Pharmacists' Impact on Patient Safety

AMERICAN PHARMACISTS ASSOCIATION Pharmacists’ Impact on Patient Safety A Joint Project of the American Pharmacists Association Academy of Pharmacy Practice and Management and Academy of Pharmaceutical Research and Science This publication was developed by the American Pharmacists Association. © American Pharmacists Association. All rights reserved. Printed in the U.S.A. Expert Panel Members Chelsea M. Anderson, PharmD, MBA, BCPS—Chair Dorothy L. Smith, PharmD Project Manager CEO and President Center for Medication Safety Advancement Consumer Health Information Corporation Purdue University College of Pharmacy McLean, Virginia West Lafayette, Indiana Terri Warholak, PhD, FAPhA Kimberly Sasser Croley, PharmD, CGP, Associate Professor FASCP, FAPhA The University of Arizona College of Pharmacy Clinical Pharmacist Tucson, Arizona Laurel Senior Living Communities London, Kentucky Daniel A. Zlott, PharmD, BCOP Oncology Pharmacy Specialist Calvin “Clay” Daniels, PharmD, PhD—Observer National Institutes of Health PGY2 Medication Use Safety Resident Bethesda, Maryland St. Jude Children’s Research Hospital Memphis, Tennessee Stefanie P. Ferreri, PharmD, CDE, BCACP, FAPhA Project Coordinator and Director, PGY1 Community Residency Program Contributing Author Clinical Associate Professor and Executive Vice Chair Angela T. Cassano, PharmD, BCPS, FASHP University of North Carolina Eshelman Pharmfusion Consulting, LLC School of Pharmacy Midlothian, Virginia Chapel Hill, North Carolina Elizabeth Flynn, PhD Clinical Associate Affiliate Professor APhA Staff Contributors University of Florida College of Pharmacy Ryan M. Burke, PharmD Artesia, New Mexico Associate Director, Practice Initiatives John A. Galdo, PharmD, BCPS, CGP Anne Burns, BSPharm Assistant Professor Vice President, Professional Affairs Samford University McWhorter School of Pharmacy Birmingham, Alabama Lindsay Kunkle, PharmD Director, Practice and Science Affairs Ashley Lorenzen, PharmD, BCPS Assistant Professor James A. Owen, BSPharm, PharmD, BCPS Concordia University Wisconsin School Vice President, Practice and Science Affairs of Pharmacy Mequon, Wisconsin Margaret Tomecki, PharmD, FAPhA Director, Practice and Science Academies Todd R. Marcy, PharmD, BCPS, CDE, CACP Associate Professor The contributions and significant commitment University of Oklahoma College of Pharmacy of these individuals in the development of this Oklahoma City, Oklahoma publication is gratefully acknowledged and sincerely appreciated. PHARMACISTS’ IMPACT ON PATIENT SAFETY • 1 Background care technologies. Pharmacists use this education and training to prevent medication errors, drug Medications are powerful tools that, if used interactions, and other adverse medication events correctly, can prevent or treat disease. If used from reaching patients. incorrectly, there is potential to cause great harm The safe distribution of medication to patients, to people who take them. These unintended also called dispensing or filling medication or effects, called adverse effects, can occur from prescription orders, remains a core function of any medication. As health care teams, which pharmacy practice. Ensuring the right dose of the include physicians, pharmacists, and other health right drug reaches the right patient at the right care providers, are making decisions about using time by the right route is the minimum standard by specific medications to treat an individual patient, which a pharmacist reviews every medication order they must weigh the potential risks against the for every patient. This practice is known as the “five desired benefit of each medication to minimize the rights”; it focuses pharmacists’ attention on patient chance of harm to the patient. safety and requires pharmacists to thoroughly As important members of the health care team, review each time a prescription or medication pharmacists work collaboratively with patients’ order is dispensed. In addition to the five rights, other health care providers in all types of patient pharmacists have responsibilities to make sure that care settings ranging from community pharmacies patients can get the medication they need and to hospitals and long-term care facilities. Across have the correct information to use the medication these settings, pharmacists take specific actions safely and effectively. that regularly contribute to improving patient With the expanding number and complexity safety. In the United States, a pharmacist is of medications, pharmacists’ roles and required to complete six to eight years of responsibilities have expanded broadly beyond education that includes training about diseases and medication distribution. Pharmacists are providing the medications used to prevent and treat them. patient care in almost all health care settings In addition to training on medications, pharmacist to help people of all ages get the most from education and training includes assessing health the medications that are prescribed to them. status of patients, providing education and Examples of pharmacists’ patient care services counseling, managing diseases, and using health include providing health and wellness screenings, managing chronic diseases, assisting patients with medication management, administering immunizations, and working with hospitals and Ensuring the right dose of the health systems to improve patient care and reduce the number of patients who are readmitted to the right drug reaches the right hospital following their hospital stay. patient at the right time by Pharmacists’ medication distribution and patient care services increase patients’ understanding of the right route is the minimum their medications and contribute to improving patient safety. standard by which a pharmacist reviews every medication order for every patient. 2 • PHARMACISTS’ IMPACT ON PATIENT SAFETY Pharmacists’ Actions to Improve Patient Safety and the Pharmacists contribute to improved Potential Impact patient safety by: As health care providers, pharmacists take an oath • Ensuring medication access: Making that reads, in part, “I will apply my knowledge, sure patients can afford their medications experience, and skills to the best of my ability and get the medications they need to assure optimal outcomes for my patients.”1 • Supplying medication information: Optimal outcomes include the safe use of Sharing information with patients medications resulting in the desired benefit to and their caregivers so they can take the patient’s health. While there are many actions medications safely and effectively that pharmacists can take to fulfill this oath and contribute to optimal outcomes, this publication • Evaluating medication appropriateness: highlights eight specific pharmacist actions that Assessing each medication to be sure improve patient safety within the health care that the medication treatment is the system. These eight actions are routinely taken by most appropriate, effective, and safe pharmacists in daily practice across patient care choice for the individual patient settings. The actions were compiled by an expert • Improving medication adherence: panel of pharmacist leaders and other contributors Helping patients take medications as from a variety of patient care settings. The actions prescribed by their health care providers are not listed in any specific order. For each action, • Providing health and wellness services: example scenarios are provided to illustrate how Delivering needed patient care services pharmacists address specific patient care issues designed to improve the health of through their actions and the outcomes and the patients impact those actions have on patient safety. • Performing medication management services: Comprehensively reviewing all of a patient’s medications, ensuring that they will work together without avoidable problems, and developing an effective, well-designed treatment plan for the treatment or prevention of disease • Assessing patients’ health status: Determining the current status of a patient to provide treatment guidance and assess the effectiveness of medication therapy • Coordinating care transitions: Assisting with care coordination and medication management coordination for patients as they transition from one care setting to another 2 • PHARMACISTS’ IMPACT ON PATIENT SAFETY PHARMACISTS’ IMPACT ON PATIENT SAFETY • 3 Measuring Impact Ensuring Medication Access There are many ways to measure the impact that The costs of health care, particularly those a particular patient care action has on the patient related to medications, can prevent patients from and the health care system. While some measures, achieving their treatment goals. Patients may such as how many days a patient spends in the choose to skip a dose of medication or completely hospital, are quantifiable, others are not. For stop taking a medication due to cost. Since patients, the focus is often on quality of life, the medications are an important part of managing cost of care, or how satisfied they are with the care disease, not taking them can result in patients they receive. In almost every case, pharmacists’ returning to the hospital, which can be very costly actions aimed at improving patient safety result for both the patient and the health care system. in a positive impact to the patient and the health Pharmacists have the knowledge and resources care system. to help patients address medication costs. In cases where insurance coverage is an issue, pharmacists can work directly with the patient’s insurance company to resolve problems.

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