Company policies can contribute to pharmacy errors

When Tabitha Jones picked up her stepson's medicine at a Walgreens store near Nashville in 2004, she had no way to know the pharmacy was so busy that its manager had asked for more staffing months earlier to "decrease the pharmacist's stress."

She also had no idea the drug Walgreens gave her that day was a steroid never intended for children, and not the blood pressure drug prescribed to treat Trey Jones' hand tremors and hyperactivity. Walgreens refilled the prescription four times, eventually at double the adult dosage, before the error was caught. The 5-year-old not only went into premature puberty but also erupted in rages.

Trey's parents sued Walgreens, fearing the steroid could stunt the boy's growth or cause liver damage. "We don't know what could happen later on down the road," his father, Robert Jones Jr., said in a 2006 pretrial deposition.

Pharmacy chains say they've spent billions of dollars on safety technology and other improvements that have cut their prescription-error rates to a fraction of 1 percent. As aging baby boomers and other Americans increasingly rely on prescription drugs, an Auburn University pharmacy study in 2003 projected the odds of getting a prescription with a serious, health-threatening error at about 1 in 1,000. That could amount to 3.7 million such errors a year, based on 2006 national prescription volume.

A USA Today investigation found evidence that corporate operating policies — such as allowing or encouraging pharmacists to fill hundreds of prescriptions daily and rewarding fast work — can contribute to errors like the one that befell Trey Jones.

The investigation reviewed policies and alleged errors at rivals Walgreens and CVS, the nation's two largest drugstore chains, which fill nearly one-third of all retail prescriptions nationwide. It included a review of scores of lawsuits, as well as pharmacy board disciplinary actions in 10 states and interviews with pharmacists, drug-error victims, their families and attorneys. Some common factors emerged:

• Too many prescriptions, too few pharmacists. Some stores fill so many prescriptions that pharmacists work long shifts with few breaks. In the case of Benjamin Goldberg, a North Carolina baby whose parents were given an antibiotic with instructions for five times the prescribed dosage, the state pharmacy board reprimanded a CVS pharmacy for filling prescriptions "at such a rate as to pose a danger to the public health or safety."