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In some professions, eternal vigilance comes with the territory.
In April, I wrote about Molly's mom ["The stroke that shouldnât have been," April 2016], who began cutting her blood-pressure medication dose from the prescribed once per day to every other day and eventually to every third day, because she could not afford the drug. After several months, Molly's mom had a stroke. Until that happened, no one â not her doctor, pharmacist, or family â noticed that refills were increasingly delayed.
Several Drug Topics readers wrote to me about that article. The responses from pharmacists and pharmacy technicians were essentially the same. All agreed that Molly's mom deserved better treatment from her healthcare providers.
Some attributed more responsibility to the physician, but no one excused the pharmacy staff completely. Many offered reasons that the pharmacists in their own pharmacies would not or could not have responded earlier to Molly's mom. Almost all those reasons had to do with not having the time to review patient profiles. Many commented on their management's demand for more efficiency from their pharmacy personnel.
Those who responded seemed to agree that there is a gap between their ethical duty to act as a risk manager for the patient and the practical need to keep up with a workflow that demands faster performance, by less staff, of the mechanical duties associated with dispensing increasing numbers of prescriptions.
Most respondents appeared to look forward to some change in the workflow that would enable them to move from being restricted to a limited number of mechanical duties to a higher, more professional level of patient care.
An encouraging theme ran though the messages from these respondents. These pharmacists and technicians expressed a belief that pharmacy should provide help to patients like Molly's mom; we should be able to recognize problems and intervene to help patients take their medications properly and thus reduce the risk of a medical crisis.
Taking the responses together, I was struck by how far we, as a profession, have come in just one generation.
In the mid-1980s, the practice of pharmacy began to change. New laws increased the professional duties of pharmacists, starting with the adoption and expansion to all patients in all 50 states of the federal OBRA-90 requirements. Each state's practice regulations now include the concept that a pharmacist is to perform a prospective drug review before dispensing any prescription.
Starting with court cases such as Riff v. Morgan1 in 1986, judges have increasingly recognized that pharmacists can and do possess special and superior knowledge that in some cases can help patient and/or physician prevent allergies, interactions, and contraindications.
Increased duties can result, of course, in increased liability for the pharmacist and pharmacy.2
Not long ago, pharmacists accepted their role as dispensers of drugs, complying with a seemingly omnipotent physician exactly as ordered. Some courts still accept that limited viewpoint. However, pharmacists and pharmacy technicians now believe they have the skills and education to supply a higher level of patient care.
In addition to legal duties, pharmacists have ethical duties. To meet these new expectations, the pharmacy workflow must change and duties must be reallocated. Pharmacy design must evolve to keep up with the needs of patients and healthcare.
One thing no reader mentioned was why neither pharmacist nor technician pointed out, when the drug was first prescribed, that older, less expensive alternative drugs were available. A conversation with the patient, followed by a call to the doctor at that time, might have resolved the problem before it occurred.
1. Riff v. Morgan Pharmacy, 353 Pa.Super. 21, 508 A.2d 1247 (1986).
2. For example, Happel v. Wal-Mart Stores, Inc., 766 N.E.2d 1118 (2002); Horner v. Spalitto, 1 S.W.3d 519 (1999).