My Letter to the USA Today Journalists »

Feb

The REAL Numbers

Posted by The *Angriest* Pharmacist as Errors

Let’s analyze error rates. If you’re going to bitch about how big a deal it is, I’m gonna show you right here and now.

USA Today *says* there were ~3.7 million prescription errors in 2006. This is of course, a huge estimate. Data isn’t even available on the ISMP website. I remember reading, at some point, that the number was 1.5 million in 2007. That’s definitely not in line with what USA Today says. If the number I remember is correct, cut all the numbers I wrote below in HALF.

Projections for prescriptions filled each year range from 3 Billion in 2000 to 4 Billion in 2008 (but I’m not sure how reputable the Toledo Globe is). I’m sure it’s closer to 4 Billion if the 3 Billion number is correct - especially with the Baby Boomers now coming of age. I accept the fact we are comparing 2006 errors with projected 2008 numbers. Data is damn hard to find as there are so many companies and reporting of total fills as well as misfills are not required.

3,700,000 / 4,000,000,000 x 100 = 0.0925% of Rxs Misfilled Nationwide
0.0925 / 100 = 0.000925 Error Rate
4 Bill, Fills per yr / 59k Pcys in USA = 67,796 rx fills/pcy/year
67,796 rxs x 0.000925 Error Rate = 62.7 errors/pharmacy/year

-=+ ALTERNATIVELY +=-

67,796 rxs per pharmacy per year / 357 days per year = 189 rxs/day
(8 Holidays off)
189 rxs per day x 0.000925 Error Rate = 0.175 Errors/Pharmacy/Day

-=+=-

There you have it. 0.175 Misfills per day. That means I make one mistake every 5.7 days - I’d like to see any other profession compete with that number. Hell, most industries (food service) can’t handle 5.7 CUSTOMERS without fucking up an error.

Now - I don’t want to hear all this “1 error is too many” bullshit that you pansy asses would try and throw down our throats. That’s irrational. It’s impossible. There’s no such thing as perfection when you have human techs typing prescriptions for human pharmacists to check. (There’s an H-word in there making my point)

I think that some people need to realize the difference in quantity of Million and Billion. It’s not just a few letters apart. They also need to realize the quantity of scale we’re dealing with here.

Some people also need to realize that a misfill does not constitute something that WILL kill you. Sometimes, it something you won’t even notice! Granted, it’s still wrong/incorrect, but you still got the right drug, right dose, right regimen, and right quantity.

Here’s some common errors that would be reported as misfills that put the patient at no risk:
- Incorrect doctor on bottle (I can’t read a scribbled line, anyway. So…we guess — especially if it’s a resident or from an ER where you won’t be getting refills.)
- Incorrect Original Date (So you got it yesterday and I didn’t change the date. Do you care? Would you notice?)
- Quantity miscounted (So you got 31 instead of 30 or worse, 30 instead of 60. It’s easily fixed, if you got the short end of the stick, but it’s a misfill nonetheless.)
- Drug changed and quantity increased and you found out (So, I changed your Lisinopril 40mg to 2 tablets of the Lisinopril 20mg. Sue me. This may not be classified as a misfill, but irrational people may construe it as such.)
- Your name is spelled wrong. The word “daily” is misfilled as “daiyl” - Some other typo occurred that was negligible and a person with any sense could understand that it was a typo and not going to kill them.
- The tech/pharmacist fails to put an applicable auxilary label on the bottle and you get a belly ache for not eating with your Biaxin XL.
- You got a child-safe cap when you requested an easy open (this ones a stretch, but I’m making a point that just because the pharmacy did something wrong - it doesn’t mean someone is going to die)

The above miniscule errors are the VAST majority of “misfills,” in my opinion.

Note: My errors and numbers are purely speculative and have no scientific bearing. They also do not take into account any error made in a hospital by any member of a hospital staff (unless filling scripts as retail I would assume). Those would be considered “medication errors” or “order errors” and not “prescription errors.” The difference is that the hospital order is for RIGHT NOW, and the prescription is for a length of period while not under hospital care.

More Numbers:
3.7 Million Errors / 200,000 Pharmacists = 18.5 Errors/Pharmacist/Year
4 Billion Scripts / 200,000 Pharmacists = 20,000 prescriptions/pharmacist

That means each of us fills 20,000 prescriptions per year (thanks for pullin’ yer weight boys!) and makes 18.5 errors out of those TWENTY THOUSAND OPPORTUNITIES. Alex Rodriguez would be so lucky for a fielding rate that high…[For those not following the math, that's an error rate of -- you guessed it -- 0.000925 or 0.0925% and a success rate of 99.9075%]

If, let’s say 3,000 of those people that got a misfilled prescription error DIED as a DIRECT result and not due to poor health - do you realize how miniscule that number is? NASA would launch with an chance of failure that slim…

BTW - The chances of YOU getting a misfilled prescription leading DIRECTLY to YOUR DEATH is 3000 deaths due to misfills/4 Billion Prescriptions Filled! That figures to:

0.000075%

So, I ask you this — how many errors do you make in a year’s time?

-=+=-

What are your odds of getting hit by lightning? 1/700,000 (in the year 2000)
Number of people struck in 2000? 400
Number of people struck in 2008 (proj. for pop 300 million): 429

Odds of winning the grand prize for Powerball? 1/146,107,962

1/1081 scripts are misfilled
1/700,000 people get hit by lightning
1/1,000,000 people die from 300-mile car trips (per US DoT)
1/1,333,333 scripts filled leading to death because of a misfill
1/146,107,962 lines played will win Powerball Grand Prize

So, I ask you this — Have you bought your Powerball tickets and stood under a tree during a storm today? Or, are you sitting at home in fear that your pharmacist may kill you?

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Pharmacy Meanie says February 26th, 2008 at 7:03 am

I know most of hte mistakes I see myself making are of the “micro K vs slow k” type. same damn drug. same damn dose. Wrong manufacturer. Hardly lethal.

JenRPh says February 26th, 2008 at 11:07 am

Please send this to every type of mass media! The public needs to hear our side! How about an editorial in all the major newspapers? I love that you did all the math…it sounds a lot worse before you see the actual percent. And I had no idea I fill 20,000 rxs per year…no wonder I’m so tired!

pharmacy chick says February 26th, 2008 at 1:34 pm

Whoa, you must have burned up your calculator figuring that one :-)
Nice job tho. But just as a reminder. Dont jinx yourslef into thinking it can’t happen to you. I have been blessed to have had errors that have never harmed anybody, but one almost did and it was not caught by our computer drug interaction software. Azothiaprine and Allopurinol. he spent 10 days in the hospital. I felt horrible and thought all the blood left my body. He felt the blame rested mainly on the fact that two different doctor prescribed and he used both mail order and retail. But it was there, in his profile, the Aza was just old, and it didn’t appear he was still using it, (mail order).
Good work however. Thats why we have all this verification soft ware, and procedures, so hopefully we will never be among the wrong end of your statis (and in the courtroom)
Great blog,
pharmacy chick

The *Angriest* Pharmacist � Blog Archive » My Letter to the USA Today Journalists says February 26th, 2008 at 1:59 pm

[...] rss search « The REAL Numbers — Updated 2-26-07! [...]

Heather says February 26th, 2008 at 8:44 pm

Bravo!

Mellee says February 26th, 2008 at 11:35 pm

I am not a pharmacist or a tech, I just really enjoy reading your blogs, some of them crack me up. I totally agree with this posting. I am a single mom and I am on Medicaid, but I only use it for scripts I can not get OTC. I also work my ass off. So TAP keep up the good work :)

Zi Long NYC PharmD student says February 27th, 2008 at 1:35 am

You should put the up things that can happen more commonly like like getting hit by a car or something of the sort instead of the lotto LOL

ArkieRN says February 27th, 2008 at 8:37 am

TAP in the last sentence of the third paragraph, change their to there. Otherwise, truly excellent post! Pharmacists ROCK!

TheAngriestPharmacist says February 27th, 2008 at 10:15 am

Thanks…:-)

Quilt Lady says February 27th, 2008 at 11:20 am

WOW - My brain hurts disseminating all that!! The illustration is grand, but the root of the problem is still a “numbers game”. Stop the merry-go-round, I want to get off. Pharmacy wasn’t like this 30 years ago…

Lux says February 29th, 2008 at 8:16 pm

I’ve delurked to say that you’ve written a good article and I’m forwarding this around to anyone who’ll read it.

I’ve got fam and friends in the pharmacy trade and your working conditions are unbelievable.

Phil says March 16th, 2008 at 5:54 pm

Nice analysis, but as they say, there are lies, damn lies and statistics.

As with most every other profession, most errors are not reported, a lot are not even noticed. At best, you have to chalk ‘errors’ into the realm of human beings and concede that there is probably some kind of bell curve at work.

To suggest that humans are capable of less than a 1% error-rate is, at best, fallacious and, at worst, dishonest.

Aimee says May 2nd, 2008 at 5:55 pm

I love it! How many mistakes do doctors make? I had a patient at my old pharmacy who had colon cancer! The surgeon removed a HEALTHY part of her colon and left the cancerous tissue inside her! Talk about mistakes!!! I think the worst mistake I’ve ever made was pulling the wrong NDC (diff. manufacturer!)

G-zilla says May 17th, 2008 at 6:56 am

Wow … I’ve apparently seen/participated in more errors than I thought … I’m not even an RPh or CPhT … Had I known these were all errors, I”d have done more to keep these Rx’s from killing our patients!

How will I ever get over this utter lack of caring?

In my opinion, most scripts should just be written as the medication, the daily dose the doctor wants the pt to get, and number of refills. The exception to this is if they are prn scripts and … that’s all I can think of right now.

Then, a bunch of hassle could be avoided due to doctor stupidity.

I think, also, that PharmD people should be able to have a greater leeway of professional judgment. As such, the suggested new way of scripts, would simply have a place to note if an extended/sustained release is wanted.

Then, give the patient the script and let pharmacists actually be what they are - medical professionals that know a lot more about drugs than 99% of doctors.

The Pharmac(y/ist/y tech) can give the patient the options available with their insurance and pricing and everything.

Only shitty thing about it is that it causes more patient interactions and Pharmacists are already overworked.

I’m tired of having to call doctor offices because The Great and All-knowing Dr. Oz writes for “Wellbutrin SR 300 1 po qd”. I don’t believe that is an available strength, and/or we don’t stock it. So we wait around for 10 days, and call and deal with their shitty staff, and hopefully we get a response of “yes, dispense Wellbutrin SR 150 2 po qd”

Or maybe it is just the policy of my workplace to not do those types of things?

Wow, long ranty type thing by me. I suck.

Love the blog!

First time reader - First time commenter!

The *Angriest* Pharmacist � Blog Archive » Updated ODDS! says July 17th, 2008 at 11:00 pm

[...] Some may remember when I outline the odds of your getting a misfilled prescription (as well as dying as a direct result). You can refresh your memory HERE. [...]

The *Angriest* Pharmacist � Blog Archive » Walgreens Bashing FOOL says October 18th, 2008 at 12:00 pm

[...] http://www.theangriestpharmacist.com/2008/02/26/the-real-numbers/ http://www.theangriestpharmacist.com/2008/02/26/my-letter-to-the-usa-today-journalists/ [...]

aligirl says November 7th, 2008 at 10:33 pm

So I was just going through some of your older posts and came upon this one. I am currently in a class pharmacy related. And our assingment today was to watch the freaking news cast from ABC attacking pharmacies, mainly WAG. So anyway we were supposed to watch it than describe all the errors and crap like that. Anyway this one student who is in her first year of college and pursuing to be a pharmacist starts complaining how all these mistakes are freaking being made. First I told her that the video was one sided. Then I told her that if she looked into all those supposed incidents that there really is more to them than what they say. I really wish I could tell her to come read this blod because now she just keeps complaining of all the errors made and how pharmacists are so bad. I basically told her to shut the f*** up because she was getting on my nerves, and that if she dislike pharmacists so much than what the hell was she doing in this class. I hate people like her and wish she would do some more research the way you have and open her freaking eyes. She keeps saying how the pharmacist needs to have caught this or that. Hell shouldn’t the freaking patient take some kind of responsibility for their health. If a doc tells you that you are getting 1 mg of coumading and you little bottle says 10 mg shouldn’t you freaking question that. If you are giving your seven month a medication that is in a tablet form…(how can he swallow if he is seven months, because that is what they showed in the video was a bottle of tablets.) when it should be a liquid , shouldn’t you question that. Patients always freaking complain about how things are wrong, hell if you took a few minutes and actually read your bottle before just taking the pills than you would realize that it is once a day not twice a day.
Sorry but that girl just pissed me off!

Print this bitch out and take it to her! The numbers don’t lie…

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