Ongoing issues that can obstruct safety at the drugstore

When a pharmacist dispenses a medication, especially a new one, it's important to assure the patient has all the information they need to use the medication safely. For this reason, state boards of pharmacy in NJ, PA and DE have regulations on the books that require pharmacists to educate or "counsel" the patient. Yet, in most cases, when a prescription is dispensed patient actual counseling is only a veiled "offer" at best.

The effectiveness of patient counseling by a community pharmacist to detect and prevent medication errors, and its link to improved medication adherence and positive clinical outcomes, has been well documented in the literature. Yet studies place patient counseling rates at only 8% to 42% nationally. There's no reason to think things are any different in the Delaware Valley. In fact, the next time you have a prescription filled, see for yourself. Or, the next time you shop at a CVS, Walgreens, Rite Aid, etc., just observe what goes on at the pharmacy counter. This critical interaction between pharmacist and patient almost never takes place, even for medications that are more likely to cause harm if used in error – those that healthcare professionals refer to as high alert medications.

An increase in the frequency and quality of patient counseling has been linked to state-specific regulations that require patient counseling for new prescriptions, but this must be linked to strict enforcement surveillance, which isn't happening here. It goes beyond just requiring that there be an "offer" to counsel. Patients often fail to recognize an offer to counsel when simply asked, "Do you have any questions?" or when they are told to "Sign here." They may not even know what to ask.

This means that, with few exceptions, pharmacies in states that require only an offer to counsel will likely dispense a powerful opioid such as fentanyl patches, for example, and allow the patient or caregiver to walk out of the pharmacy without so much as a brief discussion about safe use and disposal.

ISMP has long promoted mandatory patient counseling in community pharmacies for targeted high alert medications, with less emphasis on current ineffective regulations that require an "offer" to counsel for all medications. It's time that the Pennsylvania State Board of Pharmacy (and other Boards) takes up the challenge of revising patient counseling regs to assure that no patient ever walks out of a pharmacy without receiving the information they need to use high alert drugs safely.

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