When the front tire of an out-of-control car in Bridgeport, Connecticut tore off half of a man's foot, no one suspected at first that the cause could be an improperly filled prescription. However, as our investigation later revealed, the driver of the car had long suffered from epilepsy, and had been prescribed an anticonvulsant, Dilantin, to control his seizures. The chain drug store where he went to refill his Dilantin mistakenly dispensed a drug with a similar name: Dyazide, a diuretic. As a result of being deprived of the medicine he needed, the driver had a seizure behind the wheel and lost control, with tragic results.
This case is far from unique. In a recent study for the Institute for Safe Medication Practices (website: www.ismp.org), 307 hospital pharmacies were asked to fill ten different drug orders that had killed patients in 1998. Some contained an overdose, and the remainder were for deadly drug combinations. Shockingly, only four of the 307 pharmacies detected all 10 unsafe orders.
A 1995 study by a health policy analyst at the Harvard School of Public Health found that over 6% of patients at two teaching hospitals had been injured by medications, and one-third of these injuries involved mistakes.
Faulty prescribing and filling of prescriptions lead to death or injury in a number of ways, including adverse reactions, improper combinations of drugs, and deprivation of medications essential to patients' well being.
Several factors account for the appalling number of Americans killed each year as a result of the faulty prescribing or filling of medications:
- the existence of prescription medications with nearly identical names;
- an increase in the number of medications being prescribed;
- overburdened pharmacists;
- the proliferation of drugs used to treat a single disease or condition.
In addition, since doctors and pharmacists are not required to report prescription-related problems to the federal Food and Drug Administration (F.D.A.), this information does not get published, making systemic solutions slower and harder to achieve.
More drugs, more prescriptions. A vast increase in the number of new drugs being developed and marketed has made it more difficult for physicians to keep abreast of the information they need to make sure they prescribe medications correctly. Furthermore, with the increasing involvement of managed health care companies, medication decisions are no longer being made solely by physicians. The F.D.A., which had long been criticized by industry, doctors, and patients for the slow pace of new drug approvals, has been issuing approvals at a record pace.
In addition to the greater variety of drugs, more prescriptions are being written than ever before, largely because of the increasing population of elderly patients, who account for one-third of all drugs consumed. According to the National Association of Chain Drug Stores, the number of prescriptions dispensed in retail pharmacies increased from 2.03 billion in 1992 to 2.78 billion in 1999, and the number is estimated to increase to 4 billion by 2005.
Attempts to reduce the problem. In a report released in May 2000, the F.D.A. (website: www.fda.gov) called upon pharmacists, doctors, hospitals and drug manufacturers to collaborate to create a new framework for reducing risks from prescription drugs. In June 2000, the agency began to require manufacturers of certain particularly risky medications to distribute warning pamphlets to patients.
Experts have called on the F.D.A. to go further, by requiring drug makers to standardize their labeling for easy reading, and put bar codes on these medicines, to allow doctors and pharmacists to use scanners and make sure that drug names are correctly noted.
The problem of pharmacist overwork is dealt with, if at all, at the state level. In North Carolina, the Board of Pharmacy decided that when a pharmacist who fills more than 150 prescriptions per day makes an error, both the pharmacist and the store will be held liable and face possible license suspension or revocation.
Some hospitals are attempting to improve their safety rates by manually double-checking prescriptions, making sure textbooks are current, and conducting ongoing staff education.
A few hospitals already have systems allowing doctors to enter their prescriptions into computers, where they are checked, double-checked, and corrected to avoid misspellings, overdoses, and dangerous interactions with other drugs the patient is taking, before they are sent to the pharmacy. An analysis of such a system at Boston's Brigham and Women's Hospital found that medication errors were reduced by 80 percent.
What you can do. Although patients do not have the medical knowledge to control the process, you can take the following measures to decrease the risk of becoming a victim of the improper dispensing of prescription medications:
- Educate yourself. To find out about the medications your doctor prescribes, you can consult the Physicians Desk Reference in your local library, or visit a site like druginfonet.com, rxlist.com, Medline Plus or PDR Health to get information about dosages, interactions to avoid, etc.
- Inform your doctors. Make sure each of your doctors is aware of the medications you are taking, including dosages.
- Inform your pharmacist. Have all your prescriptions filled at the same pharmacy. Consider using at a pharmacy that is equipped with a computer that keeps track of all drugs you are taking and can flag overdoses and potentially dangerous interactions. In any event, make sure to tell your pharmacist about all your medications and dosages.