Pharmacist Pete Kreckel prays to his profession's patron saints, Cosmas and Damian, to protect him from error, and for 29 years he's never made a mistake that hurt anyone, he says.
But the Broad Avenue Pharmacy employee does more than trust in prayer: He relies on error prevention policies that include multiple sets of eyes, computerization, an $18,000 counting and verification machine, his red pen and - not least - a conversation with customers about every first-time prescription.
That kind of conversation could have prevented the recent pharmacy error at a Giant Eagle in Pittsburgh that sent a woman to the hospital with an allergic reaction when she got an anti-depressant instead of a fertility drug with a similar name, Kreckel said.
Talking with a customer about dosage strength and frequency, side effects and a drug's purpose before ringing up a purchase can quickly alert a customer to a miscue, he said.
The mistake in Pittsburgh occurred despite company policies "to ensure quality and accuracy in the prescription fulfillment process," Giant Eagle spokesman Dick Roberts said.
It's an anomaly, "as evidenced by our recent honor as an Institute for Safe Medication Practices award recipient," he said.
It was probably an example of "wrong clicking," Kreckel said.
A pharmacy employee probably started typing the name of the prescribed drug, Clomiphene, calling onto his screen a list of drugs beginning with those letters - like when you type a search into Google - then simply clicked the wrong choice, Clomipramine, he said.
Why?
Eighty percent of pharmacy errors result from interruptions, Kreckel said.
He tries to minimize distractions at what for him is the most critical time, when he checks a drug, its potency and the number of prescribed doses by name and code number on the prescription itself, the supply bottle and the prescription bottle.
At Broad Avenue, the process begins with a technician who enters the customer's birth date on screen, brings up his history with the store chain, calls up or types in the drug, its potency and dosage information and creates a label with a bar code.
If there's a doubt about the doctor's handwriting, the tech eliminates it by consulting the patient's history or the doctor.
A fourth of prescriptions are handwritten, an eighth are phoned in and the rest written by machine - either on a hand-carried prescription or by fax or electronically, Kreckel said.
Another tech operates the counting machine, which reads the bar code, shows a picture of the pill and the name of the drug, and accepts the bar code on the supply bottle and the label as a match.
Then it's Kreckel's turn to verify.
Ultimately, it's the pharmacist's responsibility to get it right, no matter who initiated an error - unless it was that of the doctor who wrote the prescription, he said.
"Errors are every pharmacist's worst nightmare," he said. "You worry about it before work, during work and after work."
Pharmacist Kylee McDougal of Martin's Food Market on Chestnut Avenue said it's easy to overlook something when you're busy, especially during a 12-hour day filling 250 prescriptions. But she always calls the doctor if there's a question about a prescription.
Giant Eagle "includes numerous checks and balances throughout the entire transaction, from the time the prescription is received by the pharmacy to when the medication is handed to the customer," Roberts said.
It never gets to 100 percent, Kreckel said.
"Unfortunately, it's a human-driven profession," he said. "We're not perfect."
Mirror Staff Writer William Kibler is at 949-7038.
