Kansas City, MO—In 2020, partly due to the COVID-19 pandemic, pet ownership in the United States leapt up from 67% of all households to an all-time high of 70%, according to the American Pet Products Association (APPA).
Community pharmacies are expected to feel the effect of that increase, according to a new study in the Journal of the American Pharmacy Association. The authors raise concerns about high error rates with those prescriptions.
Researchers from the University of Missouri Kansas City and colleagues suggest, "Community pharmacies are poised to see more veterinary prescriptions as a result of increased pet ownership especially during the coronavirus disease 19 pandemic".
"Concern has been raised about the lack of veterinary pharmacy training that community pharmacists receive, but no studies have evaluated the actual prevalence of errors in veterinary prescriptions including the prevalence of prescription writing errors."
The study team sought to identify the prevalence of errors in veterinary prescriptions at independent community pharmacies. To do that, researchers used an electronic form to ensure required information was pulled from the pharmacy software systems in a consistent manner. Information was matched from the hard copy image to the prescription label corresponding to that fill.
The authors assessed prescribing trends, such as species and errors, using descriptive statistics for the overall sample, while quantifying error comparisons between written and verbal prescriptions and between weight-based and nonweight-based prescriptions.
Results indicate that weight was omitted from 97.8% of prescriptions. That is a problem, according to the authors, because, while not legally required, it is clinically necessary for evaluation of veterinary prescriptions.
When looking at the prevalence of errors between handwritten and verbal prescriptions, the researchers point out that errors in prescriptions handwritten by the veterinarian (105 of 119; 88%) were more likely than those provided verbally (257 of 389; 66%). On the other hand, handwritten prescriptions were less likely to omit the required Drug Enforcement Agency number on controlled substance prescriptions.
"Based on the number of errors seen in both handwritten and verbal prescriptions, emphasis should be placed on training pharmacists to be competent in clinically evaluating veterinary prescriptions and training veterinarians on handwriting prescriptions to include both legally and clinically required information needed before dispensing," the researchers concluded.
A press release this spring from the FDA cautioned about medication errors with veterinary drugs. The FDA points out that it also monitors medication errors that affect pets.
"A number of the medication errors that occur in the treatment of people are the same as those we are seeing in the treatment of animals," explained Linda Kim-Jung, PharmD, a safety reviewer in the Center for Veterinary Medicine's (CVM) Division of Veterinary Product Safety."
The FDA advises that prescriptions for pets are sometimes filled in the same pharmacies that serve human patients, and that errors can occur because of something like an abbreviation. "Unclear medica'l abbreviations are a common cause of the medication errors we review at CVM," stated Dr. Kim-Jung.
Part of the problem is that pharmacists in human pharmacies might not be familiar with certain veterinary abbreviations for different dosage amounts. CVM has found that the abbreviation "SID" (once daily), sometimes used in veterinary prescriptions, was misinterpreted as "BID" (twice daily) and "QID" (four times daily), resulting in drug overdoses.
"If the vet has prescribed a drug where there's a strong correlation between the dose and the severity of side effects, an overdose can have serious consequences," Dr. Kim-Jung pointed out. "Poor penmanship can add to the problem, too."
Problematic abbreviations such as "u" (units) or the Greek letter mu could be mistaken for the letter "μ" or a number zero "0", or the "mcg" abbreviation for microgram could be mistaken as "mg" (milligram). Also, when prescriptions are written without a leading zero or with a trailing zero, it can potentially lead to a dangerous overdose error. "So, a 5 mg dose written as 5.0 mg can be misread as 50 mg, potentially resulting in a 10-times overdose if the order is not clearly written," Dr. Kim-Jung explained.
In addition, drug-selection errors can occur because of labels or packaging that look similar. Additionally, a pharmacy might dispense a wrong drug if the drug names look alike when written on a prescription, or if the drug names sound alike during verbal orders.
The FDA offered the example of a veterinarian who called in a verbal order for Zeniquin (marbofloxacin), an antibiotic for a dog, and asked if it was available in generic form. The pharmacist misinterpreted the order as "Sinequan" and dispensed its generic formulation, doxepin. Sinequan (doxepin) is used to treat depression and anxiety in humans. The dog owner called the veterinarian 24 hours later concerned that the dog was ill; the pet was treated and recovered.
"Mistakes can happen at the veterinary clinic, but also in the pharmacy which fills the prescription, and at home, when the pet owner gives the animal the meds," stated Dr. Kim-Jung.
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