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2002 DVA Pharmacy Conference |
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Description of pharmacists’ interventions using medication prescribing privilege
KC
Huynh-Dang, Pharm.D., BCPS, Elaine Lei, Pharm.D., CDE, Yong Moon, Pharm.D.,
Michael Ascari, Pharm.D., CCP, Long Beach Veteran Affairs Medical Center.
Statement of Issue
Pharmacy
identified frequent renewal requests for expired medications from patients
served by the Long Beach Veterans Affairs Healthcare System. A prescription
extension scope of practice was approved allowing clinical pharmacists to bridge
therapy. This prescribing privilege allowed pharmacists to assess compliance,
evaluate medication regimens, order laboratory tests, schedule return
appointments, and extend prescriptions. The objective of this study is to
describe the types of prescription extension requests, reasons for these
requests, resulting pharmacist interventions, and plans to minimize the problem.
Action plan implemented
Between 8/1/00 and 10/31/00, 1377 “Prescription Extension” progress notes were
retrieved and 447 randomized for analysis. Data collection included number and
types of medications requested, rationale for requests, and types of pharmacist
interventions.
Outcomes
Prescription Extension
Requests
Of the 662 total medications requested, 521
(79%) were approved. Most commonly requested medication class were hypertension
(21%), cardiovascular (11.78%),anti-inflammatory (9.37%), diabetes (8.61%),
narcotics (8.31%), cholesterol (7.85%), GI (5.89%), psychotropics (3.63%).
Rationales for Requests
Clinic canceled appointment: 22.44%
Not enough refills: 21.71%
Patient canceled/ no show: 20%
No return appointment: 9.27%
Provider missed: 10.98%
Others: 15.61%
Pharmacist’s interventions
Extended prescriptions: 54.55%
Discussed request with provider/ attending: 11.40%
Notified provider: 9.09%
Arranged appointment: 6.45%
Advised patient to make appointment: 5.95%
Counseling 3.64%
Return appointment with pharmacist 1.65%
Others: 7.27%
In summary, clinical pharmacists approved close to 80% of the requested medications through varying interventions. One prominent avenue was employing prescribing privileges (55%).
Plans to
minimize requests
Providers now must request leave 3 months in
advance to reduce clinic cancellations. A clinic was created where patients can
see their providers urgently. Providers are more aware of clinic availability to
provide adequate refills. Cross-coverage among providers is being recommended.
There are on going clinical meetings with staff (providers, clerks) and patient
education attempts to continually minimize these requests.
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