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Peter Doukas, Ph.D., dean of Temple University School of
Pharmacy, tells every new pharmacy class, "There's a fine line between a
drug helping and a drug harming."
Pharmacists, the healthcare professionals most equipped to draw this line,
are increasingly leading efforts in hospitals and other healthcare
facilities to ensure medication safety. In 2001, under the direction of
Patrick McDonnell, Pharm.D., assistant professor of pharmacy practice, and
Michael Cohen, R.Ph., M.S., Sc.D., president of the Institute for Safe
Medication Practices (ISMP), Temple University's School of Pharmacy became
the first in the nation to establish a Drug Safety elective track for
students who want to specialize in this growing field. McDonnell and Cohen
are joined by professionals from the Food and Drug Administration (FDA),
ISMP, and the School of Pharmacy in teaching the courses. Students then go
on two rotations related to drug safety either at a hospital, a
pharmaceutical company, ISMP or the FDA.
According to the Institute of Medicine's 1999 report "To Err is Human,"
medication errors, one type of drug safety issue, account for
approximately 7,000 of the 44,000 to 98,000 deaths in the United States
from medical errors annually.
Medication errors can be costly, as well. McDonnell's most recent
publication, in Hospital Pharmacy, describes the case of a man admitted to
the hospital with a severe drug reaction to the tune of $181,000 for a
31-day hospital stay. The cause of this error was a well-known drug
interaction that was most likely missed because there were two
"prescribers" on the healthcare team who didn't communicate. Furthermore,
the interaction was not detected by the patient's pharmacist.
"In class, we look at the systems in place that allow these mistakes to
happen: bad handwriting, the placement of bottles on the pharmacy shelf
and drugs that look alike or sound alike. These constitute errors of
commission. I also try to convey to students that errors of omission, not
asking patients about other drugs they are taking, and not stressing the
importance of taking drugs as prescribed, can also occur," said McDonnell.
To understand how medication errors happen, it helps to look at medication
use as a process, or a series of events, that starts with the drug company
manufacturing the drug and extends to the patient taking the drug. At each
step there is potential for mistakes, for instance when the doctor selects
the patient's drug therapy, when the pharmacist fills the prescription,
and when the patient takes the drug.
In the United States, drug safety at the manufacturing and distribution
level is scrupulously monitored and tightly regulated. By the time a drug
reaches the pharmacy, it is usually safe in and of itself. As evident in
recent news, however, such may not always be the case when a drug is
widely used within a large population over an extended time period.
"Over the past two decades, more and more new drugs have entered the
market and some are being fast-tracked through the research and approval
process. At this point, a critical phase in terms of drug safety is
post-marketing surveillance, or monitoring the drug during and after the
initial advertising push. All drugs go through clinical trials to evaluate
safety and efficacy, but often out of economic necessity, many drugs come
to market with fewer than 10,000 participants - and at least 30,000 are
needed to accurately determine safety," explained McDonnell.
McDonnell spends half of his time teaching at the Pharmacy School and the
other half at Jeanes Hospital as a pharmacist preceptor, where he guides
pharmacy students on clinical rotation. His students analyze actual
adverse drug events, with an emphasis on prevention, first in class and
then in clinical rotations.
"We study patients who are hospitalized because of drug-induced problems
and conduct discharge counseling to make sure patients truly understand
their medicines. Hospital re-admissions due to adverse drug events
comprise 3 percent to10 percent of all hospital admissions," said
McDonnell. "One third of patients either don't understand or don't follow
medication directions. A common failure is when patients take less of the
drug than they're supposed to or stop taking the drug altogether."
According to the Institute of Medicine, patients, professionals and
institutions can all play a part in improving drug safety. Hospitals and
healthcare organizations can utilize "proven medication safety practices,
such as automated drug-ordering systems."
Patients need to ask questions, raise concerns and understand the
medicines they are taking. And pharmacists, says McDonnell, need to be
more fully utilized as drug experts within the healthcare team.
"We're in the best position to prevent adverse drug events, first by
interacting more proactively with patients and second by joining in the
patient care process; for example, by participating with the medical teams
during hospital rounds," he said. |
