NCPA Executive Update

NCPA Executive Update delivers insights on legislative, regulatory, policy, and industry developments from NCPA CEO B. Douglas Hoey, Pharmacist, MBA, to NCPA members and pharmacy leaders every Friday.

Patient Safety Wake Up Call | NCPA Executive Update | December 23, 2016

by NCPA | Dec 23, 2016

Dear Colleague,

Doug Hoey

Last week, the Chicago Tribune reported that it had sent investigative reporters into 255 pharmacies mostly in the Chicagoland area to see if pharmacists would catch common drug-drug interactions (DDIs). The results were shocking and stunningly bad.

According to the story, reporters had physician-written prescriptions for the following drug combinations:

  • Clarithromycin and ergotamine

  • Simvastatin and clarithromycin

  • Colchicine and verapamil

  • Tizanidine and ciprofloxacin

  • Norgestimate/ethinyl estradiol and griseofulvin

According to the Tribune, the prescriptions were dispensed over half of the time, and the 32 pharmacies it identified as independents missed the interactions in 72% of the cases. Chain miss rates ranged between 63% at 30 CVS stores to 30% at 30 Walgreens pharmacies.

NCPA talked with one of the reporters at length about the story on multiple occasions and while we do not believe that 32 pharmacies in a concentrated geographic area adequately represent the more than 22,000 independently owned pharmacies across the U.S., the Tribune report is a wakeup call for all of community pharmacy. Yes, the ostensible DUR and the formulary steering messages sent by PBMs during prescription adjudication are so frequent and plentiful that they can generate distracting message "noise" while processing prescriptions. However, we are the medication experts on the health care team. If we don't catch DDIs, then no one will.

We pointed out to the Tribune there are national surveys of pharmacists with much larger sample sizes than theirs that suggest independent community pharmacy provides a setting conducive to patient safety. For example, a 2012 survey of 1,300 Oregon pharmacists found that independent pharmacists were much more likely than chain pharmacists to agree that their employer "provides a work environment that is conducive to providing safe and effective patient care."

That said, even one missed dangerous drug interaction is one too many. When the drug combinations are mostly Pharmacy 101-type of interactions like these were, it makes the need for improvement stand out even more.

This is a red flag warning to review existing processes and procedures in your pharmacy, to make sure technicians are trained to alert the pharmacist when the pharmacy management system flags a DDI, to check the interaction severity settings on pharmacy dispensing system software, and to make time for a refresher on DDIs.

This is not a pleasant story to read and even if the results aren't reflective of community pharmacies overall, we are likely to hear more about this story in the future. Others might even try to replicate the investigation done by the Tribune. If there is a "next time," let's make preparations now to make sure the results are different.

Doug Hoey

P.S. Happy holidays to all. This is the final Executive Update for 2016. The regular schedule will resume Jan. 6, 2017.