Thousands of patients experience complications from prescription errors. Here's how to make sure you're taking the right drugs, at the right times, in the right dosages.

Sarah Grey* has been standing on her feet in nearly the same spot for the past eight straight hours. Just four and a half more hours till she can grab a bite to eat. She's got an inch-tall stack of white papers in front of her, a less-than-happy crowd of people staring at her and a phone that seems to find pleasure in ringing non-stop. It's four o'clock at this large Atlanta pharmacy and for Grey, a pharmacist, prescription rush hour has just begun. 

Grey's high-stress, pressure-cooker role places her at the nexus between patient and doctor, an interpreter or middleman of sorts with the critical and not-so-simple task of correctly delivering to you the medication you need. On one hand, she's got to interpret written directions from overworked doctors, who have to remember countless drugs, their dosages and their interactions; and on the other hand, she's got you, possibly in pain, tired of waiting, eager to get home and less than pleased about spending 30 minutes at the pharmacy. Her goal? To decipher and deliver an error-free prescription. Grey's mission is one shared by more than 330,000 other pharmacists across the United States. If their dedication or focus wavers, your health - and in some cases your life - is put at risk. 

The chaos will die down in about two hours, but not before many, many prescriptions pass through Grey's hands and into the hands of people like you. Grey's lucky, though; she fills only 200 to 300 prescriptions in a 12-hour day. Other pharmacists she knows at larger pharmacies fill as many as 400 to 500 a day, doubling their odds of making a mistake.

Despite distractions like patient interruptions, noise and ringing phones - or even bigger issues like being short-staffed - Grey says most errors are caught at the register. Even then, those errors usually are harmless and are most often related to quantity or dose. For example, your doctor might want you to take a medication twice a day for 30 days. Your bottle label might say you've got 60 tablets, but the pharmacist gave you only 30. In this case, your inconvenience isn't harmful - as long as you or the person at the register spots the discrepancy and gets it corrected - it's just a hassle. 

If you or your pharmacist misses an error, the "hassle" factor escalates. Prescription errors at the very least can result in exacerbated or additional side effects, allergic reactions or drug interactions, and even increased or continued symptoms of your condition caused from missing a dose of the medication you were supposed to take. At the very worst, these errors can cause significant complications and, in some cases, even death. In one year, approximately 7,000 patients died as a result of medication errors, according to a report from the Institute of Medicine (IOM). 

Most errors are made between 4 and 6 p.m., when a pharmacist has scores of prescriptions waiting to be filled, a long line of people who are tired of waiting and not enough time to offer counsel to each customer about what medicine they're taking and how to take it. "When you're hurrying, it's easier to make a mistake," Grey says. "When you've got people waiting, sometimes a pharmacist may decide to make an educated guess about a prescription that's hard to read, rather than take the time to call the doctor back." 

But Grey says her pharmacy, like most others, follows a strict series of safety measures when filling prescriptions - steps designed to reduce the number of errors. Grey's pharmacy has four safety checkpoints: the visual on-screen computer check against the written prescription, a check of the printed label against the written prescription, a workstation check of the printed label against the drug maker's bottles and then a final register check. A technician may help Grey by counting pills, but Grey must verify the amount is correct and sign off that the medication is correct before stapling the patient information sheet to the prescription bag. At the cash register, Grey pulls out the medication, again verifying she's supplied the meds she was supposed to. You, as the customer, then sign off that you've received the medication intended for you. And, finally, Grey asks if she can answer any questions about your medication.

With such strict safety measures at pharmacies, why are prescription errors still an issue? Because the problem doesn't exist only in pharmacies. It extends to doctors' offices and, surprisingly, your own home. 

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