, but dangerous errors also happen in pharmacies. Nearly half of Americans take at least one prescription drug daily. According to an article in the Journal of Patient Safety in December 2007, there are 50 million medication errors in pharmacies annually. While individual pharmacy dispensing error rates are low (less than 1% to 4%), the concern about them is valid, as some errors are fatal. A recent survey, Parata Prescription Safety 2008, found one-third of consumers report having experienced a prescription error themselves or knowing someone who has.

Pharmacy errors are one more symptom of a health care system in crisis, observes Larry Sasich, PharmD, MPH, an assistant professor of pharmacy practice at Lake Erie College of Osteopathic Medicine School of Pharmacy in Erie, Pennsylvania.

AN EMPHASIS ON SPEED, NOT ON COUNSELING:
According to Dr. Sasich, in most drugstores today, too few staff members are under too much pressure to fill too many prescriptions in too short a time period. On-site laws that dictate a pharmacist must be present at all times when prescriptions are being filled vary, however, about the educational requirements for the person who interacts with the customer. Pharmacies are commonly staffed with more lower paid technicians than pharmacists, in part because pharmacists now must spend more and more time counting and packaging "pre-fab" drugs and checking insurance coverage than actually compounding medications. Pharmacies that focus on providing great customer service compound the problem because of this emphasis on speed. This is a recipe for disaster in nearly any business, especially health care, where a careless mistake can have deadly results.

An investigation by USA Today on the policies and drug errors at large pharmacy chains like CVS and Walgreens revealed that some pharmacies actually award bonuses to pharmacists based on prescription output. Not surprising, the investigation uncovered a substantial number of prescription errors.

SAFETY AT THE PHARMACY:
Common mistakes include misinterpretation of a physician's written instructions or prescription details. Another is drug name confusion -- some names of dissimilar pharmaceutical drugs sound very much alike. Consumers must take more responsibility to protect themselves when it comes to prescriptions they are taking. That really starts in the doctor's office.

Make sure that you're clear on what drug is being prescribed, and why it's being prescribed. Be sure to inquire about what you should expect to feel while taking the drug, and about possible side effects. Be clear about dosage instructions; exactly how much you should take, when and for how long, if it should be taken with or without food, and what to do if you miss a dose.  Don't be afraid to ask if there is a safer alternative that will do the same thing, or possibly cost less.

When you present the script to the pharmacist, make certain that the pharmacist understands your doctor's instructions regarding drugs and dosages, especially if the instructions are handwritten. Computer-generated  prescriptions, used by many pharmacies, are a positive step in the right direction to minimize the chances for error.

Dangerous drug interactions are a serious problem, especially with senior citizens, many of whom take numerous, different drugs. Review all drugs with your doctor, including supplements and OTCs, and consider bringing the list for your pharmacist to review, as well. Don't be surprised if your pharmacist is better informed about supplements that your doctor, because nutritional supplements aren't really a part of their training, but nevertheless, this can be helpful in minimizing the possibility of dangerous interactions.

If possible, fill all your prescriptions at the same pharmacy. These are usually tracked on their computer, which is programmed to red-flag interactions, at least to the degree that these interactions have been identified and catalogued. If you have to fill a prescription elsewhere, bring the container to your regular pharmacist so the pharmacist can see the label and log the information.

When you pick up your prescription, compare that which appears on the label to the name of the drug and dosage prescribed by your physician. Make sure they match. This is time well spent.

Become familiar with what your medication looks like. When you get refills, and the new medication appears to be different in any way, ask the pharmacist to double-check that it is the correct drug. You can also go to drugdigest.org to look up what your drug is supposed to look like by dose, as well as search for drug information. When possible, call ahead for refills. This puts less time pressure on the pharmacy.

Finally, make sure to review the written information that comes with your prescription -- usually this includes a complete drug description, including possible side effects and instructions on how to take it. If there is no information provided, ask the pharmacy to print this out for you.

In Dr. Sasich's opinion, the single most important step anyone can take to remain safe from prescription drug errors is to simply "speak up." Since pharmaceutical technicians may be working behind the counter, fetching and ringing up your prescription, it's always a good idea to ask to consult with the pharmacist. Before you leave, make sure that you understand everything about your medication and how to take it. Remember, it can be, and has been for many, a matter of life and death.  

Source(s):
Larry Sasich, PharmD, MPH, assistant professor of pharmacy practice at Lake Erie College of Osteopathic Medicine, School of Pharmacy, Erie, Pennsylvania.

Personal Comment: My wife and I have completely avoided all of these dangers, for over 30 years, by searching out and choosing natural alternatives to dangerous drugs, legal or illegal.

   

   

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