When we think of our pharmacy crew, who comes to mind first? Of course we need pharmacists, technicians, sometimes we have cashiers, we might have delivery drivers, we might even have a nurse on staff. Maybe we think of our telemedicine providers. Our pharmacists and techs might specialize in areas like 340b, sterile or non-sterile compounding, pharmacogenomics, or MTM.
However, there's one member of the team we've conveniently left out of this list. They can reduce errors and improve the level of care your provide. They can even teach us lessons to improve our own processes, and some of them are experts in highly reliable organizations and can bring those lessons to our pharmacy.
Possibly best of all, they don't even want a salary! They'll happily work for free. In spite of this, we often don't include them on our team when we are in our everyday practice, aiming to prevent errors, or when we are looking back on errors that have happened.
Who is this?
Drum roll please.......
Listening to and involving the patient is the most overlooked and under-appreciated way to reduce errors of all flavors, including medication errors (which will be the subject of this post).
Sound too obvious? Maybe you disagree?
Let's look at a few of the myriad ways patients can prevent errors, if you only let them.
#1: Preventing the incorrect medication and dose from being dispensing
It's a well-known fact that counseling prevents errors. However, not only do we not have time to counsel for every refill, but very few patients even want that (grandma's been taking that medicine for 25 years - you really think you're going to tell her something she doesn't know about it?).
Most will decline counseling and leave.
That's understandable. However, even without counseling we can confirm the medication with the patient. How about these phrases to start?
"Is this what you're looking for?" (then show them the cash register tag)
"I have Sertraline 100mg. Is that what you're looking for?"
"Do you still take 10 units of your Lantus at night?"
If fast food restaurants can confirm your order by verbally reading it back to you, then we sure as heck can and should be doing it. Getting home to find your order missing that extra syrup you wanted with your bucket of fried chicken is not quite as serious as our patients getting home to find their Plavix order missing, yet somehow the fast food joints still manage.
#2 Preventing discontinued medications from being dispensed
Here's a phrase every single person who works in a pharmacy needs to learn. I'll even bold it for emphasis:
"Are you still taking this?"
I don't know why that's such a struggle to hardwire in the culture at a pharmacy, but it takes you less time to ask that then you spent looking at that last TikTok video on your phone (on the clock, by the way). Stop making excuses and do it.
Guess what you should do if the answer is no?
Here's your ultimate guide to handling that:
Technician: hand it to the pharmacist.
Pharmacist: discontinue the med and all other prescriptions for the same med. If you have older prescriptions in the same drug class (ex. a different ACE-I), confirm with the patient with those too and get them out of the profile before they get auto-refilled and cause an error.
#3 Telling us about side effects they're having
We're in a good spot to learn more from the patients about potential side effects a patient is having and also whether or not they feel like the medicine is even working for them.
Once I had a patient who came to pick up dronabinol from me. She said in passing, "I don't know why the doctor wrote this - it doesn't do anything." I asked her to tell me a little more. "I don't have a problem with my appetite! That chemo left my mouth burning and it hurts to eat."
There you go, folks. The source of her struggle to eat, revealed. She is absolutely right - if the dronabinol works, I imagine it would have only made her more miserable by making her even hungrier than she already was. She was already choosing between hunger and mouth pain.
How can we handle this? I called the doctor and asked him to write viscous lidocaine instead. She came back and, guess what? It worked!
As a pharmacist this switch sounds simple, but a patient cannot be expected to know viscous lidocaine (or any other alternative) even exists. If our goal is truly to optimize medication outcomes, then taking a second to hear a patient out is one of the best tools in our toolbox.
#4 Telling us what they're really taking
When I was on my geriatrics rotation, I was asked to do a house call on an older patient. The geriatrician told me to get there an hour before her so I could get a complete medication history, and then she would come and evaluate the patient. I of course said yes, but inside I was thinking "does it really take an hour to get a med history?"
I'm glad I didn't say anything or I would have had to insert my foot right into my mouth. I barely finished before she got there. The patient was on 28 meds! She had everything the doctor prescribed her, plus some of her own vitamin cocktails, plus some stuff Dr. Oz or Oprah told her to take.
In this case, the doctor knew her very well and was able to do house calls, but in most settings providers don't have time to do that. MTM is one way we can dig deeper into what a patient is taking, but I would argue that it doesn't take an MTM session to ask some probing questions
I'm going to keep the point short and simple today - involve the patient every step of the way and you'll drastically reduce the risk for errors, improve the patient experience, and improve healthcare quality.