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Inform patients about ways to minimize medication errors
Using electronic medical record programs may help in reducing errors.
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The public has long rated trust in their pharmacist very highly, often rating them as more trusted than clergymen or physicians. Yet, year after year serious and sometimes deadly medication dispensing errors occur, usually unbeknownst to patients or their physicians.
Last year in the United States, almost 4 billion prescriptions were filled by community and mail-order pharmacies. With the recent implementation of Medicare Part D prescribing benefits and the aging and often unhealthy lifestyle of the American people, that number will steadily climb.
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There are many places during the prescription process that errors can occur, beginning when the prescription is written and culminating when the prescription is handed over to the patient. Many studies have documented error rates at each step along the way, and while many of these studies have limitations related to methodology, there are some important points to consider:
- Cognitive review of the prescription by a pharmacist prevents most prescribing errors from ever reaching a patient, including incorrect medicine, strength or quantity for indication, and potential therapeutic duplication and/or interaction with other medications the patient may be taking.
- Dispensing errors, defined as a discrepancy between what was correctly prescribed and what was given to the patient, occur with varying degrees of seriousness.
- In a recent study evaluating 4,481 prescriptions filled in 50 community pharmacies (chain, independent or health-system affiliated) in six major U.S. cities, 77 errors were noted. Only 13 of the 50 pharmacies had 100% accuracy for prescriptions filled during the observation period. Of the errors observed, 6.5% were judged clinically important. The most frequent type of error was wrong label instructions, but there were also errors in the categories of wrong quantity, wrong strength, wrong drug, and omission of information deemed important. Most errors occurred in pharmacies without robotics or other technologies designed to minimize errors, and the majority of errors were associated with new, rather than refill, prescriptions.
- Based on the total number of prescriptions filled per year, the authors estimate as many as 51 million medication dispensing errors occur annually, and 3.3 million of these may be serious. Per year, an individual patient has a one in 30 chance of being exposed to a dispensing error and a one in 1,000 chance that error could be serious.
Several studies performed more recently confirm these findings.
Advice for patients
There are many reasons these errors occur, including look-alike and sound-alike medication names, use of error prone abbreviations, illegible handwriting, poor physical pharmacy environment, reliance on technical support staff, inadequate pharmacist staffing, distracting work conditions, and prescription volume and fatigue, just to name a few. But patients are rarely encouraged to, first, understand the contents of their prescription before leaving the doctor’s office and, second, verify their prescription before leaving the pharmacy.
One way to prevent prescribing errors is for a medical practice to utilize electronic medical record software that includes a module designed to electronically transmit prescriptions to a pharmacy and provides a printed record that can be handed to the patient for verification purposes at the time of prescription pick up. This limits the possibility of prescribing errors due to the menu-driven nature of most software packages and eliminates the potential for errors related to transcription or illegible handwriting.
Prior to leaving the doctor’s office with a new prescription, patients should be told:
- What the name of the medication is.
- Why it is being prescribed.
- What the dose is and how often it should be taken.
- What the common adverse effects are.
- What the important drug and/or food interactions are.
When picking up a prescription, patients should ask these same questions of the pharmacist in order to confirm that the patient is receiving the intended medication at the intended dose. Patients should pop the lid of prescription bottle before leaving the pharmacy, which provides the patient and the pharmacist an opportunity to do a final visual check of the contents and opens up the opportunity for dialogue. If it is a refill prescription and the contents look different than the last time the prescription was filled, patients should inquire as to why.
Rhonda Cooper-DeHoff, PharmD, MS, FAHA, is Assistant Director of Clinical Programs and Research Assistant Professor in the Division of Cardiology at University of Florida College of Medicine, Gainesville.
For more information:
- Flynn EA, Barker KN, Carnahan BJ. National observational study of prescription dispensing accuracy and safety in 50 pharmacies. J Am Pharm Assoc (Wash). 2003;43:191-200.
- Kohn LT, Corrigan JM, Donaldson MS. To err is human: Building a safer health system. Washington. National Academy Press. 1999;1-223.
- Knudsen P, Herborg H, Mortensen AR, et al. Preventing medication errors in community pharmacy: frequency and seriousness of medication errors. Qual Saf Health Care. 2007;16:291-296.
- Knudsen P, Herborg H, Mortensen AR, et al. Preventing medication errors in community pharmacy: root-cause analysis of transcription errors. Qual Saf Health Care. 2007;16:285-290.
- Szeinbach S, Seoane-Vazquez E, Parekh A, Herderick M. Dispensing errors in community pharmacy: Perceived influence of sociotechnical factors. Int J Qual Health Care. 2007;19:203-209.