The REAL Numbers

Posted on February 26, 2008

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?