Preventing prescription errors

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For veterinary clinics that have in-house pharmacies, the goal is to have their clients fill their prescriptions there. However, as online pharmacies and bigger pharmacy chains begin to pop up, some clients are looking elsewhere to get their prescriptions filled.

If this is happening with your clients, do you know how to ensure that there will be no errors or lethal substitutions? During their lecture "Working With Pharmacies: Improving Communication and Reducing Errors," sponsored by CareCredit, at the American College of Veterinary Internal Medicine’s 2023 forum in Philadelphia, Pennsylvania, Kaitlyn Boatright, VMD, and Lauren R. Forsythe, Pharm.D, DICVP, laid out some common errors that can happen when working with an outside pharmacy, and how you can avoid them.¹

Common prescription errors and solutions

Boatright and Forsythe highlighted a 2012 study conducted by the Oregon Veterinary Medical Association (OVMA) that showed a large number of serious prescription errors for veterinary patients, with 35% of responding veterinarians reporting experiencing changes in their prescription from a pharmacist, and 17% of respondents reporting serious adverse effects in patients, including death.² A solution to this issue can be found in how veterinary professionals write prescriptions, the presenters noted. Since it is legal for veterinarians to give prescriptions to pharmacies in writing, over the phone, and by fax, taking a closer look at how veterinary professionals prescribe can help patients.

“With written prescriptions, this is probably the best option as far as error prevention, because what you intend is written. That written record is getting to the pharmacists,[which could] decrease some of the issues with transcribing over a phone. You can also make a copy of that for your own records and keep that and say, ‘This is what was given.’ You can make sure that you give efficient information,” explained Forsythe.

“However, it's important to make sure that all the information necessary is there and that's clearly indicated. That's where we get into some of the issues with that dialect between professions. Something that may seem obvious in the vet world may not be obvious in the pharmacy world and vice versa," Forsythe added.

Forsythe further told attendees that if they are writing prescriptions, to put as much information as they can, even if it feels like it’s too much, and not write in shorthand or abbreviations. If a particular dose of a certain medication needs to be given, attendees should write no substitution on the script. There are times when pharmacists and the client may discuss using a generic brand or a different brand than prescribed, which is legal for them to do, but this can have lethal side effects.

For prescriptions given over the phone, always have them say what you said back to you. If you do not, this can turn into a 'he said she said' scenario and the patient could not be getting the medication it needs. The pharmacist may think you said one drug when you said another if the medications have similar names in some cases.

“One is medication with similar names [such as] azithromycin as in azathioprine. They sound sort of similar [and] if you're saying them fast over a phone, you could hear where [there could} potentially be some disruption there. This is probably happening either because our scripts are illegible or that unclear phone conversation,” said Boatright.

“There was a report of a dog that was prescribed azathioprine for an immune mediated condition and received azithromycin. Obviously [this is] not going to suppress the immune system. And that dog ended up dying because it didn't get the immune suppression that it needed. On the other side, we had a report of a cat that was supposed to receive azithromycin and got azathioprine and died from severe bone marrow suppression. So we can have severe, severe side effects if the wrong medication is filled,” Boatright concluded.

This scenario can be especially deadly when it comes to veterinary medicine. Pets that are not getting better or are getting worse because they are receiving the wrong medication could be at risk of death. Taking preventive measures such as writing out scripts clearly with extra details as well as calling pharmacists to make sure they understand what you prescribed can be the extra steps needed to help improve the quality of life or even save the life of your patient.

In conclusion

Although some of these prescription errors can be prevented with the pearls given during the lecture, Boatright and Forsythe wanted to make it clear that these mistakes were not done on purpose or with anything other than good intentions or lack of knowledge.

“When errors occur, there is no malicious intent. We all want to do what's best for our patients. So then the question is, ‘what process in this or what system process is defective that we need to address or can address to help prevent errors in the future?’ Unfortunately or maybe fortunately, vets do not have the control over what pharmacists are taught in school. This can be frustrating, so pharmacists generally do not get veterinary pharmacy information in school. Maybe we'll see that changing in the future,” said Forsythe.

“The American Pharmacists Association at their annual meeting, which is the pharmacist’s version of AVMA (American Veterinary Medical Association), they and their House of Delegates passed a recommendation that pharmacy curriculum should include information on medication and medication use and veterinary patients, as well as supporting the offering of continuing education for pharmacists and pharmacy technicians. So we're seeing steps in the right direction,” she concluded.

References

1. Boatright K, Forsythe L. Working With Pharmacies: Improving Communication and Reducing Errors Presented at: ACVIM Forum Specialty Symposium; Philadelphia, Pennsylvania. June 17, 2023.
2. Kolb G. Veterinary Prescriptions and Retail Pharmacies Summary of Membership Survey. September 2012. Accessed June 17, 2023. www.ftc.gov/sites/default/files/documents/public_comments/request-comments-and-announcementworkshop-pet-medications-issues-project-no.p121201-560891-00569/560891-00569-84588.pdf.