A Prescription Analysis Exercise in a Pharmaceutical Care Laboratory Course

Article excerpt

INTRODUCTION

Medication errors are among the most common medical errors, harming at least 1.5 million people in the United States every year. (1) Medication error morbidity and mortality costs are estimated to be $77 billion per year, imposing a significant financial burden on patients and the health care system. (2) While most medication errors occur at the points of prescribing and administration, (1) pharmacists play an important role in preventing errors that occur at the point of dispensing. In the mid-1990s, there were errors with 24% of prescriptions dispensed in the community pharmacy setting. (3) Improvements in prescription dispensing systems and technology over the last 2 decades have significantly reduced dispensing errors, and a large-scale study in 2002 of both new and prescription refills dispensed in the community pharmacy setting found an error rate of just 1.7%.4 While dispensing errors have declined drastically, with an annual prescription volume of 4 billion in the United States, pharmacists are still in a position to identify and correct 67.8 million prescription errors before they are dispensed to patients. Because pharmacists play a key role in preventing clinical and financial complications resulting from prescription errors, student pharmacists must be trained to identify and resolve medication-related problems at the points of prescribing and dispensing.

Approximately 57% of pharmacists in the United States work in community settings and 23% work in hospitals. (5) Medication dispensing is a part of the job requirement for most of these pharmacists. Furthermore, graduates who pursue an accredited residency will participate in dispensing services as a required component of their training. (6) Because prescription dispensing is a component of a majority of pharmacists' work expectations, and because it is an essential step in ensuring safe and appropriate medication use, it is important for student pharmacists to establish a process by which they can accurately and efficiently verify prescriptions. Additionally, states such as West Virginia, North Dakota, and Georgia require pharmacists to pass an errors and omissions practical as part of the licensure examination. (7-9)

Educational standards set forth by the Accreditation Council for Pharmacy Education (ACPE) (10) and the Center for the Advancement of Pharmaceutical Education (CAPE) (11) require colleges and schools of pharmacy to ensure student competencies in safe dispensing practices. ACPE and CAPE developed competencies related to processing and dispensing prescriptions: identifying and prioritizing medication-related problems; preparing, dispensing, and administering medications to promote safe and effective medication use; and demonstrating professional accountability, responsibility, initiative, and leadership.

Pharmacy colleges and schools use a variety of approaches to achieve these goals. Several approaches have been used within the pharmaceutical care laboratory setting to train students in providing prescription-dispensing services. Purdue University School of Pharmacy implemented a laboratory session to improve first-year pharmacy students' knowledge and confidence concerning the prevention of medication errors. (12) The session focused on errors arising from incorrect or illegible prescriptions, missing information from the patient or caregiver, and incorrect filling of the prescription. The University of Toledo College of Pharmacy implemented a computer-based training module to teach students how to identify and correct prescribing errors. (13) Following completion of the module, students were better able to identify and correct such errors. Many colleges and schools purchase electronic software licenses, such as QS/1 (JM Smith Corporation, Spartanburg, SC) to simulate prescription processing and dispensing. Other colleges and schools create a "mock pharmacy," complete with shelves of medication stock bottles for students to use in prescription-filling simulations. …