Q&A: Real-World Examples of Pharmacist Prescribing Saving Lives

As calls for expansion of scope and prescribing authority continue to circulate, pharmacists across the country are managing patients’ medications regardless of what their state and federal governments allow. Amid the persistent need to advocate for better payer coverage and expansion of billable services, pharmacists continue to improve outcomes on a life-saving scale due to their medication expertise.

“There’s so much education and so much that we as pharmacists can have an impact on when it comes to patient outcomes,” Jennifer Griffin, PharmD, clinical pharmacist at Harps Food Stores, told Drug Topics. “It’s really just having the space and the time and the payers on board to realize the impact that we can have and pay us for those encounters.”

In part 2 of our interview series, Griffin was joined by her colleague Duane Jones, BS Pharm, regional pharmacy supervisor and clinical program director at Harps Food Stores, to discuss some of the real-life prescribing examples and interactions they encounter on a daily basis.

READ MORE: Expertise, Protocols Make Pharmacists Essential Prescribers

Drug Topics: Can either of you give me some examples of improvements in patient outcomes that stem directly from pharmacists prescribing?

Jennifer Griffin: It’s all day, every day that we’re coming in contact with these patients. Honestly, I wish that I could do more. I wish we had the time and got paid for these services to really sit down and have these encounters with these patients. We see the positive patient outcomes whenever a pharmacist is involved in this equation. For example, I had a patient who had diabetes. It was a brand new diagnosis. The patient was getting started on insulin therapy and had never used an insulin pen and was prescribed sliding scale insulin. There was no education provided to this patient in the office visit with the specialist. There was no talk about checking your blood glucose, how to use a blood glucose meter, all of that.

I could sit and spend at least an hour talking to this patient about managing hypoglycemic episodes, what to do in certain situations, like for example, when this patient gets sick, how does that affect your insulin management? There’s so much education and so much that we as pharmacists can have an impact on when it comes to patient outcomes. It’s really just having the space and the time and the payers on board to realize the impact that we can have and pay us for those encounters.

Duane Jones: Examples that recently have occurred; I had one gentleman that was getting some swelling in his extremities. We switched him from amlodipine over to verapamil, and we eliminated that. Had another gentleman that had a history of seizures, and he had Legionnaires’ disease when he was younger, so he had a lesion in his brain, so he didn’t have epilepsy. The medication he had been on was causing some liver functions, and he was getting some liver toxicities. They switched his medication, and he was having breakthrough seizures. He said, “I’m really frustrated because they have me scheduled for MRIs, [and] now they have me scheduled to see an epilepsy doctor.” He said, “I don’t have epilepsy.” I said, “What are you taking?” He told me they put him on an immediate release dose. I said, “Well, when are your seizures occurring?” He goes, “It’s occurring in the morning, before I take my dose, and at night, before I take my dose.” I said, “Let’s prescribe a sustained release product for you.” Same medication, but sustained release. We switched it over to a sustained release dose. He called me 2 days later and said, “I’ve had no seizures.” He said, “They canceled all of my MRIs and my appointment with the epilepsy doctor.”

It’s a simple process of understanding the pharmacology that’s behind this medication that, quite frankly, the other professionals and prescribers don’t have the extensive education that we have. Sometimes that might be a simple change, but at the same time, it changed his life. Those are things that we can do. I have one lady that’s probably my favorite story of all, and Jennifer’s heard me tell this many times. She’s a nurse and her husband was a doctor. She brought her prescription in, and I was talking to her. It was for amoxicillin, and I said, “What’s wrong with your son?” He’s like 7 years old. He has little bumps all over him. I said, “What do they look like?” She goes, “They have little pus pockets in them.” I said, “So is it like chickenpox?” She goes, “No, it’s not that big. It’s smaller.” I said, “Well, when did this start?” She said, “Just in the last 24 hours, and it’s over his entire body.”

I said, “Well, this is not going to help you. This medication will not be effective for that. What you need to do is you need to get in touch with an infectious disease doctor. I’ve got his number here. Call him immediately.” That was on a Friday, and on Monday, she calls me and she says, “Thank you very much.” She said, “We had to LifeFlight him to Children’s Hospital. He had a rare viral infection that was systemic, and they said that if we hadn’t gotten there, he would have died within 24 hours.” It was a matter of incorrect medication. They started treating him. He will be on that medication [with it] at his side for the rest of his life. Those are things that [pharmacists] have the expertise to be able to prescribe based upon what we understand about medication therapy and the effectiveness of it, especially when it comes to specific disease states.

READ MORE: Pharmacist Involvement Speeds Prior Authorization for GLP-1s