Common Causes of Medication Errors
More prescriptions - fewer pharmacists. The number of prescriptions filled in the U.S. each year is approaching 4 billion while the number of pharmacists (approximately 240,000 in 2006) has been decreasing steadily. Additionally, many drug stores have such a high volume of prescriptions that pharmacists are forced to work longer hours and take fewer breaks. Even some pharmacists agree that the higher workload and additional stress that goes with it increase the risk of prescription errors.
Speed over Safety describes the mixed up priorities reflected in the policies of many drug stores, especially the larger chain drug stores. The guidelines of one of the largest chain drug stores in the country imply that pharmacists should take as little as two minutes to fill a prescription. Their emphasis on speed doesn't allow pharmacists adequate time to: 1) verify that they have dispensed the correct drug, 2) verify that the dosage is correct, 3) verify that the instructions are correct, 4) give patients necessary counseling, or 5) effectively supervise the work of less trained pharmacy technicians.
Reliance on technicians for processing and packaging prescriptions may also contribute to medication errors. Pharmacy technicians are lower paid and do not have the training or education possessed by a licensed pharmacist. The pharmacist is, however required to verify that each bottle contains the correct medication, dosage and instructions. Unfortunately, mistakes made by technicians are not always caught by the usually over-burdened pharmacist.
Tying pay to volume poses a significant risk to customers. A common practice among larger drug store chains until recently was to base bonuses in part on increasing prescription volume and meeting goals for filling them quickly.
Distractions such as ringing telephones and crowded stores may contribute to dispensing errors. According to a CNN article, fatalities due to prescription errors rise by as much as 25% during the first few days of each month. The rise is believed to be linked to fact that Social Security checks come at the beginning of the month. Many people wait to receive their check before going to buy their medicine. When they show up at the pharmacy counter in large numbers, they create an added distraction for the pharmacist.
One survey of pharmacists, conducted by a professor of pharmacy practice and administration at Ohio State University and published in the International Journal for Quality in Health Care, revealed a correlation between the presence of a drive-through window in the pharmacy and dispensing errors.
Inadequate regulation likely plays a role in the incidence of pharmacy errors. Many in the industry believe that the risk of pharmacy mistakes increases with a higher workload. Shockingly, only one state, North Carolina, requires pharmacies to report all major drug errors and none regulate pharmacist hours or workload. Government should also regulate the number of prescriptions a pharmacist is permitted to fill each day.
Doctor error or medical malpractice can be the cause of medication errors. When doctors prescribe the wrong medication or an inappropriate dosage of the correct medication, the consequences can be disastrous. Other examples of medication malpractice include doctors or hospitals prescribing: 1) medications which are contra-indicated due to an existing medical condition, 2) medications to which the patient is allergic or, 3) contraindicated combinations of medications where harm can result from the interaction with other drugs. Any of these medication errors can cause significant, adverse health consequences. One study revealed that mistakes in dispensing drugs are so prevalent in hospitals that a patient will be subjected to an average of one medication error each day of his or her hospital stay.