Working Conditions at Major Retail Pharmacies Contribute to Prescription Errors
When Norma Segui gave daughter Kimberleigh her usual medication from the CVS Hope Mills, NC Pharmacy, Kimberleigh said her stomach felt funny. Because the pill looked different from the usual medication—this pill was pink and marked with an X, instead of the usual yellow pill with a number on it—Ms. Segui immediately called CVS. She was advised to return the medication, so the error could be fixed. Instead of the 5 milligram medication prescribed by the doctor, the pharmacy had dispensed 10 milligram pills, which contained twice the recommended dosage and had included two extra pills. The pharmacist commented that Kimberleigh might experience sleepiness and an upset stomach.
The pharmacist corrected the prescription and told Ms. Segui that the pharmacy was short staffed, which was an explanation but not an acceptable excuse. The same pharmacy was issued a written warning for a 2013 error when it gave a patient Topiramate, a seizure medication, instead of Tramadol, a general pain reliever. In these cases, the patients did not suffer serious harm.
Why Do Pharmacists Make Mistakes?
Some believe performance metrics imposed by corporate pharmacies are at the root of many pharmacy mistakes. Performance metrics is a system that measures how many prescriptions are filled by the pharmacist and how fast he performs this task. It also includes the number of flu shots given and phone calls made to urge patients to get their prescriptions filled. Other factors which increase the chance of pharmacist error include:
- Interruptions. Concentration is required to correctly fill prescriptions. However, the multi-tasking necessary to work in a pharmacy creates distractions as often as every two minutes according to a study published by the Institute for Safe Medication Practices (ISMP).
- Understaffing. In addition to completing their own work, the supervising pharmacists are responsible for verifying the work of low-wage and high turnover technicians. Under constant time pressure, the verification step is where many errors occur.
- Fatigue. Many pharmacists work long shifts—up to 14 hours a day. Their work requires standing for most of the work day and eating while standing over their computers.
- Unreasonable Time Demands. While observing a 15 minute wait time, the pharmacist must also take phone calls, counsel patients, administer immunizations, transfer prescriptions to other pharmacies, and transcribe new prescription orders called in by physicians.
- Drive-through windows. Accuracy is more important than speed in correctly filling prescriptions, but customers expect quick service when using a drive-through. This can increase the likelihood of errors.
Common Pharmacy Mistakes
Not everyone spots a medication mistake, but the result of an error can cause overdose, toxicity, poisoning, or death. According to statistics by the Food and Drug Administration (FDA), pharmacy errors cause one death a day and harm at least 1.3 million people yearly in the U.S. Common mistakes include:
- The right drug is dispensed in the wrong strength. Kimberleigh received the right drug but at twice the dosage written by the doctor. The harm caused in this situation may not be evident immediately and only discovered over time.
- The wrong drug is dispensed. A distracted pharmacist or technician may mistake similar sounding drugs for each other or choose the wrong drug altogether.
- The wrong number of pills are dispensed. Taking more or less of a prescribed medication will negatively affect treatment.
- The wrong person receives the drug. Mistakes can occur when a prescription is directed to another person in the same family or to a customer with a similar name.
- Label mistakes. Wrong dosing instructions can be written on the label. A drug which is meant to be taken once a day can cause harm if mislabeled to be taken 3 times a day.
- Dangerous drug interactions. Patients who see more than one doctor may receive multiple medications, which may cause a pharmacist to overlook dangerous drug interactions or contraindications.
We Can Help
A patient should not have to pay for the injuries caused by pharmacy errors. If you or someone you love suffered injuries due to a prescription error, you need information that can help. Contact the pharmacy error lawyers of Kennedy Hodges at 888.526.7616 for a free consultation, or fill out our confidential online form.
Filed under: General Problems
Makes me wonder how these big chains find the time to demand MRIs, demand to talk to doctors, and deliberately give patients a hard time. They could save some time by not being jackasses. CVS made mistakes on 2 prescriptions of mine, wrong med that would have been very harmful and gave me a larger dose than prescribed on a pain med prescription. When I took it back to them THE pharmacist said that it wasn’t like it would have killed me. I might have gotten over it otherwise.
“The same pharmacy was issued a written warning for a 2013 error when it gave a patient Topiramate, a seizure medication, instead of Tramadol, a general pain reliever.”
OMG I had completely forgotten about this, but a few years ago, this happened to my dad. The pharmacy had dispensed Trazodone (a tetracyclic antidepressant, which is sometimes prescribed as a “sleep aid”) instead of Tramadol. I think at that time he was taking 1 or 2 pills 4 times a day.
After a couple of days we all noticed that he was extremely sedated, confused, slurring, sleeping a great deal of time, etc., At first, I was scared to death he was experiencing diabetic ketoacidosis, but his blood sugar was “normal” (well, normal for him lol).
I had just watched one of those investigative programs (like 20/20) about pharmacy errors, so I asked him to let me look at all his medications and google each of the pills that were dispensed to him within the last week.
He was also on about 18 to 20 different medications for various other conditions including 100mgs of amitriptyline, which can also have a very sedative effect, so you can imagine how it easily could have been so dangerous. When I googled the numbers/letters on the pills, I was shocked to find that they were Trazodone pills.
My family has used this pharmacy (local, independently owned) since 1990. They were horrified this had happened and was very, very apologetic. Thankfully, he was not permanently damaged. It was a mistake which never happened again. That being said, we have stuck with them because they’ve always treated us so well.
They now have some fancy, expensive machine and computer system that they automatically scan the barcode on the bottle of medication into the computer to verify it’s the correct medication to fill (I think it also spits out the correct number of pills too).
There’s no way I could ever do what pharmacists and pharm techs do. I can see how easy it would be to get distracted (and I’m so easily distracted) and/or how fatigue could contribute to these scary mistakes. I read the reddit pharmacy forum sometimes and have read how these chain pharmacies work their employees half to death.
The chain pharmacies are all about profit, so they’re probably more likely to keep their pharmacies short-staffed so they don’t have to pay more employees. (At least, this is what I’ve gathered from reading). It’s really sad when greed is more important than patient safety.
I remember earlier in my pharmacy career telling my boss, “Sure…I can perform an almost infinite number of tasks, but you need to understand that the quality of every task assigned will go down with each additional task added to my workload.” His response was that it wasn’t his fault. It was corporate that was making the demands. His sudden enthusiasm for impressing us in a staff meeting that we had a slew of additional expectations to meet and he was “behind the new program all the way” wilted after I made that comment openly during the pharmacy staff meeting. I gave my notice shortly after that meeting and have refused to be employed in a retail chain outfit since…this was about 20 years ago.
The performance metrics concept isn’t a new thing. It’s only been better defined in terms of what makes the most profit. These then are the tasks are being pursued and emphasized.
Efficiency experts and computer generated production quotas seem to have tore the heart and soul of so many occupations , and to me pharmacists are like airline pilots so many times they only get one mistake or should I say we only get one mistake ?
I still have flashback nightmares of the metrics and it’s been 8 yrs