A drug safety lesson from your pharmacy’s photo counter

By Michael R. Cohen: president of the Institute for Safe Medication Practices

I wish people were as intent on checking their medications before they leave the pharmacy as they are when they pick up photo prints.

Have you ever watched people at the photo counter? Chances are they eagerly open the bag, pull out the photos, and look them over closely to make sure they came out ok. But most people pick up their prescription and leave the pharmacy without even opening the bag. We know what a good print should look like, and we'll tell someone if we see a problem with the way our photos were developed. But we're not as familiar with our medicine, especially new prescriptions, so why bother to look, right?

 Sure, taking medicine is simply not as enjoyable as reliving happy moments captured in photographs. People spend more time and energy on the things they enjoy. This is another reason that photos are examined while medications are not given as much attention. Yet, based on our own research, one of the leading causes of medication errors is people taking someone else’s prescription that accidentally found its way into a bag with your name on it.

So, here’s an important question: Did you know that it's a good idea to check the prescriptions your pharmacist has given you? Maybe you know, but you don't feel comfortable doing it, since you know your pharmacist and trust him or her to be the expert. In fact, we've rated pharmacists as one of the most trusted professionals. And when we trust someone, we often accept what he says and does without question.

The point is: You are an important factor in preventing errors. Yes, pharmacists deserve the trust we've placed in them. But a pharmacist, being human, could make a mistake. So could the doctor writing the prescription. So here are some important guidelines.

Every time you pick up a prescription, whether it's new or a refill, take it out of the bag and read the label. Are your name and your doctor's name correct? Don't assume that any errors are just typing mistakes. A misspelled name could mean you have someone else's prescription. Read the directions on the label. Make sure it’s what your doctor told you, and that you understand how much medicine to take and how many times a day you should take it.

While you're still in the pharmacy, read the drug information sheet stapled to the bag to learn what the medicine is supposed to treat. Is that what you're being treated for? If not, it could signal an error, so check with your pharmacist.

If you're getting a refill, make sure the medicine looks the same as it did last time. If it looks different, ask the pharmacist about it. As I pointed out in a recent Check-up, most likely the pharmacist has filled your prescription with a generic drug that looks different from what you're used to. But mistakes are possible, so check with the pharmacist to be sure.

Be sure also to read about the possible side effects. If you're picking up a refill and you realize that you've been having these side effects, tell the pharmacist immediately. He may want to call your doctor.

Finally, when picking up a new prescription, ask the pharmacist at least one question about it. Here are some examples:

- "Is there anything special I should know about taking this medication?"

- "Does the information sheet you gave me have everything I need to know?

- ”I'm allergic to ______. Should I take this medication?"

- "I'm also taking _____, which I got at another pharmacy. Can I take both safely?"

For more on ISMP’s consumer website, go www.consumermedsafety.org.