Kameron, a med tech in the pharmacy, caught a significant medication error. She found a critical mistake in medication labeling from the patient’s retail pharmacy. The patient had filled a prescription for hydroxyzine (an antihistamine) at a local pharmacy, and it was mistakenly labeled and filled as hydrochlorothiazide (a diuretic).
The patient presented to the ED with confusion and low sodium (due to the diuretic). Because this was realized, the pharmacy department was able to reach out to the local pharmacy and notify them of the error so it could be corrected and they could work on their internal process, helping to prevent similar errors in the future.