PVMA Keystone Veterinarian Summer 2020 - 19

Two of the most common medications to have dosing concerns
include Levothyroxine and Phenobarbital.1,2
Clients may be advised by the pharmacists that the dose
prescribed by the veterinarian is too high and recommend
dose reduction without consulting the veterinarian. In the
2019 Pennsylvania survey, 73% of veterinarians reported that
a pharmacist had questioned the strength or dosage of the
prescribed medication.3
Prevention of Error:
* Build relationships with local pharmacies and encourage
	 them to call with concerns before discussing them with
	 a client. Be patient when the pharmacy team calls with a
	question.
* Consider donating an old copy of your favorite animal
	 drug reference to area pharmacies as many do not have
	 access to an animal formulary.
* For medications with large dosing differences between
	 animals and humans, inform the client that the pharmacist
	 may express concerns regarding the dosage when they
	 pick up the medication.

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Error 3: Insulin and Syringe Errors
A specific subset of dosing and dispensing errors that has a
large potential for harm in veterinary patients are changes
in insulin type or mistakes in insulin syringes. Veterinarians
recommend a specific type of insulin based upon the species
they are treating. Pharmacists have been known to suggest
substitution of a less expensive insulin in an effort to help
clients, which can result in a poor response to therapy and
even lead to a patient progressing into Diabetic Ketoacidosis.1
Additionally, many pharmacists are not aware of the difference
between U-40 and U-100 syringes.4 The misuse of syringes can
result in under- or over-dosing of patients.

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Prevention of Error:
* Provide a written prescription to your client and specify
	 "No substitutions" to ensure they receive the intended
	 insulin product.
* Dispense veterinary-specific (U-40) insulins and syringes
	 directly from your office.
* Discuss the costs of insulin with your client prior to
	 starting treatment to prevent surprises when they arrive
	 at the pharmacy.
* Educate clients on insulin and syringe types before they
	 leave the office.
* Advise clients to bring insulin and syringes to rechecks to
	 ensure they received the correct product.
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Pennsylvania Veterinary Medical Association | 19
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PVMA Keystone Veterinarian Summer 2020

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