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Jewish World Review April 20, 2001 / 27 Nissan, 5761

Bernard Starr

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Consumer Reports

Frightening rise in prescription errors -- PUBLIC confidence in our healthcare system was rocked two years ago by the Institute of Medicine's startling report that medical errors in hospitals result in 44,000, and possibly as many as 98,000, deaths each year. That makes medical error a bigger killer than motor vehicle accidents, breast cancer or AIDS. Recent data on prescription drug errors warn that your community pharmacy can also be hazardous to your health. Prescription errors are leading causes of hospital admissions and result in more than seven thousand deaths each year.

Heddi Fischer, a retired pharmacist, was suspicious of the unfamiliar tablet when she picked up her prescription for the hormone Premarin. The pharmacist mistakenly gave her Procardia, a heart medication. A knowledgeable consumer caught this dangerous error. But what about the rest of us who count on our doctors and pharmacists to care for our health, not harm it?

According to Michael Cohen, President of the Institute for Safe Medication Practices, studies of prescriptions that have been filled but not yet picked up show 2 to 3 percent errors. That adds up to millions of errors for the three billion prescriptions filled annually. And these figures do not include errors by physicians at the prescribing end.

Leading causes of prescription error are pharmacist overwork and fatigue, distraction, illegible handwritten prescriptions, errors in telephone transmissions, use of untrained pharmacy technicians, skimping on consultation, and lack of complete patient data.

At one time, 50 to 70 prescriptions a day was high volume for a pharmacist. Now, pharmacists in big chain stores may fill as many as 200 prescriptions a day and the store as many as 2000. Michael Cohen cautions that errors mount after 120 prescriptions. Adding to the pressure cooker environment of prescription overload, an Arthur Anderson study found that 20 percent of the pharmacist's time is diverted to administrative work with third party insurers. That doesn't leave adequate time for consultation with patients about dosage, side effects, allergies, drug interactions and the total medical picture.

Technology exists for physicians to electronically transmit patient information to pharmacy computers where sophisticated software can analyze data and raise red flags. But who will pay for the equipment and time? And thorny privacy issues will stall implementation of a national database.

The notoriously sloppy handwriting of physicians accounts for as much as 25 percent of prescription errors. Yet these errors can be virtually eliminated with new technologies like prescription writers. The American Pharmaceutical Association has proposed an end to handwritten prescriptions by 2005. Is that soon enough?

Back at the pharmacy, the person in the white coat may not be a licensed pharmacist but a technician with little or no training. The Pharmacy Technician Certification Board offers a certification exam. Still, only four states require certification. Pharmacists are supposed to supervise technicians, but how can supervision be guaranteed or enforced? Since training is the best assurance of quality, Carmen Catizone, Executive Director of the National Association of Boards of Pharmacy favors mandatory certification of all pharmacy technicians.

Beware! Picking up your prescription is another danger point. Filled prescriptions are typically placed in a pickup bin, then given to you by a sales clerk. Even silly mistakes can happen. Recently, a clerk gave my wife the wrong prescription-same last name on the envelope.

If you don't want to be a casualty of prescription error, here's what you can do to take charge.

- Use one pharmacy for all your prescriptions.

- Provide the pharmacy with information about your medical history and conditions including allergies and any previous adverse reactions to medications

- Team up with your pharmacy computer; make sure all your medications are entered. Include both prescription and over-the-counter products

- When your physician gives you a prescription make sure you know the name of the drug and the dosage. If it is not legible ask the doctor to print clearly.

- Make a copy of your prescription so you can review it with the pharmacist against what is dispensed.

- Insist on speaking to a pharmacist when you pick up a prescription - it's your right. Get confirmation that the filled prescription is for your medical condition.

- Save the last pill or capsule. Match it with the refill. If it looks different ask why. It could be the same drug in a generic form-but don't assume that.

Finally, many pharmacies offer caring professional services and compassionate consultation. Pharmacists are trained consultants and educators. It's only the system that keeps them from their mission. Help yourself -and the pharmacist-by demanding quality care.

Bernard Starr, Ph.D teaches psychology at Marymount Manhattan College and is host of "The Longevity Report" on WEVD-AM Radio in NYC. Comment by clicking here.


© 2001, SHNS