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Managing Visits From Pharmaceutical Sales Representatives
A pharmaceutical sales representative visited a behavioral health unit of a hospital to market an analgesic that contained acetaminophen. After speaking to the physician director of the unit, the sales representative left a substantial supply of sample tablets on the counter at the nurses’ station. A patient noticed the tablets, confiscated them from the counter, and took all the tablets at the same time. When the problem was discovered, the patient was sent to the emergency department and treated with gastric lavage. Fortunately, the patient had no ill effects from the overdose.
In an incident depicted in the film Beyond Blame,1 several patients mistakenly received mivacurium (Mivacron, Glaxo Wellcome/Abbott), a neuromuscular blocker, instead of metronidazole (Flagyl, Pfizer). Three patients experienced respiratory arrest and were rescued, but another patient died. The error occurred after the anesthesia department had ordered mivacurium following a sales visit by a pharmaceutical representative. The carton of mivacurium was delivered to the pharmacy and was placed in stock next to metronidazole. Both products were packaged in foil overwraps.
Before the error occurred, metronidazole had been the only foil-wrapped, pre-mixed solution in the pharmacy; mivacurium was not on the formulary. Neither the technician nor the pharmacist who prepared and dispensed the erroneous drug was aware that a trial carton of mivacurium had been delivered to the pharmacy. Thus, they failed to notice that the foil-wrapped bags contained mivacurium, not metronidazole.
At the time of the error, the drug name was not on the foil overwrap and was not easily visible through a clear plastic window. Thinking that the drug was light-sensitive, nurses who administered the drug did not remove the foil overwrap entirely and therefore also failed to notice the error.
Some medical schools and hospitals have begun reinforcing prescribers’ natural skepticism and have encouraged them to raise challenging questions during sales pitches from pharmaceutical salespeople.2–4 A few medical schools and affiliated hospitals, including Stanford, Yale, and the University of Pennsylvania, have banned prescribers from accepting gifts from pharmaceutical representatives.3,4 A report by the Association of American Medical Colleges endorses these strategies and calls for additional restrictions to limit drug and medical device company interactions and influence at medical schools and teaching hospitals.3–5
Even though most prescribers believe that they can avoid being affected by a sales pitch or a gift,3–6 robust processes to mitigate undue influence in academic and clinical arenas will help prevent and halt potentially harmful influences on prescribing habits.
- ISMP Online Store. Beyond Blame: Solutions to America’s Other Drug Problem Horsham, Pa: Institute for Safe Medication Practices (ISMP). 10-minute documentary, DVD. Available at: https://www.ismp.org/resources.
- ECRI Institute. Sales representatives and other outsiders in the OR. Healthcare Risk Control 1999;4:1–10.(
Surgery Anesthesiaseries 24).
- Caruso DB. Med schools warn of drug sales pitches. Associated Press. November
22006;Available at: and www.insur-anceheadlines.com/pdf/3016.html. Accessed April 3, 2012.
- Caruso DB. Medical schools train doctors to resist marketers’ siren songs. Associated Press. November
12006;Available at: www.commercialalert.org/news/archive/2006/11/medical-schools-train-doctors-to-resist-marketers-siren-songs. Accessed April 3, 2012.
- Industry Funding of Medical Education: Report of an AAMC Task Force Washington, D.C: Association of American Medical Colleges. June 2008;Available at: https://www.aamc.org/download/157370/data/industry_funding_report.pdf. Accessed April 2, 2012.
- AAMC Calls for Strict Limits on Industry Support of Medical Education Washington, D.C: Association of American Medical Colleges. June
192008;Available at: https://www.aamc.org/news-insights. Accessed April 2, 2012.