Medication errors in a retail setting (Web Extra)

All retail/community pharmacies assert that medication safety is their first priority. Here's an example of what one pharmacy chain is doing in that regard.

"Prescription safety is our highest priority at CVS Caremark," said Mike DeAngelis, company spokesman. "All of our pharmacies have well-defined processes in place to ensure accurate dispensing," he said, citing the following quality assurance dispensing measures:

• Accuracy scanning. The National Drug Code (NDC) must be scanned on both the pharmacy bottle and the prescription label to ensure a match.

• Pharmacist verification screen. Computer displays show the image of the pill being dispensed, identify pediatric and infant patients, and display the patient's age (not just date of birth).

• Drug utilization review. Performed by the pharmacist to evaluate the appropriateness of therapy and to check for drug interactions.

• High-alert medication program. Combining on-screen messaging with pharmacy-shelf-awareness stickers, in order to differentiate between look-alike and sound-alike medications.

• Refrigerated prescription bookmarks. Refrigerated medications are stored with the patient's prescription and can be pulled together while a "bookmark" is put in the waiting bin.

• Echo check box. Enhanced entry screen provides a reminder to "echo" back and verify the drug, strength, prescription, and indication for prescriptions that have been called in by a physician.

• Comprehensive quality assurance check. A registered pharmacist verifies the accuracy of key patient, drug, and medication information prior to dispensing to the patient.

"We are also a leading advocate for the adoption and use of e-prescribing technology, because we believe the direct transmission from prescriber to pharmacy leads to improved prescription quality, safety, and ultimately, improved health outcomes," DeAngelis said.

"All of our pharmacies are equipped to accept electronically generated prescriptions. Our effective pharmacy systems and processes enable us to accurately fill hundreds of millions of prescriptions every year. In the rare event that a prescription error does occur, it receives immediate attention by a pharmacy supervisor for follow-up." This typically includes:

• Contacting appropriate individuals affected by the event, such as patients, caregivers, and prescribers.

• Submitting an incident report for analysis and investigating the incident to determine how it occurred.

• Taking necessary corrective measures to prevent future occurrences. This may include staff retraining and, where needed, modifying operating procedures.

• Tracking and reporting errors internally and adhering to reporting requirements of state pharmacy boards.

DeAngelis also noted that "while the total number of prescriptions we fill has steadily increased, our overall number of prescription errors has declined. [Medication errors] now amount to a small fraction of one percent of total prescriptions filled.

"In addition, the support of our pharmacy technicians allows our pharmacists the ability to focus on the professional duties that are specific to their role. Our technician-training program involves a rigorous curriculum that meets or exceeds the standards of state pharmacy boards. We require technicians to pass internal training at three levels as they advance their responsibilities, and we encourage them to obtain national certification through the Pharmacy Technician Certification Board."