ISMP Safe Medicine, March/April 2006, Volume 4, Number 2. ©2006 ISMP
Brand name medicines appear in green;
generic medicines appear in red.
Nothin' but the fax, ma'am
You may have noticed that some doctors’ offices will no longer “call in” a prescription for you. They may offer to fax it to the pharmacy instead, or ask you to pick it up at the office. While this is a change from what has been done in the past, it can be safer than a phone call. Spoken words can be misheard or misinterpreted, as shown in the cartoon below.
Many pharmacies now have a voice mail system to answer calls. Messages that your doctor’s office staff leave can be misunderstood, and there is no way for the pharmacist to ask callers to repeat the prescription for clarity. In one instance, a message was left for Prilosec (omeprazole) 20 mg daily (to treat stomach acid reflux). When the patient arrived, her prescription was not ready yet. In the rush to fill the prescription quickly, the pharmacist misheard the medicine’s name on the message machine as Prozac (fluoxetine), an medicine for depression. Luckily, the woman read the label on the bottle before leaving the pharmacy and the prescription was corrected.
Much of the time, it is not the doctor who calls in the prescription. Most often, it is a nurse, but it may be a person with no medical training. They may be unfamiliar with the names of medicines or unable to answer any of the pharmacist’s questions. For example, a medical secretary was supposed to call in a prescription for ranitidine (used to treat stomach ulcers and reflux). She had trouble pronouncing the name of the medicine. The pharmacist thought he heard the secretary say “amantadine,” a medicine that treats Parkinson’s disease. The patient picked up the prescription for amantadine and began taking it. When his stomach pain was not relieved, he visited his doctor and brought the medicine bottle with him. When the doctor saw the bottle, he realized the man had been taking the wrong medicine.
Eventually, doctor’s offices will have computer systems that allow them to electronically send your prescription directly to the pharmacy. Until then, it is safer to have the staff at your doctor’s office fax your prescription to the pharmacy. Having your pharmacy’s fax number handy when you call your doctor’s office is helpful. Better yet, you can pick your prescription up at the office and take it to the pharmacy yourself. This way, the pharmacist can check with you, face-to-face, if he or she has any questions about why the medicine is being prescribed.
Don’t take medicine in the dark!
A man was awakened by a toothache in the middle of the night. Without turning on the lights, he pulled out and applied what he thought was a spray of pain reliever for his toothache. Afterwards, he did not rinse his mouth. In the daylight of the morning, he realized he had actually used Lamisil AT Pump Spray in his mouth. Lamisil AT (terbinafine hydrochloride 1%) is used for fungal infections on the skin such as athlete’s foot and ringworm. It should never be placed in the mouth or swallowed. The medicine can be absorbed by the body through the gums. It also has a high alcohol content (28.7%). The man called Poison Control (800-222-1222), which advised him to see his doctor immediately. He did, and he was not harmed. However, this story should serve as a reminder to avoid taking medicine in the dark!
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