PRESCRIPTION ERRORS: HOW MISTAKES CAN HAPPEN
Prescription errors can be devastating. Although it may not be possible for you to prevent a dispensing error, your understanding of the process of how a prescription is filled and your vigilance can help you avoid being injured by such an error.
The first step in the process of filling a prescription takes place when the prescription is dropped off at the pharmacy by the customer, or the prescription is called in by the physician. A pharmacy staff member is supposed to ensure that it is complete and correct. Although state law requirements may vary, this would typically include a verification of the patient's name, medication prescribed, the dosage prescribed, directions for taking the medication and refill information. If there are any uncertainties, the pharmacy should contact the doctor to clear these up.
Mistakes can happen at this point if the pharmacy staff fails to properly interpret a physician's handwriting, the prescription codes/abbreviations, or the verbal instructions that are provided during a telephone call. One situation we are aware of involved a physician's prescription indicating that four tablets were to be taken twice daily for chronic pain that was mistyped by the pharmacist to instruct the patient to take four tablets by mouth as needed for chronic pain, resulting in an accidental prescription drug overdose.
The second step of the process may involve a review of the patient's demographic profile. Questions of age, known drug allergies and whether other medications are being taken that the pharmacy is unaware of all might be asked. Typically is asked in order to make certain that the new prescription is compatible with medications already prescribed. If this process is not completed, errors may result, particularly if there are compatibility problems with the medications.
The third step of the process involves the pharmacy staff entering the prescription into the pharmacy computer system. This may involve digital imaging scanning or in some cases manual entry. Incorrectly inputting the dosage or the formulation of the drug, or the medical history, condition, or allergies of the patient, or can lead to serious injury or even death. Choosing the wrong code for the drug can result in a misidentified drug, resulting in patient harm. For example, a pharmacy filled a prescription for the anti-nausea drug compazine with drug code COM with a generic blood thinner coumadin with a similar but different drug code COM.
In the fourth step the pharmacist compares the original prescription with the pharmacy's database to verify that the patient name, address, DOB, and so forth are the same. The pharmacist next checks the particulars of the prescription. The pharmacist doesn't always catch the technician's mistakes in the initial prescription input.
During the fifth part of the process the technician takes the drug from storage on the shelf and checks the identification number and matches the bottle and info sheet by scanning their bar codes. At this juncture the technician can make a mistake by misidentifying the drug or possibly choosing the correct drug but the wrong prescription strength. Drugs located next to one another, similarly labeled, can be mistaken for each other. For example, a child's Zyrtec antihistamine prescription was filled with Zantac stomach acid control.
The sixth step is the final verification and the pharmacist checks the patient’s name, prescription number, and remaining information, and scans the bottle's bar code and checks the photograph of the pill shown in the computer illustration with a visual inspection of the medication itself. Additionally, the pharmacist checks a second time for allergies or drug interactions with whatever medications the patient is taking at that time. Mistakes can occur at this stage when a pharmacist fails to recognize a mistake between the drug that was prescribed and the drug that was provided. Mistakes can also be made if the pharmacist fails to check the contents of the bottle.
The seventh and final step in the process is when the cashier, typically a low level technician, completes the sale and asks whether the patient wishes to speak to the pharmacist regarding the purpose of the drug, the instructions, or any possible side effects. Mistakes happen when the pharmacist fails to provide counsel and advice every time the customer arrives to retrieve the drug.
Although the process described above is designed to be safe, mistakes can happen. You can help prevent unnecessary injury from prescription errors by being involved in your medical care and the filling of prescriptions. Know what the doctor has prescribed, how much and for what conditions. If something doesn't seem right, ask questions before taking the medication.
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