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Patient Safety and Quality

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Pharmacists help identify patient safety and quality issues by clarifying prescriptions

Pharmacists commonly call primary care doctors to clarify ambiguities in prescription medication type, dosage, instructions, and/or amount. In a new study, one-fifth (21 percent) of these callbacks involved clarifications of dosage (dosage was unclear or missing). Such callbacks may have prevented serious patient problems due to inappropriate dosing. Medication types that most often required clarification were gastrointestinal (21.7 percent), cardiovascular (13.9 percent), and analgesic/anesthetic (13.2 percent) agents.

Other callbacks addressed administrative issues such as prior drug authorization (37 percent) and drug formularies (26 percent). The time spent resolving these problems can result in delayed therapy or patient compliance errors due to changes in medication frequency or dosage. Frequent formulary changes are also confusing for clinicians, as they struggle to prescribe formulary-approved medications for their patients.

Researchers at the University of Colorado Health Sciences Center suggest use of electronic prescribing systems, readily accessible and accurate medication formulary lists, and including indications for drug therapy on the prescription to ensure patient safety. Their findings were based on a study of 22 primary care practices participating in a patient safety study. Callbacks from pharmacies were logged for 2 weeks to determine the reasons for callbacks, the drug classes involved, whether issues were resolved on the same day of the call, and variability of callbacks among practice types. Practices recorded 567 clarification calls during the 2-week period. Residency practices averaged more issues per call. The study was supported by the Agency for Healthcare Research and Quality (HS11878).

See "Pharmacy clarification of prescriptions ordered in primary care: A report form the applied strategies for improving patient safety (ASIPS) collaborative," by Laura B. Hansen, Pharm.D., Douglas Fernald, M.A., Rodrigo Araya-Guerra, and others, in the January 2006 Journal of the American Board of Family Medicine 19(1), pp. 24-30.

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