Terry Spears, RPh

As trusted community health advisors, pharmacists can promote the safe use of medications and improve clinical outcomes.

Community Pharmacists Play Key Role in Improving Medication Safety

Americans rely on prescriptions to manage their health issues. In fact, according to health care market intelligence from IMS Health, prescription sales in 2009 grew by 5.1% versus 1.8% in 2008. Consequently, as more medications are prescribed to patients, the more likely it is that those patients will experience medication interactions if they don’t receive proper education from their health care professionals. Sadly, it appears that adverse interactions, medication overuse, and errors are a perennial problem. A recent study by researchers at the University of California, San Diego, and the University of California, Los Angeles, found that fatal medication errors rise in the month of July, just when new medical residents arrive at hospitals.

There is a powerful tool that can be employed to help patients avoid dangerous drug interactions and adverse health effects—that tool is the pharmacists themselves. The pharmacist often interacts with patients more often than the prescribing medical professional. Helping patients understand their medication regimens certainly improves health outcomes, but it also strengthens pharmacist—patient relationships and helps reinforce the role of the pharmacist as a trusted health advisor.

Pharmacists are in a unique position to improve medication safety because:

• Pharmacists have the time and clinical expertise to make a difference in the way patients manage chronic conditions for which they may be taking multiple medications.

• Pharmacists are an affordable and accessible health care resource. For many patients, it is probably easier to consult with a pharmacist than with a physician.

• The community pharmacy often becomes the de facto community health center, with pharmacists acting as the first point of care.

• Pharmacists already play an active role in coaching patients on potential side effects of their medications and why it is important to take them exactly as prescribed.

For patients with chronic conditions, pharmacists have an opportunity to monitor their patients’ use of combined medications and pass along information about possible interactions. However, to increase the effectiveness of these ongoing interactions, pharmacists need a plan for how best to communicate with their patients, because an ad hoc approach does not yield success.

A structured framework for patient consultations can improve the way patients monitor their medications and prevent potential problems with medication safety or drug interactions. In general, such programs include the following steps:

 Ask patients about existing health issues, such as high blood pressure or diabetes, that might worsen due to medication interaction.

 Schedule oneon- one time with patients to go over all their medications. This step can help prevent side effects or drug interactions resulting from prescriptions from multiple doctors.

 Remind patients of the role and importance of each medication in their regimen.

 Stress the importance of adherence for better outcomes.

One example of a structured approach to medication safety is the Pharmacy Quality Commitment program, offered by McKesson, which helps pharmacists reduce medication errors for their patients by offering a workflow for the prescription process and an online system to record interactions with patients. McKesson also offers assistance to pharmacists looking to take on a greater role in improving patient care and medication safety. Sponsored Clinical Services are an integrated set of services sponsored by payers and manufacturers that provide eligible patients with access to advice and education from trained pharmacists. These programs support both pharmacists and patients to improve patient outcomes.

All of these medication-monitoring programs can help keep patients safe by reducing harmful situations—and overall, by creating a bond between patient and pharmacist that helps connect the pharmacist to the care process.

Thanks to the Internet, pharmacists have quick access to a wealth of information about medication safety—information they can easily share with their patients. The Institute for Safe Medication Practices (www.ismp.org) offers fact sheets and tools on medication safety. For instance, the site offers printable PDFs on “high-alert medications” (those that can cause significant patient harm when used in error) and a “do not crush” list of medications that should not be crushed or chewed. (See also the Pharmacy Times Medication Safety column by Michael Gaunt, PharmD, in each issue.)

The combination of educational materials and ongoing patient counseling can go far toward detecting and preventing safety issues. For example, diabetes patients often suffer from other debilitating conditions, such as high blood pressure, high cholesterol, and obesity. These conditions may require additional medications along with a patient’s diabetes regimen. Pharmacists play a key role in ensuring that patients understand the interplay of medications that help manage diabetes. Since diabetes causes considerable strain on health care costs and management— according to the Centers for Disease Control and Prevention, 10% of all health care dollars are spent on diabetes and 20% are spent on conditions that result from diabetes&mdash;pharmacists can do their part to help manage these costs.

Recently, I was visited by a regular patient who requested a potentially dangerous combination of prescriptions. The patient was 

hypertensive, diabetic, and on kidney dialysis. He requested Humulin 70-30, Lantus, and Humalog, all at once, which immediately raised a red flag. As you probably know, Humulin 70-30, Humalog, and Lantus represent a combination of fast-acting, intermediate-acting, and long-acting formulations. Had the patient taken all 3, his blood sugar might have dropped significantly, resulting in a hypoglycemic state, or possibly death.

It turns out that the patient was refilling his regular prescription for Humulin 70-30 from 1 doctor and filling 2 new prescriptions from a recent hospital visit. I contacted the patient’s primary care physician to make him aware of these new prescriptions, and we agreed to fill only the new medications (Humalog and Lantus). In a situation like this, the community pharmacist often serves as the patient’s front line of defense against potentially dangerous medication combinations.

Medication errors and interactions have a financial cost as well as an impact on the well-being of an individual. When patients become ill due to safety issues, recovery time increases. As the health care industry and patients look at ways to reduce health care costs, community pharmacists can be part of the solution.

Pharmacists play a vital role connecting patients and medical professionals. They are specially trained to help manage side effects and counsel patients on taking multiple medications effectively and safely, and they are also more easily accessible than physicians. Community pharmacists offer a trusted environment in which to reduce medication errors and improve safety, while reducing costs and improving the quality of care.

Mr. Spears is owner of Family Health Mart in Vernon, Texas, and has been a licensed pharmacist for 30 years. He was the winner of the 2010 Next-Generation Pharmacist Award for Civic Leader of the Year. 

Terry Spears, RPh

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