Not Only How, But Why

A recent edition of Pharmacy Today magazine contained an article that talked about pharmacists getting the right drug at the right dose to the right patient at the right time.  The article was discussing pharmacogenetics and not dispensing errors.  However, the article did remind me how critical it is to deliver the proper medication to the patient.

The Pharmacists Mutual Claims Study highlights drugs that are commonly involved in claims.  The claims result from dispensing the wrong drug, the wrong strength, or dispensing a prescription with incorrect directions.  Many of the drugs commonly involved in these claims are not surprising.  Both hydrocodone and oxycodone are on the list at numbers eight and eleven, respectively.  What is revealing is the reason that drugs are on the list beyond the fact that they are widely dispensed.  Hydrocodone and oxycodone are available in a number of different strengths and combinations.  This presents challenges in the dispensing process to make sure that the correct product is dispensed.

The number one drug involved in claims is warfarin.  A closer look at warfarin errors reveals that incorrect directions are seldom the error involved.  Almost two-thirds of the time, it is dispensing the wrong strength.  Levothyroxine, at number two, is similar with strength errors accounting for over two-thirds of its claims.  Considering the number of strengths of these two products available, these results are not surprising.

Toprol® comes in at number five in the study.  It is commonly dispensed in place of Topamax® (and vice versa).  Here, about two-thirds of the errors are dispensing the wrong drug.  It is easy to see how that could happen.  Claims involving oral hypoglycemic drugs (primarily glyburide) is in third place on the list.  These claims also involve the patient receiving the wrong drug.  But here, it is a whopping 90% of the errors!

Our last example is prednisone, which comes in at number 9.  Prednisone claims are spread almost equally among wrong drug, wrong strength, and wrong directions categories.  Again, this is not surprising given the variability of dose and duration for different patients and conditions.

The key to a successful risk management program is data.  Knowing where dispensing errors occur is helpful.  Knowing why they occur is much more useful.  Performing a root cause analysis allows you to better understand not only the how and where, but the why.  Knowing the why allows you to implement a risk management program that is both efficient and targeted.  Increased accuracy should follow as the data shows you where changes are needed.