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Protect Yourself from Misfilled Prescriptions Practical Advice from a Friendly Neighborhood Pharmacist
I have the greatest compassion for Mr. Gower. You remember him, don’t you? Mr. Gower, the pharmacist in the movie It’s A Wonderful Life, starring Jimmy Stewart. Mr. Gower is saved from killing a young child with gel capsules that he’d inadvertently filled with poison. In his grief over his own dead son, Mr. Gower made one of the most famous misfills in film history, and was rescued by the attentive eyes of the young George Bailey. Had it not been for that attention and care, Mr. Gower, the family and the community would have suffered a great tragedy. The older and more experienced I become as a pharmacist, the more that scene affects me. There, but for the grace of God, dumb luck, and/or the attentive eyes of my technicians, my own patients or their caregivers--go I, and a lot of other pharmacists. I know I speak for many of my colleagues when I pray each work day--“God, If I can’t help them, please let me NOT hurt them!” It’s an awesome responsibility made all the more challenging by the myriad tasks laid at a retail pharmacist’s feet. Between phone calls to insurance companies, doctor’s offices, public address systems pumping music and announcements, cash registers, folks asking what medicine is recommended for poison ivy, allergies, headaches, etc. ...and by the way, “are the Pepsi products on sale this week?”—we pharmacists are also doing everything we can to ensure that we get it RIGHT! That is, that the piece of paper you just presented from your doctor will be filled accurately and safely. Sometimes that involves tracking your doctor down because we couldn’t read her handwriting, or s/he’s written a medication order we need to verify for strength or directions. You see, the doctors, PA’s and nurse practitioners are often ALSO juggling a number of variables throughout the day! So, how do you ensure that the medicine we pharmacists have given you is the CORRECT one for you? I’ll take you through a number of steps to help ascertain the accuracy of medicine dispensed.
· Is the medication a NEW prescription order (i.e. one you’ve never received before to your recollection)? When you initially receive that written order from your doctor, take the time to ask a few questions. What’s the medicine’s name? What’s it supposed to do (antibiotic, anti-inflammatory, etc.)? What are the side effects? Does it “go” with the other medicines you’re taking? (This is an excellent opportunity to review such medications with your pharmacist.) If you are allergic to “x” drug, is it related to that medicine? When you have the order filled, ask to have the pharmacist explain the medication to you, including pouring a few out of the bottle to show them to you. THIS is where a number of misfills are caught, particularly on new meds the patient has never had filled before. Patient education is what MANY of us went to school for, so please ask. The information your doctor and pharmacist give you should MATCH! If it doesn’t—it looks like the pharmacist is making ANOTHER phone call to double-check!! · If the medicine is a REFILL, does it look the same way it always has? Same shape, size, color, distinguishing markings (many tablets and capsules have numbers and letters printed on them, which significantly helps in identifying the pill in your bottle). IF the product looks different, DON’T put it in your mouth... yet! Contact your pharmacist and ask them to verify the identification of the tablets you have. Many pharmacies switch generics based on which generic company can offer the best pricing. · Often you can investigate a medication identity for yourself, with the help of the NDC (National Drug Code), which many pharmacies print on their prescription receipts. Think of an NDC as an exclusive identification number for a particular medication. For instance, Ethex’ product Guaifenex PSE 600/120 has a drug code of 58177-0208-01. This white tablet bears an imprint on one side stating the company’s name “Ethex,” and on the other side, the code “208”. The first five digits of the NDC signify the company. ALL Ethex medications’ NDC codes will begin as 58177. The next four digits signify the specific drug. “0208” is used for only that compound in THAT company. The last two digits indicate the package size we dispense from, be it a bottle of 100 or 1000. While many medications can be verified this way, some manufacturers still don’t match their tablet/capsule markings to the NDC. More’s the pity, since this can be an easy cross-check folks can do at home. · Parents of small children—ask your child’s doctor to use metric designations with a decimal point and leading or following ZERO to ensure accurate measurements for your children. I’ve encountered more than ONE example of a provider’s directions where the decimal point was barely visible and 0.5 milliliters looked more like five milliliters. What do you have there? A ten-times greater dose than intended! You must be particularly careful with dosing chemicals to your wee ones! · Read the label instructions. Do they make sense to you? If not, ask us. I’ve had a number of patients question their prednisone dosing for poison ivy, (“Am I really supposed to take five tablets ALL AT ONCE?”), after initially telling me they had no question about the medicine. That’s OK! That’s why I preemptively inform folks of the vicissitudes of prednisone. But you should always ask--because there are NO dumb questions when it comes to your health.
Yes, retail pharmacists are an unusual breed of folks. Many of us run twelve to fourteen hour shifts on our feet, sometimes back-to-back and we are doing the best we can. Some of us have run as many as sixty hours in one week (which is NUTS!) But that doesn’t mean we don’t want to be sure you get the right medication with the right directions. With increasing demands for prescriptions (two billion orders filled in 1994, rising to three billion this year alone), and the rising tide of available pharmacists NOT rising fast enough to meet demand for their services, this issue will only become more pressing. So, please stay informed about your medication. If it’s appearance changes or anything about the order seems amiss, DON’T use it until you confirm its correctness.
That’s my prayer for all of us. Be well.
Thea |
