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Letters to the Editor
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Dispensing errors
A question of contributory negligence
From Mr G. Southall-Edwards, MRPharmS
In an item on labels (PJ, 18/25 December 2004, p886), Onlooker states: “Pharmacists
are well aware of the need to include all matter of data on a label that
will instruct or warn the user of a product, and guide the expert who may
be concerned.”
As a pharmacist and lawyer whose firm deals with a great many dispensing
errors on behalf of pharmacists’ insurers and as a person who practises
pharmacy in mainland European countries where it is not routine practice
to label dispensed medicines, I am now wondering whether the continental
system of handing out a box in its original state, without a label and
perhaps with the patient’s name written on (only rarely, however)
is not the better method? I ask this because, just before I read the article,
I was dealing with a dispensing error involving the prescription of Voltarol
MR 75mg (diclofenac), where Efexor ML 75mg (venlafaxine) was supplied.
Unusually, the pharmacy had supplied a photocopy of the returned container.
On the front, it said in large print “Efexor ML 75mg” printed
on by the manufacturer. In addition, there was a pharmacy-applied label
upon which it said in much smaller print “Voltarol 75mg”. Furthermore,
on the end of the box, two other sides and the rear face, the manufacturer
had printed “Efexor ML 75mg”; inside the box there was a patient
information leaflet for Efexor ML 75mg, in which the treatment of depression
was detailed. The manufacturer’s box was also nothing like the colour
or design of the Voltarol 75mg pack that the patient was used to.
The letter from the patient to the pharmacist’s insurer states: “I
looked at the tablets which were totally different in size, appearance
and colour from those I normally get for my arthritis and I noticed that
the name had changed too; but on the label it said ‘Voltarol 75mg’ which
is what I usually get, plus it had my name on the label, so I took them
without further hesitation.” The claimant goes on to say that he
read the information leaflet, which described the use of the tablets for
depression (and he knew he was not being treated for that), but that he
continued to take them, because the “label” said they were
Voltarol 75mg. But for the pharmacy label, it seems he would not have taken
them, and this is an important factor in as much as 75 per cent of all
dispensing errors my firm handles.
The law on “taking the medicine without question” has not yet
been tested; I think it is long overdue for testing and hope that it soon
will be. Insurers ask (rightly in my opinion) why it is that people who
take what is almost obviously wrong should be compensated fully without
an allowance being deducted for their contributory negligence, when those
who climb into cars and fail to wear their safety belts have, for nearly
30 years, had their damages automatically reduced by at least 15 to 25
per cent.
In the meantime, given that the “correct” labelling of the “wrong” medicine
accounts for well-over 60 per cent of all errors I handle, should we not
be seriously questioning present practices? Is it now time to reconsider
the practice of including the medicine name on the dispensing label? Indeed
is it also time to stop putting the patient’s name on the label or
box, too, or even stop labelling them altogether and at the same time,
by using original packs without exception, come into line with continental
Europe? The fact that “it said Mrs Jones on the label” is the
other reason, usually given by Mrs Jones, for taking medicines intended
for “Mrs Smith”.
My wife has commented many times that it is so much harder to make an error
here in Austria, when (in her words) “you do not have to waste all
that time printing and applying labels” and the dispensing is done
over the pharmacy counter, right in front of the patient, with the prescription
and the medicines lying on the counter for both pharmacist and patient
to see as the dispensing and patient counselling process proceeds.
G. Southall-Edwards
Tirol,
Austria |
The
Pharmaceutical Journal