Pharmacology Errors

A pharmacist and pharmacy technicians have a very big responsibility to ensure the medications they provide are safe and accurate, and in most cases, they are.  Pharmacists have extensive training, and ongoing training to ensure they are providing the safest delivery of medication possible.  That being said, sometimes errors occur, regardless of the great systems we have put in place to try and prevent them.

The Filling Process
When a prescribed medication is received from a pharmacist, the work begins.  The pharmacist does not simply open a bottle of pills or liquid and dump into another bottle and place a sticker on the bottle with the patients name and dosage information.  It's actually a lot more involved than most people think.

• The prescription is received by the pharmacist.  They generally look the patients name up in their system to determine if this patient has an account with them. This is a very important step because just like a doctor in a medical practice, a pharmacist must have detailed information regarding the patients' medical conditions so that they can safely deliver the correct medication, without causing an interaction. If the patient has no standing record, the pharmacist or a tech must speak with the patient and obtain information, including medications and medical conditions.
• Next the pharmacist will check the prescribed medication and ensure there is no reaction likely to occur between the medicine and the patient’s current medications.  If there is a potential issue with medication interaction, the pharmacist will either alert the physician's office or the patient.  Based on information provided by the patient on their medical conditions, the pharmacist will also verify that there are no medical conditions that could create a problem with the newly prescribed.  For instance, if the patient has a history of high blood pressure, and yet has been prescribed a medication that is known to increase blood pressure, it needs to be noted that this is not a safe combination.  

• If everything is verified, and deemed to be safe and accurate, the pharmacist then starts the process of filling the prescription.  In some cases, the pharmacist may pull the bottle from a shelf and instruct a technician to count the pills and place in the new bottle.  This process is closely monitored by the pharmacist, and only a trained pharmacy technician would be allowed to perform this procedure.  

• A label is then placed on the bottle or box.  The label contains vital information, including the patient's name, sometimes date of birth, and usually any known allergies.  Once this is done the pharmacist checks the name against the prescribed drug again, and the medication is then ready for the patient to pick up.  Most pharmacies require a consultation between the pharmacist and the person prescribed the medication, or the person picking up the medication.  They will ask if the patient has taken this particular medication before, and then they will ask if there are questions or concerns.  

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It is a detailed process just to fill one prescription, so imagine doing many during a day.  Regardless of how careful someone is, human error can occur along the way.
Common Mistakes

• The most common mistake with prescription medications is incorrect dosage or frequency.  This area has been greatly improved over the last 10 years since, many prescriptions are sent electronically, it avoids the interruption of reading the doctor's handwriting.
• Overlooking medication interactions.  Most patients take what is prescribed to them without giving it a second thought. If the doctor orders a medication, and the patient has not provided the doctor with details of their visits to a specialist that has prescribed medication, there could be a problem. This then is up to the pharmacist to catch that there could be an adverse reaction.  
• Mixing prescriptions up among consumers is rare, but does happen. Patients should always advocate for themselves, and check to see that they have the right pills. Most are available online to indicate what the pill looks like.

The main thing with prescribed medications is that you should encourage patients to learn their own medications, and to always use the same pharmacy for every prescription. Polypharmacy is a dangerous practice.  As the nurse, always ask the patient if they have any questions or concerns. This may prevent them from not taking prescribed medications if their concerns are heard.
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