Keys to Minimizing Prescription Drug Errors

Cindy Nguyen, PharmD, MPH candidatePatients come to the pharmacy to obtain their prescription, assuming their medication is safe and efficacious. However, according to the FDA, medication errors harm 1.3 million individuals each year and kill at least one person a day. Health care costs from medication errors in the U.S. are estimated to be $21 billion dollars per year.²

Why do medication errors occur-and what we can do about it? I have identified three areas of concern.

Inadequate work environment

Adequate pharmacist staffing is key to minimizing errors. Nearly half of the pharmacists from all health care settings reported that they “had so much work to do that everything cannot be done well” in a 2014 National Pharmacists Workforce Survey.³ Additionally, more than half of the chain and retail pharmacists reported high stress work environments from “having to meet quotas” and “not being staffed with an adequate number of technicians.”³ Such working conditions are a breeding ground for medication errors.

In his article “Understanding Medication Errors: A Cognitive Systems Approach,” Dr. Anthony Grasha noted that pharmacists have a limited ability to stay and focused.⁴ Inadequate staffing leaves pharmacists with limited time for lunch and breaks, which are  imperative for cognitive improvement. Grasha found that pharmacists who had adequate breaks make fewer mistakes.⁴

Dispensing time limits

In a survey by the Institute for Safe Medication Practices, 83% of surveyed pharmacists reported that “performance metrics contributed to dispensing errors.”⁵ On average, a pharmacy dispenses 250 or more prescriptions per day. This means 31.25 prescriptions per 8-hour shift or 1.92 minutes to input, fill, and prepare each prescription. This doesn’t account for the time that pharmacists exhaust to check for medication drug allergies, interactions, and contraindications-- or answering phone calls from insurance companies, prescribers, or patients.

Lack of consultations

A survey by the Enforcement and Compounding Committee by the California Board of Pharmacy found that about 85% of the pharmacists indicated “workload too high” and 73% cited “insufficient staffing” as barriers to consultations.⁶ At a minimum, consultations should include the name and description of the medication, directions of use, potential side effects, and expected benefits. Prescription errors can be found and corrected 89% of the time during such consultations. However, timed metrics inhibit consistent consultations.

Keys to preventing medication errors

The keys then to ensuring that the medications patients receive are safe and effective?

. Adequate staffing needs to be addressed at the pharmacy organizational level. This would allow for other actions, such as utilizing quality assurance programs, incorporating technology to restructure the work environment, and conducting prospective drug utilization review (pro-DUR) programs.⁵ Quality assurance programs incorporate error documentation and follow through with preventative measures that increase patient safety.⁵

. Technology, such as bar-coding and electronic patient records, provides a check-and-balance system within the pharmacy that improves efficiency and reduces distractions.

. Pro-DUR programs allow pharmacists to capture and produce a detailed patient profile that will enable them to find any potential medication-related problems.

Cindy Nguyen is a 2019 PharmD/MPH candidate at Touro University, Vallejo, California. She would like to thank Aglaia Panos, PharmD for her assistance in preparation for this article. Contact her at cindy.nguyen2@tu.edu

REFERENCES

• U.S. Food and Drug Administration. Medication Error Reports. U.S. Department of Health and Human Services. 2009. Retrieved from http://www.fda.gov/Drugs/DrugSafety/MedicationErrors/ucm080629.htm

• National Priorities Partnership. Preventing Medication Errors: $21 Billion Opportunity. National Quality Forum. 2010. Retrieved from https://www.qualityforum.org/NPP/docs/Preventing_Medication_Error_CAB.aspx

• Midwest Pharmacy Workforce Research Consortium. (2015). Final Report of the 2014 National Sample Survey of the Pharmacist Workforce to Determine Contemporary Demographic Practice Characteristics and Quality of Work-Life. 2014 National Pharmacist Workforce Survey. Retrieved from http://www.aacp.org/resources/research/pharmacyworkforcecenter/Documents/FinalReportOfTheNationalPharmacistWorkforceStudy2014.pdf

• Grasha A. Understanding medication errors: a cognitive systems approach. Medscape Multispecialty. 2001. Retrieved from http://www.medscape.org/viewarticle/418538

• Abood R. (2013). Part 1 & 2: The Legal Risks of Pharmacy Errors. Rx Consultant. 22(9),2015.

• California Board of Pharmacy. Enforcement and Compounding Committee Meeting Materials. 2015. Retrieved from http://www.pharmacy.ca.gov/meetings/agendas/2015/15_sep_enf_mat.pdf