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Published: 2/18/2008

Put safety above speed

PHARMACY customers certainly appreciate fast service when they bring in prescriptions to be filled, but there's troubling evidence that retailers in the highly competitive business may be pushing their pharmacists too hard, putting the public at risk of injury from misfilled orders.

A USA Today investigation, "Rx for Errors," found that such mistakes often are the result of corporate policies that require pharmacists to dispense prescriptions rapidly, in as little as two minutes.

The newspaper found similarities in heavy demands on pharmacists at CVS and Walgreens, which has the two-minute rule. Together, these chains handle about a third of the nearly 4 billion retail prescriptions filled nationally each year. Pharmacists at chain stores were more likely to report a high or excessively high workload.

Moreover, the investigation found, the risk of error rises when pharmacies rely on "lower-paid, lesser-trained" technicians, even though a registered pharmacist is required to personally sign off on each order.

A study at Auburn University in 2003 estimated the likelihood of a consumer having a serious health problem from a pharmacy mistake at 1 in 1,000. Extrapolated nationally, that would be 3.7 million mistakes a year, based on the 3.7 billion prescriptions filled in 2006.

Luckily, some errors are caught and patients are either not harmed seriously or not at all. But mistakes can be catastrophic.

In one case cited by the newspaper, a 5-year-old boy who was prescribed a blood-pressure drug for hand tremors and hyperactivity instead received a steroid not intended for children - at double the dosage recommended for adults.

The prescription was one of 477 filled by just two pharmacists in a single day in 2004 at a store in Springfield, Tenn. The drug pushed the boy into premature puberty and prompted uncontrollable rage.

Oddly, corporations don't necessarily make a connection between workload and error. Philip Burgess, national director for pharmacy affairs at Walgreens, blamed errors in general on a "lack of focus," but that's a reasonable explanation only if personnel aren't being overworked.

The investigation found that no federal agency tracks pharmacy errors, an oversight Congress should correct, given that prescription drug use by Baby Boomers is virtually guaranteed to push the demand to ever-greater levels in coming years.

At the state level, monitoring of errors is spotty. The Ohio State Board of Pharmacy says from 100 to 200 errors are reported annually, while the Michigan Department of Health gets 30 to 40. Penalties depend on the severity of the error, ranging from fines to revocation of the pharmacist's license.

Some cases end up with exceedingly costly court judgments, of course. Walgreens, alone, has lost three lawsuits involving deaths due to mistakes since late 2006, with verdicts totaling some $61 million, USA Today reported.

To their credit, retailers have spent huge amounts of money on high-tech safety systems and employee training intended to reduce errors. At the same time, the pharmacy business is among the most competitive and stores naturally are under pressure to cut personnel costs.

To protect themselves, pharmacy customers should check that the drugs they receive are what the doctor prescribed, or confer directly with the pharmacist if it's a new prescription.

The surest safety measure, however, would be for the industry to recognize that the safety of its customers matters more than money.



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