The error-prone elephant in the pharmacy room

Can we talk about this new trend of extended expiry dates on COVID products?

Pharmacy is all about accuracy and risk reduction, and for good measure. A mistake in the dispensary can lead to serious adverse outcomes for the patient. It makes sense then, that we have such an exhaustive list of rules and regulations surrounding the dispensing of medications.

To be honest, when I first started practising it seemed a bit of overkill.  Fresh out of school, with confidence oozing from my pores, I hadn’t yet seen the myriad of “silly” mistakes that can be made in the fast-paced environment of the dispensary.  Six years later, however, I understand how necessary these controls are in preventing human error.  I now find myself explaining to new pharmacy assistants the reasons these rules exist, and the ways things could go wrong if they are not followed.

So, why in the world are we suddenly allowed to just cross off an expiry date and put a new one on!?

Pharmacists and Registered Techs are so overstimulated and overburdened, that errors like injecting insulin instead of a vaccine are reported in the news, and yet we’re adding more nuance to the checking process? 

I am sure the folks at the top who came up with this scheme did a thorough analysis of the benefits and risks. They decided that the risk for error is acceptable to save product (money?). 

My question is this: If those at the top are allowed to make these judgement calls, does this not leave room for others on the front lines to feel it’s okay to make their own? Maybe a pharmacy owner struggling with inflation and declining profit margins needs to save money in their business?  Or maybe a burnt-out staff pharmacist looks the other way when an assistant combines bottles of different lots.  Are these not also judgement calls on risks vs. benefits?

If we are to have optimal safety in drug distribution, there is no room for different rules at different levels. There must be absolute confidence in the validity of the regulations such that there is uniform adherence. 

In my opinion, it’s time to end this relabeling practice before human nature puts us on a slippery slope to the wild west of drug slingin’.