Last week, I had the opportunity to attend the Missouri 2014 Joint Regulatory Patient Safety Conference, held on Thursday, August 7, in Columbia. This was a conference sponsored by the Missouri Dental Board, Missouri Board of Nursing, Missouri Board of Pharmacy, and the Missouri Board of Registration for the Healing Arts, to promote patient safety across multiple disciplines, and to encourage communication among fellow practitioners.1 For those who couldn’t make the conference and would like the materials or topic information, continue to check back with the Board of Pharmacy website and materials should be available soon.
The day was packed full of informative topics including many ways to enhance our patient’s safety through communication and collaborative efforts. Many of the speakers encouraged inter-disciplinary communication and teamwork as not only ways to reduce the rate of medical errors, but to also empower patients to be involved in their own care. Communication was also mentioned as a way for practitioners who have experienced a medical error to begin to recover from the guilt associated with the error. Encouraging open communication lines across disciplines is an important step in protecting our patients and ensuring complete medical care.
The profession of pharmacy has often-times been seen as a profession that stands behind a counter to dispense pills. Often times the clinical skills we possess are not completely understood or utilized by our patients. However, the times are changing, and pharmacists are now being included in patient-centered discussions that occur in health institutions and our status as being formally recognized as health care providers is on the move. This collaboration of multiple experts including physicians, nurses, pharmacists, and others is important for the health of our patients; and it’s important to assert our role as medication experts.
As pharmacy students, we are infused with the idea of collaboration and the importance of patient advocacy, and institutional learning helps us gain insight to what types of problems we may encounter in the real world. I was lucky enough to have the opportunity to work on an inter-disciplinary team while in school, and it afforded me the appreciation that having a team with different mind-sets can positively impact the patient’s care as a whole. In school, we are taught how to manage chronic disease states, to offer preventative health such as immunizations, to tailor health plans to our patients, and to open up lines of communication with our patients’ providers. And while it may be daunting to begin to update how our profession is viewed from the outside, it is important to back-up our function on the patient care team with some evidence on how we can improve patient safety.2
Either in school or during subsequent training, we gain the knowledge to help our patients manage chronic conditions to improve quality of life. One such chronic condition is diabetes. The Asheville diabetes project famously showed how the utilization of the cognitive services pharmacists provide can significantly improve the quality of life of patients suffering from chronic disease.3 This project also demonstrated the cost lowering-effects inclusion of a pharmacist can offer: with better management of a disease, health care costs are significantly decreased.3 Another study compared how the addition of the pharmacist to primary care helped improve long term health in diabetic patients.4 At 12 months, of those with a pharmacist added to the patient care team: 62.6% had reached goal HbA1c <7%, 85% had achieved goal LDL-C <100mg/dL, and 61.9% had reached goal systolic and diastolic blood pressure <130/80mmHg; all markers were statistically significantly decreased from baseline.4 The study suggested that adding a pharmacist to the primary care team would improve long term markers, and in turn long term goal achievement.4
The ICU setting is no different. In a review of literature, it was noted that not only do patients subjectively define care as better when a pharmacist is part of direct patient care, but the physician also rated the care as “higher than that of desirable or optimal services.”5 It was also noted within the paper, that the addition of pharmacists to antimicrobial therapy services (in multiple studies and situations), reduced the time it took to initiate optimal therapy, reduced hospital stay, and reduced the rate of adverse effects and mortality.5 The paper also looked at anticoagulation services, analgesia and sedation protocol implementation, and emergency response, and with the addition of a pharmacist to the team, “patient safety and clinical outcomes are enhanced.”5
As the patient safety conference had demonstrated all day, communication is the key. It’s important that our patients realize the benefits of keeping their pharmacist up to date in changes made to their medication regimen; community pharmacists are in a unique advantage to be involved in point-of-sale conversations to offer education. It’s also important to communicate to providers that the evidence points to the safety advantage of the addition of the pharmacist to the care team, whether this be through inclusion on rounds, or via telephone conversation pertaining to medications. Through collaboration and communication, together we can improve patient safety.
- Department of Insurance, Financial Institutions, and Professional Registration. Health profession boards team up to sponsor patient safety conference. http://difp.mo.gov/news/2014/Health_profession_boards_team_up_to_sponsor_patient_safety_conference#.U-jeieZ0zIU. July 10, 2014. Accessed August 11, 2014.
- Alldredge AB, Koda-Kimble MA. Count and be counted: preparing future pharmacists to promote a culture of safety. Am J Pharm Educ. 2006;70(4): 1-3.
- National Business Coalition on Health. The Asheville project: recognizing the pivotal role pharmacists can play in chronic disease management in local communities. http://www.nbch.org/The-Asheville-Project-Case-Study. 2011. Accessed August 11, 2014.
- Ip EJ, Shah BM, Yu J, Chan J, Nguyen L, Bhatt D. Enhancing diabetes care by adding a pharmacist to the primary care team. Am J Health-Sys Pharm. 2013;70:877-886.
- Preslaski C, Lat I, MacLaren R, Poston J. Pharmacist contributions as members of the multidisciplinary ICU team. CHEST. 2013;144(5):1687-1695.