FEATURE
MORE THAN JUST SAFETY CAPS AUTHOR Tom James , MD
Every physician has treated patients who suffer adverse effects from medications . Fortunately , most cause minor problems but quite a number are serious . Many of these adverse drug events ( ADE ) are preventable . The National Quality Forum ( NQF ) has identified improving medication safety as one of its top priorities . The scope of the problem is alarming .
The NQF has formed a Work Group which has divided the elements of the problem into large buckets which they term “ Medication Safety Pain Points .” These may not be groupings that most physicians would identify , but this is a Work Group comprised of physicians , pharmacists , patient advocates , government representatives and patients . So the taxonomy reflects diverse thinking .
CONCURRENT MEDICATIONS
The term , “ concurrent medications ” seems a bit awkward to most physicians who would more easily understand the term “ polypharmacy ,” but that word connotes multiple prescription medications . Adverse effects frequently come from combining prescription medications with over-the-counter products and herbs . St . John ’ s wort ’ s inhibition of serotonin and antidepressants , or Ginseng ’ s effect on prothrombin times in patients on Warfarin : these are examples of OTC products mixed with prescription medications . But even with multiple prescription medications , the impacts of mixing various drugs in the human organism is not fully appreciated . Individually , new drugs are well studied . But there are not enough studies on the impact of multiple disparate pharmaceuticals within the individual . Which ones are the cytochrome p450 inducers and inhibitors ?
COORDINATION OF CARE
Physicians recognize that there are several handoffs in the path between the physician ’ s prescription and the patient ’ s informed acquisition of the medication . Typically , all involved along this “ supply chain ” have a trust relationship , including everyone from physician to pharmacy tech . Expensive medications are often handled by a specialty supplier . This adds an additional level of complexity as expensive drugs ( e . g ., the biologics , many chemotherapeutics , etc .) are moved from manufacturer to physician to administer to a specific patient . Whether through a retail or specialty pharmacy , the physician is not aware of the steps and people engaged in this process . Along some of the pathway there may be steps for audits , but in aggregate the steps from prescriber to patient are not well-defined , yet are left completely independent .
PATIENT AND CAREGIVER ENGAGEMENT
Once the prescription is ready to be picked up , it leaves the medical
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