This blog was about the small, daily medical errors that doctors and pharmacists make writing and filling prescriptions. But the topic has been hijacked by The New York Times’ investigative report about the understaffing and unreasonable pressure chain-store pharmacists are under to increase the amount of drugs sold.
In an effort to increase profit, the NYT claims that chain-store pharmacies have too few pharmacists filling too many prescriptions too quickly. And, worse, the pharmacists are “forced” to push patients to agree to auto refills that are medically unecessary and not directed by doctors, in order to reach goals set by management.
“‘Medication’ and ‘corporate performance metrics’ should never be in the same sentence,” tweeted @forsakebook on the New York Times comment chain in response to the story.
Why do we allow pharmaceutical companies, pharmacies and hospitals to be run for profit? Isn’t using profit as a primary measurement contrary to the ethical requirements of practicing medicine?
We all benefit from physical and mental health and from the health of others. But the options are limited and expensive. Scarcity creates demand which in turn commands a higher price. As a firm believer in capitalism, I draw the line here. Healthcare must be managed, supported if necessary, and available to all.
Back to my original blog — until the day that doctors and pharmacists are no longer under unreasonable time pressures and corporate goals, you must take steps to protect yourself and your family from the mistakes that humans make under pressure.
The Institute for Safe Medication Practices (ISMP) is a nonprofit organization devoted entirely to preventing medication errors. ISMP published a list of the top 10 most common medical errors that doctors make. The list is to warn doctors and some don’t apply to patients.
The first five of the ten common mistakes are ones that you, the patient or the care giver, can spot and correct, preventing harm to you and your family. MedShadow is sharing the most common medical errors so that you can be on the alert.
Here are the five common medical errors that doctors make and that you can correct:
1. Selecting the wrong medication after entering the first few letters of the drug name {on the on-line prescribing forms/electronic health records}. Entering just the first few letter characters of a drug name or combination of the first few letters and product strength can allow the presentation of similar-looking drug names on technology screens, leading to selection errors.
What can you do? Listen carefully and write down the name of the drug when the doctor discusses it with you. When you pick it up at the pharmacy, check the label to make sure it’s what the doctor ordered.
2. Daily instead of weekly oral methotrexate for non-oncologic {non-cancer} conditions. An ISMP QuarterWatch® report analysis of methotrexate administration errors over 18 months between 2018 and 2019 found that approximately half were made by older patients who became confused about frequency, and half by healthcare providers who inadvertently prescribed, labeled, and/or dispensed methotrexate daily when weekly was intended.
What can you do? About half of the errors were mistakes on the prescription instructions, but half were patient errors. First, listen to your doctor’s instructions. Double check with the pharmacist. Read the label and be careful.
3. Errors and hazards due to look-alike labeling of manufacturers’ products. Highly stylized graphics and prominent corporate names and logos that may overshadow essential information, along with similar label and cap colors, can make different products look alike and lead to mix-ups.
What can you do? When you pick up the prescription at the pharmacy, check the label to make sure it’s what the doctor ordered. Confirm with the pharmacist what the drug is for and how to use it. If it’s a refill, look at the pill and packaging. Are they familiar? If not, stop and ask the pharmacist if you have the right pills (or patch or liquid) before you take them.
4. Misheard drug orders or recommendations during verbal/telephone communication. Even in an era of electronic health records, certain situations still require verbal or telephone orders for medications, such as prescribing a drug during an emergency or sterile procedure, or oral communication of consultant drug therapy recommendations. Those oral communications can be misunderstood and result in errors if not verified.
What can you do? This happens most often in an emergency. However, when you are in the hospital or the emergency department always try to bring a family member or friend to help you remember and understand what is going on. After all, you’re having an emergency and might not be able to advocate for yourself. You, or your family member, should stop the nurse or PA before you are given the drug to ask what it is for. If the drug is for a condition or complaint that you don’t have, you might have spotted an error. Also, it’s a good time to make sure the person giving you the drug knows all the medicines you are taking (and supplements!) and ask about drug interaction.
5. Unsafe “overrides” with automated dispensing cabinets (ADCs). ISMP continues to receive reports of unsafe practices associated with ADCs that have jeopardized patients. Now that ADC use is widespread, healthcare organizations should review safe use and identify vulnerabilities; ISMP’s ADC guidelines outline standard best practices and processes.
What can you do? Again, this is an in-hospital procedure, but asking what a drug is, how often you will get it and what it does is your best way of avoiding errors.
Don’t refill a prescription because your pharmacist suggests it. Taking medicine for longer than you need to leads to side effects, developing a resistance to the drug so that it won’t work next time and dependency or addiction.
Always remember, your doctor is your consultant. You have to live with the outcome of the healthcare decisions that are made. Protect yourself — participate and ask questions.
