I don’t want to sound like a corporate shill, but I have to point out that the error rates at my company’s automated filling pharmacies for our mail-order prescription business aren’t measured in ‘percents’. They’re measured in ‘per millions’. And it’s still a smaller number than what’s reported here for retail pharmacies.
I recommend to anyone on long-term medications for chronic conditions to at least check into available mail-order plans for potential cost savings, improved convenience, and accuracy. And I won’t mention my company’s name so that this doesn’t come across as an advertisement.
I also work in the pharmacy industry. The horror stories you hear about medication errors are just awful. Even the minor ones upset me – there just isn’t room for error.
Electronic prescriptions do reduce problems with legibility, although anytime a prescription is presented that is illegible or even questionable, a pharmacist or pharmacy technician is supposed to call the prescribing physician for clarification.
Some of those medication errors are patient-induced though. Patients frequently don’t take the medication as prescribed, or mix the meds with something they shouldn’t. Many patients fail to report the herbal supplements (including some teas) they are taking, which can have harmful interactions with medication.
Cecil, tell Una that if her pharmacy screws up her prescriptions that often, she should report it to the State Board of Pharmacy shortly after she takes her business elsewhere. There’s a pharmacy on every damn corner; no reason to put up with shoddy – and potentially lethal – service.
I have to share a funny story in a not so funny topic. A friend of mine worked in a pharmacy back when we were in high school. One of the pharmacists got labels mixed up on a husband & wife’s prescriptions. They found out when the husband called to complain that he could not swallow the medication & his wife found her medication unpleasant. Since he had been prescribed a liquid cough syrup, they asked him for details. The medication he described as being too big to swallow was a vaginal suppository.
My wife often got an extra pill or two in her Celebrex prescription (and presumably that would count as an error, even though there’s no harm to the patient.) She got a second prescription at the same time, but it was always the Celebrex that was wrong. She figured it was the way the pill looked that made it hard to count correctly.
I stay with the pharmacy I’m with because their error rate was better than the other ones I was using. And it’s very convenient. Now, the errors they make for me aren’t necessarily dangerous (such as, 29-gage needles instead of 31-gage…not dangerous, just painful), but they are frustrating - especially when I tell them on the phone “make sure that you do X and Y, and not Z”, and when I go to pick it up they’ve done W.
That’s terrible, Una. I’m really sorry to hear that.
I once was given a pack of birth control pills that had expired three months earlier. I noticed once I got home and exchanged them, but I moved my prescription to a different pharmacy after that. Any place that isn’t controlling its inventory well enough to know when to return/discard expired meds shouldn’t be dispensing.
My sister is a pharmacist. For many years she has worked in hospitals, but her first job out of school was in a drugstore. She said then that the handwriting of the doctors she saw on prescriptions was just as bad as she’d heard it was. But no mistakes were going to get by her, she never hesitated to call the doctor for clarification. Somtimes they got mad at her, especially older male doctors. “How dare you second guess me!!!” But my sister said no patient was going to get hurt on her watch, not if she could help it.
And as for working in hospitals, she’s still had doctor’s yell at her. But that’s mostly because she won’t drop what she’s doing and bump them to the head of the line.
Printed orders don’t allways help, as my GF’s best friend found out about 4 years ago, although briefly. The girl was admitted for radiation treatments and soon after het health began to deteriorate quicker than expected. Several months later her family found out that the techs were giving her twice the dose of radiation she was supposed to get. The 4th memorial service for her is to be held this week.
Before reading this thread I had no idea that US doctors still wrote prescriptions by hand. In the UK all prescriptions are typed into a computer by the doctor and printed out for the patient to take to the pharmacy.
I can provide a bit of anecdotal data here. As happened to many people who worked professionally with computers in the 1960s, I used all-caps print so heavily in my job that it eventually became my default way of writing. (If I am holding a nib pen, I naturally write in script, but with anything else, even if I start in script or mixed-case print, I’ll change to all-caps print as soon as I stop thinking about what I am doing.) The result? My print is nearly illegible, while my script is formal and precise (except for my signature, which is just a couple of squiggles).
The last time I turned in a script, I briefly looked at it before handing it to the pharmacist. I was on an obvious copy of the doctor’s script pad. I couldn’t believe he wrote in on that.
I handed it over, and she looked at me like a mother would look at her 14 year old son who she just caught masturbating.
“What is this?” she said, holding the scripts like they were used Kleenex.
I told her that I knew they looked fake, but just to call my doctor to verify them, because that is what I got. She told me to wait a minute.
Then the “manager” came over and again asked me what I was giving them. “My prescriptions” I said again, getting a little irritated. I again told him to call my doctor.
He said that if he called the doctor and if the doctor didn’t write these scripts then he was going to be forced to call the police, and shouldn’t I take this opportunity to leave now?
Now, I was really mad. I understand that people try to fake scripts and get drugs a lot, but I was demanding from minute one to call my doctor.
He said and I quote " Okay, it’s your funeral." Then he proceeded to call the doc and the doc said that he had run short on prescription pads so he made copies and that my scripts were legitimate. He proceeded to apologize and I told him to cram it up his ass, just give me the pills…
There are so many ways a medication error can happen in a hospital. First, the doctor might prescribe the wrong med or the wrong dosing. Or they might prescribe the right med & dose but the handwriting is so bad that it is misread by the nurse or pharmacist. The nurse could mis-transcribe the order, and so could the pharmacist. Finally, the nurse might give the wrong medication, or give it to the wrong patient. Many hospitals are trying to address these potentials for error. At my hospital, here is what we do:
1.if a doctor hands me an illegible order, I ask them to rewrite it. It is so ingrained in them now that they must write legibly, that they don’t yell like they used to.
2.The nurse checks the order for legibility and also to make sure this is a correct dose.
3. Then we fax the order to the pharmacy. If the doc has written something that is an unsafe dose or the pharmacy can’t read it, they call us.
4. Then the nurse checks on what the pharmacy did with the order in the medication computer, as they make mistakes too.
5. The nurse writes the medication order into the patient’s medication sheets, and has another nurse check on their work and co-sign that the order has been noted.
6. Finally the med can be given! And even then, we are to bring the medication record with us, very carefully identify the patient as the one the medications should go to, go over the medication(s) and doses with the patient, as we check the meds for a final time as we take them from the packaging.
And with all this, errors are sometimes still made! We track them very carefully, and have to do a long report for each mistake, and identify where we went wrong. A huge amount of the checking and rechecking belongs to the nurse. When the pharmacy puts the wrong medication in the computer or omits a medication, we spend hours calling them, re-faxing the physician order, and in my case, cursing under my breath a lot. But it is all worth it when we have few or no medication errors on my unit!
It is funny that nobody on this board asked the question as to why physicians write so that it is illegible. The reason is that physicians are busy. Most docs go to the hospital in the morning, have office hours in the afternoon, and go back to the hospital in the afternoon. Say a physician has five patients on the Med/Surg floor, one in the ICU, one in the CCU, two in the step-down unit and one on the pediatric unit. This physician has ten patients which he must look up lab values, read X-rays and CT scans, read nurse’s notes, look at vital signs, review EKGs, physically assess, dictate H&Ps, put in consults, and review medications being given on each patient, in six different units! And this is all before he/she goes into their office to see patients in their office. This doesn’t include patients in their service that present to the ER, situations which arise with their patients who are in the hospital, and a heavy patient load for the day. Physician’s are very busy. So when they write an order, whether it be in the hospital, or a script in their office for you to take to your pharmacy, they do it quickly, losing neatness in the process. The rigors of medical school have trained them to write quickly from all the note taking, and they continue this practice when they are practicing physicians, who value every second of the day. I do not agree with this at all. You are all right, patient’s lives are at stake. It would be very, VERY beneficial to take the extra three seconds and make the order/script neat. Thank you. -Andy
I would think the bigger benefit would be doctors not having to visit 10 patients on 6 floors before they go in to their practice, where they will almost assuredly have overbooked their schedule and will thus be “busy” there, too.