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Auburn faculty aims to clarify role.

AUBURN, Ala. -- The portrayal on "20/20" of community pharmacy as error-ridden lacked balance, according to the professors who designed the test of prescription-dispensing accuracy used for the television show.

"What was aired was a classic case of journalism telling a story out of context," says R. Lee Evans, dean of the Auburn University James I. Harrison School of Pharmacy. Members of the school's faculty designed the "20/20" investigation of pharmacies, which found 22 errors in 100 prescriptions.

"Safety measures have clearly been effective at minimizing the risk of errors," notes professor Elizabeth Flynn.

She adds that ABC taped many examples of "good counseling" that were not presented on the show.

At the same time Flynn says that the order-entry environment at pharmacies remains problematic and that labeling errors should be reduced by minimizing staff interruptions. She also calls for studies of pharmacist placement for counseling frequency and prescription inspection.

Professor Bruce Berger notes that serious systemic woes have led to the kinds of problems presented on the segment.

Faculty members told "20/20" interviewers about such problems as increased demand for prescriptions, the pharmacist shortage and pressure from patients with a "fast-food mentality about medications," he comments. The show omitted mention of such factors.

At the same time reimbursement cuts have increased pressure to dispense more scripts to maintain profits, and there is inadequate compensation for counseling, Berger says.

"If a harmful prescription is caught and not dispensed to the patient there is no compensation," he says. "Incentives do not focus on providing the patient the most appropriate care."

The professors note that the school's Center for Pharmacy Operations and Designs was contacted by ABC in November.

Center staffers said the issue of dispensing errors was complex and subject to serious misinterpretation without the involvement of research pharmacists. They reached an agreement giving Auburn the responsibility for identifying errors and evaluating counseling, and the right to publish its part of the study, which it will do in an upcoming issue of the Journal of the American Pharmacists Association. Flynn was assigned to direct the project.

Faculty members at the Auburn pharmacy school stress that the center had no control over the information ABC presented.

One hundred pharmacies in Atlanta; Tampa, Fla.; and New York were selected at random, based on chain market shares. Actors presented a new prescription for one of the study drugs (Coumadin, Toprol XL, Depakote ER, Novolog MIX 70/30 insulin or Lantus insulin).

The actors attempted to purchase aspirin when they picked up Coumadin, and Sudafed PE with Toprol XL. Hidden cameras taped the results.

Of the dispensing errors there were 16 wrong instructions, five wrong quantities and one unauthorized drug. Three of the errors were judged by two clinical pharmacists to have a risk for patient harm.

The instructions on a Coumadin prescription read, "Take one tablet by mouth daily as needed," instead of "Take one tablet by mouth every day and as directed."

The second significant error was for a Depakote ER prescription that was dispensed without a childproof cap.

The third was on a label for Novolog Mix 70/30 insulin where the instructions were cut off. The label read, "Inject 15 units subcutaneously 15 minutes before breakfast, and 15 units 15 minutes," leaving off "before dinner."

Aspirin was purchased without any warning from the pharmacy staff with 17 of 25 Coumadin prescriptions. These two medications can be used together safely only if the patient's blood work is monitored closely for adjustments in Coumadin dosing.

Sudafed PE was purchased without warning with 23 of 24 Toprol XL prescriptions. There is a precaution concerning the use of Sudafed PE in patients who have uncontrolled hypertension.

The lack of warning about the potentially harmful interactions was alarming and should be addressed, say the professors.

Of 27 instances of counseling, six were initiated by the pharmacist with 21 coming after the pharmacist asked if the patient had any questions. There were 16 additional cases where patients stimulated counseling by asking what they were signing. There was no counseling on 57 prescriptions.

When counseling occurred three to four topics were typically covered. Patients with new prescriptions are required to receive verbal information on as many as 14 topics by regulation.
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Publication:Chain Drug Review
Geographic Code:1U6AL
Date:Apr 23, 2007
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