Can you read this Prescription ???

There were days when teachers used to scold us for bad handwriting at school citing it as doctor’s handwriting. I was unable to decipher the exact meaning of it at that time. Days gone, I am getting the exact taste of that sarcasm.

When I started my professional career as a Hospital Pharmacist the first thing I had to do was to understand the code language [ doctor’s way of writing medications] in the prescription. Now after more than two years of work at hospital pharmacy the cycle is repeating and for how long I am unsure. 

During day to day encounter with such prescriptions, I have seen really bad to very good written prescriptions. Errors are bound to happen and I have experienced it. Sometimes wrong medicine was prescribed which I corrected by consulting the doctor. I have received some prescriptions with wrong dosing issues [ ciprofloxacin 200mg two times a day, ciprofloxacin 500mg three times a day, azithromycin 500mg three times a day and so on] but corrected them through doctor consultation. I sent back those prescriptions containing narcotics but without name of the prescriber and the date. Some prescriptions were so bad that I got confused whether the drug should be taken for certain days, week or months. So yup, we can minimize the errors and we are only the right person to do so.

I wonder why doctors don’t think it important to write the prescriptions correctly and neatly. Patients waste their entire day to meet the physicians. Doctor fill up the prescription but what is its use if it cannot be understood by the pharmacist who dispense the medicines to the patients. A mere change in letter can change the medicines given to the patients. Then what if wrong medicines are dispensed. Aren’t we playing with lives of people. Are doctors so much busy that they cannot even write it clearly what patient need to take in order to cure the diseases. 

Grow up, I still remember a quote by Dr. Vikash during the Pharmacovigilance training at Yak and Yeti hotel “gone are the days where doctors with bad handwriting were thought to be good doctors. Reality is if a doctor cannot write a medicine properly then he/she cannot be considered as good one. They are the bad ones’. I agree with this statement.

In the present context most of the overdosing and medication errors are due to bad prescription writing and wrong dispensing. The confusion with LASA medications and guess work by the pharmacist is another reason. We have read the characteristics of the good prescription. We are the one to dispense correctly and we are responsible for anything wrong that happen due to medications. So we must be careful while reading the prescriptions. 

Why not we send the confusing and badly written prescriptions back to the doctors or we can contact the doctor and clarify the issue. We cannot repeat mistake just by guessing wrong. If you get the prescriptions with narcotics without details of the prescriber and the patients, send back. It’s not your fault. 

Now time has come to be good at writing prescriptions. The medication errors that we are getting today can only be resolved when doctors give some extra seconds to write neat prescriptions. Doctors should at least consider writing the name of drug, dose and the frequency of taking the medicines correctly. This is directly linked with people’s lives. What about try E-prescriptions. This can minimize errors by 80 % I guess. On the other side of the coin, we should update ourselves on handling prescriptions. Training might help this out. Reading leaflets and searching about the daily used medicines on internet will enrich you. 

The diagnosis and treatment that a doctor does is finally complete when the patient gets correct medications and gets cured. Otherwise everything is of waste. So pharmacist should play a role in controlling bad dispensing. Never guess the medicines. Say no to bad prescriptions. 

HOSPITAL PHARMACISTS AND THE RISK OF INFECTIONS

“We pharmacist are the bridging link between the Physicians and the patient” Nobody can deny this fact. People from outside world [outside the pharmacy] only see Pharmacists reading out prescription carefully and dispensing medicines. They only look at the aprons and IDs of the dispenser.  Nobody ever thinks of the risk involved while handling the medicines.

Firstly, we pharmacists are unaware about the packaging, handling and transport of medicines. The environment at which the medicines are exposed to. Secondly, once the medicines are brought for dispensing, are handled by many individuals over a time. With bare hands the medicines are taken out from the package and dispensed to the patient party. How many of we without doubt tell about the condition of our hands. Are they really free of germs or bacteria? I doubt.

Also, there is a system of medicines return if they are not needed by the patients or the physicians prescribe another one. Also, the medicines from Hospital wards are returned to the pharmacy once they become unused. These are the medicines handled by the patients: may be suffering from fatal diseases. With regular contact with the patients, the medicines may also contain bacteria and germs, which may get transferred to other healthy individuals. We pharmacists are most susceptible to these.

Patients with communicable diseases come to visit the pharmacy coughing and sneezing. We pharmacists come in direct contact with such patients. Is that not a risk? Certainly, a huge risk. The droplets from the patients carrying the carrier agents pose greater threat of infection transfer.

I frequently hear hospital staffs complaining about headaches, uncured cough and fever. Even doctors and nurses come to the pharmacy asking for medications. This is all due to the infection transfer from the patients.

So, we should consider the risk factors involved while dispensing the medicines and act carefully. Use of disposable masks and gloves may be a better option. But what about the returned medicines? Can they be sterilized at first before dispensing again? Are the manufacturer prepared for the sterilization of such medicines? Until and unless these questions remain unanswered, the risk factor still remains.