A Last Line of Defense: Pharmacists and the Duty to Warn
The Chicago Tribune recently published a shocking investigative report showing that many pharmacies are failing to warn people about potentially deadly drug interactions when dispensing medications. Over the past two years, the Tribune tested 255 pharmacies in the Chicago region to see whether pharmacists were warning patients about drugs that were deadly or had serious consequences when taken together; only 52% passed the test. The pharmacies ranged from major chains such as CVS, Walgreens, Walmart, and Kmart, to regional chains such as Jewel-Osco and independent pharmacies.
Because bad drug interactions hospitalize thousands of patients every year, it’s crucial for pharmacists to serve as a last line of defense before people take home prescriptions. Though patients are supposed to disclose which medications they’re taking to their doctor, in practice many simply forget to. Other patients may see multiple specialists or urgent treatment doctors for different medical issues and may be prescribed different medications by doctors who aren’t comparing notes.
Part of the problem, the Tribune discovered, was the emphasis on speedy service in major chains. Computer systems keep track of how long it takes for pharmacists to fill medications and often penalize them for not providing fast enough service. This is problematic when pharmacists may need to contact a patient’s doctor to enquire about a questionable prescription. Doctors’ offices may take hours to get back to pharmacists, pushing back the fill time for patients.
The computer systems for these chains also commonly have tracking systems designed to alert pharmacists to potentially deadly combinations, but the alerts flag so many different non-emergency situations that pharmacists sometimes begin to ignore the alerts. Harried pharmacists sometimes also fail to look at a patient’s medical history—or don’t look long enough to detect problems–before dispensing medications.
This emphasis on fast service also harms the independent pharmacies that pride themselves on good customer service. Though they don’t usually have the expensive alert systems employed by the major chains, they still feel the pressure to compete with the chains for customers. This led to independent pharmacies failing to tell patients about deadly prescription interactions 72% of the time in the Tribune’s test, whereas chain stores failed 49% of the time.
So what can pharmacists do to catch more of these bad prescription pairs?
- Take more time to look at the patient’s medical history.
- Call the prescribing physician when warranted, even if it takes a little longer. Your patient would rather wait a little longer on a medication than to risk death or serious consequences, such as an unplanned pregnancy.
- Take a minute to look at each prescription before dispensing. It sounds so simple but can catch so many mistakes. The pairs of prescriptions dispensed in the study were well-established medications that had been on the market for years and whose interactions were well-known. A cursory glance could have caught them.
- Don’t fall prey to alert fatigue. Even if your computer is constantly pinging alerts, take the time to look through them—you just might save someone’s life.