PVMA Keystone Veterinarian Summer 2020 - 18

PHARMACY HEADACHES PART 3:
Preventing Common Errors When
Working with Retail Pharmacies
By Kate Boatright, VMD,
and Lauren Forsythe,
PharmD

Part 1 of this series discussed why conflicts may arise between
veterinarians and pharmacists, and part 2 began discussing
ways to minimize these conflicts. Both professionals are doing
their jobs, but many pharmacists lack training in veterinary
pharmacology. With this information in mind, we can dive more
deeply into specifics of frustrations and errors that arise when
working with retail pharmacies and how veterinarians and their
teams can prevent them.
There are several different types of errors that may occur, each
with its own potential consequences. Many of these errors
were first brought to light in 2012 after the Oregon Veterinary
Medical Association (OVMA) released the results of a member
survey on pharmacy issues.1, .2

Error 1: Incorrect Medication Dispensed
The OVMA study documented multiple cases where an
incorrect medication was dispensed.1 The two primary reasons
this occurred were miscommunication of drug name and
inappropriate substitution.

specified by the prescriber. These legal substitutions have the
potential to be problematic for veterinary patients, such as
when a gabapentin suspension without xylitol is replaced with a
suspension by a different manufacturer that contains xylitol.
Sometimes, a pharmacy may substitute a medication when
the prescribed medication is not carried. Pharmacists should
check these substitutions with the prescriber, but unfortunately,
this does not always occur. Examples of common (but
illegal) substitutions include dispensing hydrocodone with
acetaminophen in place of Hycodan and prednisone in place of
prednisolone.
Prevention of Error:
* Ensure clear communication between prescriber and
	 pharmacist. Written prescriptions are best and should
	 ideally be typed. (See part 2 of this series for more
	 information on clear prescriptions.)
* 	If a prescription is phoned in, spell the drug name in cases
	 with similar sounding drugs, ask the pharmacist to repeat
	 back the prescription order, and document who you spoke
	 to in the pet's medical record.

The highest risk of a miscommunication occurs with medications
with similar-sounding names, such as Azathioprine and
Azithromycin. In extreme cases, errors can result in patient
death due to lack of improvement (i.e. Azithromycin filled
instead of Azathioprine for an immune-mediated disease in a
dog) or side effects of the wrong medication (i.e. Azathioprine
filled instead of Azithromycin for a cat leading to bone marrow
suppression).1,2

Error 2: Incorrect Alterations to Dose

When it comes to substitutions, pharmacists can legally
substitute a generic medication for the brand name product
or interchange manufacturers unless "no substitutions" is

Pharmacists are legally required to verify the accuracy and
validity of each prescription. There are numerous medications
with large differences in dosing between humans and animals.

18 | Keystone Veterinarian

* Make the client aware of what medication they should
	 expect to receive at the pharmacy. Including the name
	 of the medication on written discharge instructions offers
	 a way for the client to double check that they received the 	
	 right medication.
PVMA Keystone Veterinarian Summer 2020

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