Medication errors: What is the pharmacist’s role?
Throughout my pharmacy education and training, it was often said that medications are one of the most cost-effective strategies for treating patients with acute and chronic conditions. At the time, I naively believed that pharmacists and prescribers worked as a team to ensure that patients were achieving their therapeutic outcomes with safe and effective medications. After almost 30 years in the profession, the majority of that time spent re-engineering community pharmacy practices to provide medication therapy management services, I realize just how naive I was.
That is not to say that I haven’t seen progress in pharmacy during that time, because I have. The frustration that I continue to experience day in and day out stems from the obstacles and constraints that continue to plague our health care system, especially as they relate to health care providers working collaboratively to ensure that patients are receiving optimal care and positive health outcomes.
This hits home from a personal perspective when I see medication errors affecting my own family members. Because I am power of attorney for health decisions for my mother and stepfather, I have gotten a firsthand look at our broken system and how medication errors not only exist but are much more common than I ever imagined. This was confirmed in an article that I read about medication errors and their impact on patients.1
The article noted the following:
- Medication errors are common and vary depending on the practice setting (e.g., intensive care units have a high risk of medication errors).
- Medication errors can occur at any stage of the medication use process: ordering, dispensing, administering, or monitoring.
- Medication errors occur in both the hospital and outpatient settings.
- Among ambulatory older adults, most errors occur at the prescribing and monitoring stages (including patient adherence to medications).
- During transitions of care, patients are vulnerable to medication errors, especially as they relate to accurate medication lists.
- Health care provider factors contributing to medication errors include therapeutic training, drug knowledge and experience, knowledge of patients, high workloads, time pressures, and interruptions experienced during patient care episodes.
During my academic days at the University of Iowa College of Pharmacy, I and other colleagues were tasked with the responsibility to help community pharmacists re-engineer their practices so that pharmacists were freed up to provide medication management services to their patients. This was accomplished by improving workflow, maximizing the role of technicians, and remodeling the pharmacy. Pharmacists were responsible for finding and resolving patients’ potential and actual drug therapy problems experienced by their patients, communicating their clinical recommendations to prescribers, and documenting their clinical activities. I believed in this model so much that I left academia to create this type of practice in a traditional community pharmacy.
A decade later, I am even more convinced that community pharmacists need to be integrated better within the health care system. As I look at the bullet points from the article cited in this column, I see the role of community pharmacists in helping to prevent medication errors. Looking at the first bullet, I see that first we need to recognize that medication errors are prevalent in our health care system. Next, we need to understand where medication errors occur during the patient care process and develop interventions to minimize or prevent their occurrence.
For example, we must review prescriptions with each patient, check for accurate dosing, and ensure that patients are receiving the right medication for the indication prescribed. Next, pharmacists should assess patients’ understanding about their medications and provide them with any additional education/counseling needed. Ensuring appropriate medication monitoring is another important responsibility of pharmacists, including that patients are taking their medications as prescribed. Also, pharmacists should take extra time whenever their patients are in care transitions. This includes making sure they are receiving discharge summaries, progress notes, and labs from the discharging entity. It also means knowing patients’ current medication list.
But this is not enough. It is time for a paradigm change in community pharmacy. I cannot emphasize enough that the old practice model of high-volume dispensing is no longer an accepted model of care. In fact, as the last bullet implies, interruptions in the normal course of patient care can lead to medication errors. Pharmacists need to be freed up to provide medication services to patients in an environment that limits interruptions and supports patient care activities. We need to accept our responsibility within the health care system to ensure that medications are being prescribed and monitored appropriately. If we don’t step up to resolve the problem of medication errors in our health care system, someone else will!
- Mayo Clin Proc. 2014;89(8):1027−29