It may not be the last. There are no good statistics on pharmacy errors; no state requires routine reporting of these mistakes. But the number of prescriptions dispensed has risen rapidly, from 2 billion in 1992 to 3 billion last year. By 2004, the National Association of Chain Drug Stores predicts, the total will top 4 billion. Even if the error rate simply holds steady at 3 to 5 percent, that translates into more individual mistakes–from trivial slip-ups like typos on a label to potentially serious problems like wrong drugs or wrong doses.
Meanwhile, the ranks of druggists have grown by only 5 percent since 1992. Drugstores insist that rising workloads have not affected error rates, but pharmacists themselves tell a different story. In a 1997 study by the Massachusetts Board of Registration in Pharmacy, pharmacists said that work overloads had contributed to 59 percent of mistakes. “It used to be that if a pharmacist filled 200 prescriptions in a day, that was outrageous,” says John Kostovich, president of the National Pharmacists Association. “Now that’s considered a slow day.” In addition, managed care has imposed new burdens. Where pharmacists used to spend their day filling prescriptions, they now devote more time to dealing with insurance companies, trying to determine if this or that drug is covered, whether dependents are eligible, whether one drug can be substituted for another.
As if this isn’t cause enough for concern, the potential for drug mix-ups is also greater than ever. There are thousands of prescription medications today, many of them with names that either look or sound similar. When doctors phone in prescriptions, names like Covera (a drug for hypertension) and Provera (for hormone-replacement therapy) are easily confused. Part of the problem is that marketing departments at pharmaceutical companies love power sounds like k’s and memorable letters like “z” and “x.” That’s why we have Zantac, Zyban, Zofran, Zoloft, Zyflo, Zyrtec and Zocor, to name a few.
Fortunately, help is on the way. Some doctors are starting to print out prescriptions on computerized forms. Others are turning to handheld devices that let doctors click on a specific drug, check recommended doses and interactions within seconds, then transmit the prescription electronically to the pharmacy. New bar-coding systems in some places are providing an additional level of safety. Before completing the prescription, the pharmacist can scan the bar code on the bottle to make sure the drug name and dosage that pop up on his computer screen match the intended prescription.
Still, says Arthur Levin, director of the Center for Medical Consumers in New York City, “patients are their own best defense.” Here are three steps you can take to help avoid mix-ups:
At your doctor’s office, ask the name of the drug, the dosage and any instructions on how to take the medication. Write the answers down. Also, ask the doctor to jot the purpose of the drug on the prescription. A pharmacist is less likely to confuse Celebrex for Cerebyx if he knows your problem is arthritis rather than seizures.
At the pharmacy, open the bag to see if you’ve got the right drugs. “More people check their photos at the photo counter than check their prescriptions at the pharmacy counter,” says Tony Grasha, a University of Cincinnati psychologist who’s spent years researching pharmacy errors. “If it’s a refill, you can see immediately if the pills are the right size and color.” If you’re taking multiple medications, Grasha recommends carrying a sample of each one in a small pillbox for reference. It’s important to double-check the dosage, too. If the doctor wrote “20 mg,” make sure the tablets are really 20 milligrams.
Ask the pharmacist if there’s anything you need to know about the drug. “The answer is not necessarily for you,” says Grasha. “It’s to give the pharmacist another look at what you just got.” Pharmacists report that they pick up 30 to 40 percent of dispensing errors when the customers ask questions.
As the American population ages and managed care substitutes more drugs for hospital care, the need for vigilance will only increase. That’s why it’s smart to learn good pharmacy habits now. A dose of prevention could save a life.
