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Some
sobering thoughts from the report that I found significant:
* ‘In any two-week period, around seven in ten Australians
(and nine in ten older Australians) will have taken at least one
medicine.’
* ‘Every year there are over 100 million general practice
encounters in Australia, with around 400,000 of these thought
to involve adverse drug events’.
* ‘Results suggest that between 2-3 percent of all hospital
admissions may be medication related.’
The
report also stated:
‘In general practice, the most common medication incidents
are the use of inappropriate medicine or dose and errors in administering
or prescribing medications.
Many of these are thought to be preventable. The most common types
of dispensing errors involve selection of the incorrect strength
of a medicine or selection of the incorrect product, which can
occur when different products have similar packaging or names
that sound alike.’
One
of my primary roles as a community pharmacist is to try and ensure
that I am part of a ‘seamless pathway’ for my customers/patients
health needs.
I am appalled at some of the areas addressed in this document-there
has been much discussion on the poor transition of care that occurs
when a patient is discharged from hospital to the community but
what about the other way around?
If you are providing a medication assistance service for this
patient in the form of managed dose packs eg Webster’s, Persocare
and the patient is admitted to hospital, do you provide a copy
of your latest medication profile and history notes to the admitting
Doctor (with the patients’ permission of course)? With the
advent of rostered after hours services and large practices the
admitting Doctor is not always the patients regular Doctor.
Why should it just be a one-way communication process?
Pharmacists
bleat long and hard about wanting to be a professional member
of the health care team but you must put in the hard work to be
seen and heard as having a role.
How much easier have DMMR’s been to deliver than the original
RMMR’s were.
We learnt by our mistakes, had a better model in place and knew
what pitfalls not to fall into-it took hard work, blood, sweat
and tears but I know I receive far better communication from the
Drs with a DMMR than I ever did with the RMMR’s that were
thrust upon the Drs by us belligerent Pharmacists.
This report highlights that community based medication management
services and case conferencing have been a key strategy in helping
to reduce medication incidents.
Another
area that this report highlights is the large degree of under
reporting to ADRAC by health professionals.
This is of particular concern as many of the newer drugs have
not had long term clinical testing and some of the problems may
not appear till well down the track.
The report highlights the fact that it is estimated that 50% of
marketed medicines have serious adverse drug reactions first detected
after marketing.
ADRAC reporting is particularly important for OTC and complementary
medications, as we do not have very much data on a lot of these
products.
It is particularly pleasing that Emims now lists the ADRAC reports
in the drug profile so you can see what has been reported.
Simple
techniques that make up best practice dispensing guidelines form
a large part of this report.
For example, check the prescription to the drug three times in
three different ways, attach the repeat forms to the duplicates,
ensure notations of dispensing date and pharmacy are on the duplicate,
cancel items on the duplicates, keep the dispensary layout neat
and tidy with a clear definition between alike products.
Another
area highlighted in the report is that Pharmacists appear to be
unaware of the Interpreter services that are available through
community health centres.
In my area we use these services for all health professionals
having to interact with non-English speaking patients, but for
some reason Pharmacists are often left out of this loop.
The
use of barcode scanners in pharmacy practice is one area highlighted
in the report as needing to be advanced by software suppliers.
The current system of only checking at the end will not eliminate
all errors and a more through process needs to be in place.
The problem with this is that we still do not have uniform bar
coding on all of our products but this is being addressed.
The other problem is that the BMMS and Healthconnect projects
have not been progressed as quickly as many of us would have liked.
The report does highlight the fact that there is no evidence in
the Australian or international literature to support the theory
that current automated dispensing devices reduce medication errors
or improve patient outcomes
The
use of CMI’s and the ‘correct’ way to deliver this
information has been the subject of a project commissioned by
PSA at a National level.
PSA has now produced an educational tool to help Pharmacists understand
the communication strategies needed to be implemented to deliver
CMI’s effectively and efficiently.
These communication strategies are similar to the communication
strategies that we all learnt within the better counselling skills
of the Pharmacy only and Pharmacist only project.
CMI’s are an important tool when avoiding medication misadventures.
I
recently had a patient started on ‘Akineton’ by his
regular GP that he has been seeing for at least 20 years.
He came back to see me the next day with his CMI in hand quite
distraught.
Had I forgotten that he had glaucoma?
In this document he was brandishing it told him not to use Akineton
if he had glaucoma.
How could I not have picked this up!!
This
report is well worth a read as it is a wake up call to all of
who try to be too many people in one day in our busy community
Pharmacies.
We are a competent health professional and we should plan our
day to act like one.
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Happy Christmas to all, and medicine-safe New Year wishes.
From
Karalyn Huxhagen
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