A recent article in the New York Times reports that a man in Long Island was inadvertently provided Durasal (a salicylic acid solution used as a wart remover) instead of Durezol (a corticosteroid eye drop) following routine eye surgery. He says he suffered “grievous personal injury”. To his credit, the names do look and sound similar and the packaging is similar as well. But that is where the similarity stops. Durasal is supplied in a bottle with an applicator wand (like Liquid Paper) and has a warning statement on the front of the box saying not to use it in the eyes. Durezol, not surprisingly, is supplied in an eye drop bottle.
The similar names of these very different medications do set up the potential for medical errors. Other medications can be confused as well with even more dramatic and sometimes deadly results. The Federal Drug Administration has taken numerous steps to help avoid these errors. Names for medications are now strictly regulated. Manufacturers submit a list of potential names for a new medication to the FDA who then makes the final selection. They must select a name that is unique to avoid patent infringement issues and confusion with other medications. To complicate the matter further, each medication has three names – a chemical name, a generic name, and a brand name. The chemical name is typically used only by researchers and must follow a certain naming convention. Similarly, the generic names follow certain naming conventions often based on their drug class while the brand name is often just a made up word. Sometimes there is an effort to make the name mean something – for example, the asthma medication Advair suggests the words advantage and air. In a perfect world, every medication would be a unique word that makes sense for its intended purpose and is not easily confused with any other medication whether compared to its brand or generic name. It also should be pronounceable and memorable. If you have seen medications names lately its obvious we do not live in a perfect world.
To even further complicate the matter pharmacists are expected to read doctors handwriting which is riddled with abbreviations (often in Latin) and sometimes ambiguous punctuation. This means that words that may look completely different in print may look quite similar in script – especially the hastily scrawled script common with many doctors including myself. The solution for decreasing the potential for errors may be something called e-prescribing. At Regional Eyecare Center we began e-prescribing last year on a limited basis as we tested out the system. We’ve increased our usage and will soon be using e-prescribing as our preferred way of writing prescriptions for all medications. The system is secure and increases safety for the reasons listed above. It provides a formulary check that helps us to utilize a medication that is less costly in many cases, watches for drug allergies, and can even look for interactions between current medications.
So the next time you come into the office and need a prescription for your allergies, an eye infection, or glaucoma don’t be surprised if you don’t receive a written prescription. It’s just another way we are doing our best to care for our valued patients.
Scott McDougal, O.D.