Research studies find that American doctors make errors in writing prescriptions at rates of 5 to 81 percent. Most errors in prescribing medications are caught at the pharmacy, but a shocking number of drug prescribe in error find their way to patients.
Errors in writing prescriptions are surprisingly common. A study published in the Medical Journal of the Armed Forces of India in 2014 found an astonishing 1,012 errors in just 1,000 prescriptions. Studies of prescribing errors in the United States have found that doctors make mistakes from 5 to 81 percent of the time. For centuries, doctors whose prescriptions were incorrectly filled could blame the pharmacist's inability to read their handwriting. However, even with the advent of electronic prescriptions, prescribing errors continue.
Software glitches and system design errors very seldom cause prescription errors, but that isn't to say that e-prescription systems are easy to use. It can become cumbersome to enter patient data into the prescribing system. Sometimes the wrong patient's data are attached to a prescription. Sometimes the prescriber simply selects the wrong option. Sometimes the doctor is simply tired.
A study of prescription errors in the United States found that problems that end in the patient's getting the wrong drug fall into predictable categories:
- 11 percent of errors involve the wrong dose.
- 19 percent of errors involve the wrong dosing instructions.
- 21 percent of errors involve the wrong duration of therapy.
- 40 percent of errors involve the wrong drug quantity (for example, telling the pharmacist to dispense 60 tablets when the instructions say to take one tablet a day for 30 days).
There are some analysts who conclude that problems with electronic prescriptions outweigh their advantages. Here are seven examples of the sorts of problems you as a patient might encounter as a result of electronic prescription error.
1. Wrong drug selected from a pull-down menu
Seven-year-old Timmy was taken to the doctor with a strep throat. The doctor took a swab of Timmy's tonsils and ran a culture, determining that the boy had an infection with a type A Streptococcus. The prescription for treating this kind of strep throat is usually penicillin, but the doctor was tired and clicked on penicillamine, a medication used to treat rheumatoid arthritis, kidney stones, and Wilson's disease, a condition that causes an overloading of copper in the liver. The pharmacist did not question the prescription and Timmy was given the drug. After a couple of days, Timmy's sore throat was not any better, and he was complaining of nausea and constantly having to go to the bathroom with severe diarrhea. Timmy's parents took his to the emergency room, showed the ER doctors all of his prescriptions, and the error was caught. Timmy rapidly improved once he was given the right medication.
Many electronic prescription systems have pull down menus of look-alike, sound-alike medications. A doctor intending to give a patient Ranexa for angina, for example, is offered an opportunity to prescribe PreNexa, which is a nutritional supplement used during pregnancy. This kind of error is very distressing when the patient is a man.
2. Choosing the wrong formulation
Many medications come in an extended-release formula. The dosage of the medication is different when an extended-release version is prescribed.
A common error involves the prescription of valproic acid, which is marketed in the United States as Depakote. The manufacturers of the drug offer it as delayed-release capsules (Depakote Sprinkles), delayed-release tablets (Depakote), and extended-release tablets (Depakote ER).
A doctor intended to give her patient a 1000 mg dose of extended-release Depakote ER, but clicked on the pull down menu to prescribe 1000 mg of delayed-release Depakote. Ten hours later the full dose of the medicine was in the patient's bloodstream, with predictable side effects: extremely low blood pressure and severe sedation. Fortunately, the patient recovered.
In the United States, different pharmaceutical companies define "extended release" in different ways for different medications. The extended-release period may be 12 hours, or 24 hours, and the medication may be enteric coated (treated so it dissolves in the small intestine, not in the stomach), or not, with major consequences in patient care.
Another medication that is subject to serious prescribing errors is insulin. Some longer-lasting insulins such as Lantus are taken every 12 hours. Other longer-lasting insulins such as Toujeo are only taken once every 24 hours.