Pharmacists still the 'best placed health professionals' to check drug risks
B.C. woman's death from fatal drug combo a rare failing of a system that usually works, experts say
Pharmacists are still seen as the best equipped health-care professionals to ensure the safety of drug prescriptions, despite the failure of two of them who ignored the risks of an adverse reaction between two medications, leading to the death of a B.C. woman.
"Much is expected of pharmacists across the country, and that has been expanding over these last years," said Zubin Austin, a professor at the University of Toronto's faculty of pharmacy. "What I would suggest, though, is that pharmacists are the best placed health-care professionals to prevent these kind of unfortunate situations.
"Considering the more than 30,000 pharmacists that work across the country and actually do prevent these kinds of problems from occurring every day, we don't hear about those, we don't report those kinds of situations because they're simply doing the job they're supposed to be doing."
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CBC's Go Public reported yesterday on the story of Helena Lambert, 76, who died after her local pharmacists dispensed the medications allopurinol and mercaptopurine without noting or warning of the potential problems of taking them concurrently, even though widely used software at the pharmacy would have flagged the potential adverse interaction.
"I certainly don't think it's expecting too much of pharmacists to identify, prevent and resolve situations like this form occurring," Austin said. "Unfortunately, it didn't happen in this circumstance."
Julie Greenall, a pharmacist with the Institute for Safe Medication Practices Canada, said there's no question that community pharmacies are very busy places where, quite often, a lot is going on at the same time.
"I think pharmacists certainly work very hard to be able to focus their attention, but what we have learned on the patient safety side is that you can be very vigilant but still miss something," Greenall said. "The way the technology is designed often doesn't support recognition of something as a significant problem."
Still, pharmacists certainly have the most training in terms of dealing with drug interactions, she said.
"And I think the fact that this kind of thing doesn't happen very often speaks to what a good job pharmacists generally do in catching things and intercepting them."
Lambert's death in 2012 may have been triggered by a growing phenomenon among pharmacists called "alert fatigue." At times, pharmacists may ignore or turn off the flags in their computer systems that alert them to drug interaction risks because they are overloaded by too many warnings, from mild to severe.
However, Greenall said as the system moves toward electronic prescribing, there is an opportunity for an extra layer of protection and for physicians to see those alerts first. Currently, the software in most doctors' offices doesn't allow for this.
"So a prescriber, if it's a very serious alert, would see that first. And then if they missed it, then you'd still have an opportunity to catch it with the pharmacist," Greenall said.
"That really is a future direction. It's a whole team process where the physician, pharmacist, patient all need to be working together and have access to all information they all need."
Pharmacists' roles have changed over the years, with more emphasis put on transferring knowledge into the community, meaning not just dispensing pills, but dispensing advice.
Provincial governments are recognizing that pharmacists can play a more involved part in patient care, Greenall said, such as following up with patients to see whether their medicines are working.
"We're not just responsible for handing out pills," Greenall said. "The idea is that we should be working together with the doctors, the nurse practitioners, and other members of the circle of care to help the patient achieve their health outcomes."