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February 9th, 2011
06:57 PM ET
Empowered Patient: How to avoid errors at the pharmacyWhen you pick up your prescriptions, how closely do you look at the label? What happened to a Colorado woman may make you take a second look. Mareena Silva of Fort Lupton is six weeks pregnant, and last week went to a local grocery store to pick up an antibiotic her doctor prescribed.
According to a story by CNN affiliate KMGH in Denver, Silva says instead of giving her antibiotics, the pharmacist accidentally gave her methotrexate, a cancer drug that's also used to induce early abortions. Now Silva says she's worried she'll lose her baby.
About 3 billion prescriptions are filled at neighborhood pharmacies each year and according to the National Patient Safety Foundation, some 30 million of those prescriptions will be dispensed improperly. So what can an Empowered Patient do to protect themselves? Here are my top three tips.
For more advice, read my Empowered Patient column on how to avoid pharmacy errors.
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  About this blog
Get a behind-the-scenes look at the latest stories from CNN Chief Medical Correspondent, Dr. Sanjay Gupta, Senior Medical Correspondent Elizabeth Cohen and the CNN Medical Unit producers. They'll share news and views on health and medical trends - info that will help you take better care of yourself and the people you love. Recent Comments
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Some good points here, similar to what I blogged on this topic yesterday: http://themedicineguy.com/post/3190446239/medication-errors
Don't forget to check the birthdate and/or address on the label as well. I've seen mistakes made due to very similar or even same names. This was likely the main reason for the mistake mentioned in this blog.
Aaron Emmel PharmD, BCNSP
I took my 2 scrips in for refill. One was right..........but my synthroid when I opened it was different. I called the pharm and they said to bring it back. I did and someone had filled a generic with a synthroid label. I cannot take generic.....but they were c harging me for regular. WHAT THE HECK IS GOING ON..........YOU CAN'T TRUST YOUR PHARM TECH!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! NOT HAPPY!!!!!!!!!!!!!!
@Barb, The pharm techs have minimal training and barely make more than minimum wage. While some are great others may not be all that educated.
Barb: No mistake is justified, but I can guarantee that receiving the generic instead of brand wouldn't have killed you. MAYBE your levels would fluctuate, but it's not the end of the world. People make mistakes. I agree that everyone should be held accountable for their actions, but I think you're failing to see the employees as people. Humans. I really hope that someone berates you for your next mistake. Oh, wait! You don't ever make mistakes, do you?
always talk to the pharmists when you pick something up many times people walk away and never ask any questions and then have questions this will also stop many mistakes
Bottom line is that we are all ultimately responsible for checking our own medication. That means asking the doctor exactly what he is giving us, what it's supposed to do, and double-checking the prescription the pharmacist gives us wth a reputable online source like mayoclinic.com. I was once prescribed something for pain and the pharmacy ended up giving me heart medicine instead. I caught it because I double-checked before taking a single pill.
Dear Elizabeth,
This is pertaining to your program this morning Feb. 28, 2011 about children having fevers. You said that it is not necessary to bring down fevers in children and that they are the natural response of the body to the fever. I trust you have never seen a child with a high fever convulsing. The results of these convulsions from high fevers can result in brain damage of the child. Many parents don't understand that they must bring down a child's fever to prevent convulsions. I hope many parents did not get the wrong message this morning.
I did come into your program after you began talking about fevers so it could be that I missed your advice to mothers about high fevers.
Donna YatesAdelman
Sometimes medicines are dispensed by pharmacy techs. Colorado does not certify , register or license pharmacy techs. The person handing you the pills may not know.
No tech is "dispensing" anything in the US; at least not legally. The person handling your pills is your pharmacist and they are ultimately responsible for their mistakes. That's not to suggest that inattentive patients are doing themselves any favors for not actively participating in their health care either.
MO Pharm,
The Pharmacist is not going to hand every patient their prescription. The technicians like myself are one's who check out the patient. Also, pharmacy tech's do fill the medications and use verification systems in order to identify proper NDC codes for patients prescriptions. Then the Pharmacist checks to make sure the medication that the pharmacy tech filled is correct. The mistakes that happen are because, yes there are lazy Pharmacy tech's out there who assume that when they grab a bottle of pills that need to be filled that they are grabbing the right ones while at the same time not scanning the bottle to check the NDC. The majority of pharmacy tech's do a good job, and to be honest I have no idea how the tech who filled this thought that Amoxicillin and Methotrexate look at all the same. Amoxicillin depending on the strength, but usually 500mg is a lot large capsule form, where as methotrexate is a small white pill.
Please realize that, by far, most medication errors are PRESCRIBING errors, mistakes made by the physician, or other prescriber, most of which are corrected by the pharmacist before ever reaching the patient.
Amen. Years ago, a doctor told me not to take certain medications because I'd had a bad reaction to something in that family. Nonetheless, two specialists since then have prescribed things in that family, insisting that just because I reacted to A does not mean I'll react badly to B, "it'll be fine". Each time, the pharmacist refused to fill the prescription, because of the possibility that if you react badly to A, B might kill you. Thanks to pharmacists for saving my life!
PREGO + TEENAGER = IDIOT - Who was watching this teen all her life. OK, chances are most people wouldn't know an aspirin from methotrexate, but to not even read the bottle and realize the Rx did not have HER NAME on the bottle puts 75% of the blame on her shoulders. 25% goes to the pharmacy and not the pharmacist- the person who picked the wrong Rx and actually dispensed – have you ever taken a good look at the people who pharmacies have performing that function, high school kids, Sr. citizens with coke bottle glasses? Give me a break – This girl started making mistakes when she got pregnant and I would bet that her track record is much longer than that. I have empathy, but no sympathy – She should take more – There was a divine intervention happening here and abortion to prevent more stupid people from populating the earth. I guess she wouldn't want me on the jury.
Agreed, 'woman' may lose her baby'? I wonder who will teach the baby to read.
That's a pretty hateful opinion, don't you think?
Don't forget that all meds are stamped with identifying information. You can look these identifiers up on Google and verify what they actually are.
Yes, you're right. Also, every medication is accompanied by a patient inormation sheet..patient's name, dr's. name, name of medication, purpose, side effects, etc. The lady was remiss in not taking the simple steps of reading the information.
Every new prescription should be reviewed by the pharmacist, WITH the patient. "Hello, have you taken this medication before? Why was it prescribed to you? Do you understand what it does? These are the risks and side-effects. If you have ____ conditions, you shouldn't take it." You know... BASIC precautions. Because yes, some people are too dumb to read the labels on their prescriptions.
Dont forget – most likely your pharmacist is working a 14 hour day without a lunch or a break.
Those that say the 'pharmacist" should give every prescription to the patient is the same individuals honking their horns in the drive-thru and get upset if there are three people inline ahead of them for pick-up. The pharm tech made a big mistake that should not have happened, nevertheless, it did...I hope that the baby and mother are ok. We need to think about the importance of the medicine and getting it right rather than how long something takes..."how much time is your life worth"
Try doing any of that at Rite-Aid! Number 1 – you're lucky if they actually have the medicine to fill your prescription. #2 You're lucky if they have filled it, no matter how much advance notice you gave them. # 3 You're lucky if they don't try blaming their not filling it on your insurance company or your doctor or even you. #4 – if you insist on the pharmacist coming over to look at it to verify it, count on waiting at least another 30 minutes.
Another thing you need to ask – is how to take it the medicine and how to store it. My husband received a prescription that did not say it needed to be taken with a full glass of water to prevent stomach pain, and that it needed to be kept in the refrigerator. When he started getting stomach pains, I looked it up online and told him about the water. When he didn't feel any better by the end of it, and needed to have another ten day supply, the pharmacist told him it was his fault for not keeping the bottle in the fridge. No advice, no sticker on the bottle, no written info – this was pointed out to the pharmacist who shrugged and said (I kid you not) "You didn't ask."
Yeah...because the doctors ALWAYS call in the meds when they say they do. You are just a tad bit gullible, Katie.
First off, let the record show that I,as well as many other pharm techs, am not a mere high school graduate but a holder of a bachelor's degree in Biochemistry from UCLA... and I STILL make some mistakes. Pharmacists and pharm techs are human after all!
Secondly, we will be more prone to errors at big retail pharmacies where corporate decides to cut staff and hours all the time, but still expect you to process thousands of prescriptions per week.
Bottom line? Expect to double check your scripts or switch to a private (LESS BUSY) pharmacy. Nobody's perfect, and we are all less perfect when we have less time to double check things.
Well said!
Very well said. It is easier to pass judgment when and conjure stereotypes about pharm techs when patients or people have never worked in a retail Pharmacy.
Biiiiiiggggg lawsuit!
Noooooot likely. She didn't read the bottle – the medication wasn't prescribed to her. The Doctor did not prescribe her the wrong med. The Pharm Tech did not enter of filll the perscription incorrectly. The RPh did not screw up in checking the prescription. IT WAS SOMEONE ELSE'S PRESCRIPTION. If the Pharm Tech asked her name and it sounded similar to her name, she is ultimately responsible for checking that the script she was given was in fact hers! Bottom Line! (Although, at most pharmacies, the Pharm Tech who hands your the script usually asks for another identifier, like your address, for this very reason). This is the reason why you should always ask to speak to the RPH when you receive a new med.
The pharmacy messed up my mother's prescription once. The error was a misplaced decimal point. But I always check out the meds in the parking lot before I leave and noticed these large orange pills instead of very small orange pills. Had she taken one of the large pills it would not have been pretty. Went back into the pharmacy and it was fixed.
Responsibility is ultimately that of the one TAKING the medication. The tech giving her the prescription even warned her that it was not good for pregnant women, but she said thats what the hospital prescribed, so "it must be okay" and that she "figured he was talking about the antibiotic". Honestly, if its new, READ THE INFORMATION. I have yet to ever get a prescription anywhere that doesnt include a few pages on possible interactions, side effects, what its intended for, how to use it, etc. And if it isn't EXACTLY your name, point that out, don't just ASSUME that they made a mistake. 80% of the blame rests on the 19 year old girls shoulders, in my opinion. I really doubt she would want me on the jury either...
Yes, the pharmacy is at fault for giving her the wrong prescription. However, the patient is also at fault for not being responsible enough to even read the label on the bag or the label on the bottle. As a pharmacist, I do my best to counsel patients on new medications; however, since I work in a retail chain, my job has become more and more about meeting corporate's statistics and generating revenue. I am going slightly off-topic here, but retail chains have become ONLY about making the most profit possible. This is the goal of any for-profit business, so can't blame them for that. However, in the past couple of years, staffing has been cut to the bone. I know in my chain, we have stores filling 100 to 150 rxs a day without a single technician to help out!!! Not one. Just the pharmacist. Now, this doesn't sound that bad until you factor in filling prescriptions, answering phone calls, ringing up customers both at the drive though and in the store, not to mention keeping up with corprate's statistics in trying to make sure no wait time is longer than 15 minutes. AND we need to check every prescription for possible interactions and have that prescription filled correctly EVERY time. Not one pharmacist out there wants to make a mistake. Not one pharmacist wants to sell the incorrect medication to anyone. The current situtaion in retail pharmacies today is truly becoming unsafe for all patients! Now that the pharmacist shortage is over, chains are squeezing the life out of us with little regard to patient safety! Most of us don't mind working hard on a daily basis, but it does no one any good to have a pharmacist working 8, 10, or 12 hour shifts with little to no technician help (depending on how busy the store is); no lunch and no bathroom breaks. I barely have time to down a bottled water in my 8-hour shift.
So, yes it is very true physicians, pharmacists, and patients have to take on the responsibility of ensuring that each patient gets the correct medication. Physicians need to prescribe correctly, pharmacists need to fill the prescription correctly and counsel patients; and patients need to be responsible for being proactive in their own health care. Corporate needs to get a grip and become a little less greedy . . . . STOP pressuring physicians to see 100 patients a day; STOP forcing pharmacies to become assembly lines; and STOP rewarding top executives with million dollar bonuses for increasing profit by cutting staffing budgets. Patient safety is at risk every day in every health care setting mostly because there is never enough profit for the guys at the top!
I am a retired hospital pharmacist. I worked in a large hospital where I got a full lunch hour and two fifteen minute breaks. I thought these retail pharmacy conditions that you mentioned were mostly history? I guess that is why I never worked for over several months in a chain pharmacy. I would not restrict myself to not going to the bathroom or working so fast that I could not take time to double check each Rx. The chains prefer speed to accuracy until you get caught making a mistake!
Say what you will about WalMart but they close the pharmacy for an hour lunch when there is only one Pharmacist on duty. Also they started the $4 a month Rx. We both know a month's supply for a old generic drug can be very cheap.
just wanted to applaud your response....
My husband is a RPh for one of these huge corporations. In his district alone they had to cut the RPh hours by 190 hours a week recently. Why?? To make more profit, open more stores and look good for the share holders. His store fills thousands of scripts a week with only THREE pharmacists, and my husbands hours were cut to only 30 per week. ALL of the scripts (other than those that need to be mixed by hand) are taken, entered and filled by Pharmacy Techs (which in my state are like glorified cashiers who are paid barely above minimum wage). Some of them are very bright, but many are not. Some are just flat out terrible. My husband works 8-12 hour shifts, with no breaks, the majority of the time as the only RPh on duty (meaning he has to double check EVERY script that is filled). He is AMAZING at what he does and his breadth of knowledge astounds me every day. That being said, he does make mistakes and believe me when I say that he takes every single one of them to heart and agonizes over them. HIs most recent mistake was actually giving the wrong med to a pregnant woman, who thankfully discovered the mistake UPON CHECKING THE LABEL and realizing that was not the med she was prescribed. Thank god for this! Everyone makes mistakes and we must take responsibility for our own health and bodies. NEVER rely on someone else when they are handing you a med.
The pharmacy conditions are the exact same. I work for a very large retail pharmacy chain and the hours are being cut and breaks especially lunches are non-existent. At the pharmacy that I work at, one person has to go and and get lunch for everyone and then take turns eating when they get back so that we can have all the prescriptions done in time, this is due to hours being cut.
Pumbaa: the retail setting has only become worse...definitely NOT better. Go ask your local CVS or Walgreens pharmacist. While they are still responsible for EVERYTHING that goes on, it is difficult to choose between keeping your job and spending 5 minutes with EACH patient. In the end, that's what it comes down to...
Always request the pharmacist to verify the prescription. In particular ask the pharmacist if the dosage is appropriate for the age and weight of the patient. If you have to weight a few minutes extra then wait especially if you are buying on behalf of a child or elderly who is relying on you.
Rule #1 – you have to be your own advocate. Know what you're being prescribed and why, then talk to the Pharmacist about what you're getting and why. Get to know what the pills look like, ask questions, etc.
A few years back I was hospitalized for a long time. Things got kind of routine, and for a while I just took what was handed to me. Until one night when an unfamiliar RN gave me my evening pills – they looked different and when I asked was told one was for my heart and another to help me urinate. I was on a heart med, so just thought the pills were new. Then about half an hour later it became very clear that I hadn't gotten my pain meds. Intense throbs of pain tend to get your attention – so i went to the nurses station, the shift had changed – and was told that yes I had gotten my meds: " The records say so." When I made it clear that I hadn't gotten any pain pills, they looked around and found my entire evening's dosage sitting on the med cabinet.
I had gotten someone else's pills. Thankfully there were no bad side effects and they could give me what I needed. Oh, and that Flomax stuff does work. Well.
The point of all of this is to be your own advocate – know what you're getting and why. Doctors, Nurses and pharmacists are all peopl, and people make mistakes.
I just hope that Safeway doesnt cave in. They should fight this patient looking for a lottery payout . It is interesting that she contacted a lawyer so quickly even prior to having any damages verified or even losing the pregnancy Patients have to take responsibility for their own medications. I bet this patient would double and triple check an expiration date on packaged hamburger . Methotrexate is not an abortion drug nor is it approved for it. Per the news report she only took 1 or 2 pills. That is a very small dose and probably wont cause an issue. Per the news report she is still pregnant. Something would have happened by now if it was going to. Litigation like this just drives up costs for everyone.
Pharmacy technicians usually fill prescriptions, but state laws require pharmacists to check all medications before being dispensed to the patient. Pharmacists are the people in the pharmacy who are legally responsible for all dosing, interaction, and verification of prescriptions. It is a collaborative effort. More and more states now are requiring technicians to be certified and/or have formal training. This certification is something more states should require and citizens should encourage. At most retail pharmacies starting salary for a pharmacy technician is $8-$9/hour. Comparitively most Panara Bread Company's start out at $9-$10/hour. As a society we are saying we value the people that make bread more than we value the people that monitor and dispense medications.
READ THE F@#$% LABLE. ......... Really Pay Attention, its like drving with yuour eyes closed, not very smart. The Pharmacy is part to blame yes. BUT if you dont read THE LABE it's just as much your fault as theres. . No sympathy. Shes like 17 years old anyways , you dont need a baby when you that young. GO OUT HAVE FUN. Stupid kids
This is also obviated by the fact that people are more willing to spend more than $4 on lunch at Panera than they are on meds. Thanks, Wal-Mart!
Another great tip for everyone... Don't rush the pharmacy staff. I work at a pharmacy, and everyone there is trained on how to avoid mistakes. Although, they do happen for all types of reasons unfortunately. There is alot more to filling prescriptions than most people realize. The staff feels rushed when a guest is complaining about how long they are waiting. There are times that there are 20 and more prescriptions to be filled. This is especially true during cold and flu season. There are billing issues that occur frequently when dealing with insurance companies. Sometimes the doctor's handwriting is so horrible that we have no choice but to call their office and then have to wait for clarification. There are also times that it is the guest's fault because when we ask about a change in insurance they respond that there isn't, only for us to find while filling it that they have been sent a new card. Then we have to wait for the new card, delete the prescription and refill it with the new insurance information. The bottom line, if you didn't know what goes into filling a prescription you do now, so please don't be impatient. We really do try our best to fill prescriptions properly and safely. When people don't feel rushed less mistakes are likely to result.
We had a similar experience about a year ago. My husband had a prescription that the local pharmacy had filled for him multiple times. The last time they filled it, it was for a totally different drug that could have killed my husband had he just popped his meds as most people do without question. We contacted the pharmacy right away, took back the meds, and contacted the Corporate office. Along with being properly sorry and wanting to make sure this doesn't happen again, we were told that that company was having difficulty getting American pharmacists. They had to rely on foreigners to come here and fill the vacancies. We had noticed that shortly after this incident, the foreign pharmacist was no longer working at that store. In fact, whenever we go into one of the companies stores wherever we are, there are no foreign pharmacists.
I have a very common name, and there are at least 4 of "me" in my mid-sized town. I was once given a prescription for another person with the same name, and I realized immediately that it wasn't for me (incorrect doctor on the prescription label). Fortunately, no harm no foul. However, I see at least one doc in town who also has another patient with the same name! Fortunately our pharmacy now confirms the patients' street address and the docs now use birthdates as an additional identifier. I've learned to be very cautious about my medical records and prescriptions. I always confirm that I am the patient for whom the prescription was written and that lab results are in fact mine, and not those of one of my namesakes.