July â¢ August 2003 - Ontario College of Pharmacists

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COLUMN F O C U S O N Error Prevention Counselling Patients on Pre brand of the drug. The tablets were therefore labelled NovoPurol® 100mg. The following day, Mr. Smith continued to take his regular medication including Apo Allopurinol 100mg along with what he believed to be a new drug NovoPurol® 100mg. Ian Stewart, B.Sc.Phm. Though the pharmacist may dispense the right drug at the right dosage, patient education is critical in ensuring that the right patient takes the right dosage of the right drug at the right interval. As the following cases illustrate, lack of patient education may lead to drug administration errors. CASE 1 Mr. Smith, a 70-year-old patient, regularly takes the following medications. Drug Apo Allopurinol 100mg Avapro® 150mg Apo Atenolol 50mg Dose Once daily Once daily Once daily Recently, Mr. Smith received a new three-month prescription of Allopurinol 100mg from his physician. On this occasion, the pharmacist dispensed the Novopharm A few days later, Mr. Smith requested a refill of his Apo Allopurinol 100mg tablets. On questioning the patient regarding the need for an early refill, the pharmacist learned of the misunderstanding and as a result, the doubling of the prescribed dosage of Allopurinol. Possible Contributing Factors: • The patient was unaware of the relationship between Apo Allopurinol and NovoPurol® • The patient did not question the physician or the pharmacist regarding his ‘new’ therapy • Appropriate counselling did not take place when NovoPurol® was dispensed Recommendations: • Always review the patient’s medication history prior to counselling • Educate your patients regarding the relationship between brand names and generic names — this is especially important when switching brands. In these instances, place a sticker or note on the prescription bag to remind the pharmacist/yourself of the need to counsel the patient • Encourage your patients to ask questions, especially when they notice something different about their prescription/medication 38 Pharmacy Connection July • August 2003
COLUMN scription Renewals/Changes CASE 2 Mr. Jones, a 60-year-old patient has been taking Novo Fenofibrate Micro 200mg capsules prescribed by his family physician. In an effort to better control his cholesterol levels, Mr. Jones was then referred to a specialist. Following an assessment, a prescription was written for Lipidil Supra® 160mg to be taken once daily. Assuming that Lipidil Supra® 160mg is a different drug to be added to his medication regimen, Mr. Jones decided to take both drugs together. However, his wife convinced him to first check with the pharmacist who confirmed that the Novo Fenofibrate Micro should be discontinued. Possible Contributing Factors: • Neither the specialist nor the pharmacist provided any information regarding the discontinuation of Novo Fenofibrate Micro • The patient was unaware that the generic name of both drugs is Fenofibrate Recommendations: • Always review the patient’s medication history to identify potential drug related problems • Encourage your patients to also learn the generic names of the drugs being taken Please note the College’s generic or “single entity” drug policy: Please ensure that your pharmacy’s dispensary software is set to label these drugs according to this policy. Title: Generic Prescriptions Date of Council Report: January 1980 a) The preferred method of labelling all prescriptions for single-entity drugs is that they be labelled using the non-proprietary (generic) name of the drug, plus the name of the manufacturer, and b) Particular care should be taken when labelling generically-written and 'product-selected prescriptions' — that is when the brand name is prescribed but the generic is dispensed. In these cases, the pharmacist should use the generic name, plus the name of the manufacturer, and not the trade name. Editor’s Note: Both of these errors may have been prevented with appropriate patient counselling. Some pharmacists believe that the standard is that they only counsel on a new prescription, and only on that prescription. These cases emphasize the need for pharmacists to evaluate the entire patient profile whenever a medication is dispensed. Operational Component 1.2 of the Standards of Practice includes “The pharmacistreviews relevant information from the patient profile with each new prescription, change of prescription, and repeat prescription.” Operational Component 1.3 outlines the role of the pharmacist in evaluating drug therapy and identifying potential and actual drug-related problems. Pharmacy Connection July • August 2003 39
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Page 3 and 4: Ontario College of Pharmacists 483
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Page 11 and 12: COVER STORY Greg Ujiye, B.Sc.Phm. M
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Page 15 and 16: CLASS A PRECURSORS INDIVIDUAL EXEMP
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July â¢ August 2003 - Ontario College of Pharmacists