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Communication is vital to avoiding prescribing errors
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Recently, a 35-year-old contact lens wearer came to my office with a 3-day history of red, irritated and itching eyes. She denied any symptoms of ocular infection or recent upper respiratory infection and listed sulfacetamide as her only known allergy. My examination revealed a pair of old, worn soft contact lenses and an inflammatory keratoconjunctivitis.
I instructed her to discontinue contact lens wear, prescribed Alrex (loteprednol etabonate 0.2%, Bausch & Lomb) ophthalmic suspension ou qid x 5 days and told her to return as soon as possible if symptoms persisted or intensified. A bright and articulate individual, she returned in 3 days stating that her symptoms had worsened. In reviewing the history, I asked if she had her eye drops. She promptly handed me the bottle ... of Azopt (brinzolamide ophthalmic suspension 1%, Alcon). Ouch.
Unfortunately, errors such as these are not unheard of in eye care practice. Is it possible that my handwriting was so illegible that the pharmacist interpreted the Alrex prescription as Azopt? What about the pharmacist? Shouldn’t he or she have discussed with the patient the fact that Azopt is a glaucoma medication and that qid dosing was inappropriate for this particular drug? Finally, what about our patient? As a well-educated professional, wouldn’t she have looked at the package insert with its glaucoma labeling and potential for cross sensitization with sulfa allergy? With so many potential “safety” checks in place, it’s difficult to conceive that this scenario could have even occurred.
All providers must be vigilant
This case does underscore how important it is for all health care providers to be vigilant in monitoring prescription drug use. As optometrists, we are very much on the front line in helping patients understand the ramifications of their medications.
Certainly, with every patient encounter, we validate the efficacy of systemic medications, detect related ocular side effects and sort out adverse drug interactions. In fact, we can often take a more “global” view of our patients’ prescription drug use and are in an ideal position for identifying polypharmacy mishaps. As such, we are also in an ideal position to effect change by communicating with both patients and their physicians.
So, what about our patient? Once I explained exactly what had transpired, she readily acknowledged how this sort of thing could have occurred. I telephoned the pharmacist, Alrex was dispensed and the patient’s condition markedly improved within 48 hours.
While our patient did just fine, this particular encounter reminded me of a few things. First, there is often a fine line between therapeutic triumph and disaster. And second, communication can be as important as the medication itself.