Can Counseling Reduce Medication Errors?

By Baker, Ken | Drug Topics, April 2009 | Go to article overview

Can Counseling Reduce Medication Errors?


Baker, Ken, Drug Topics


I teach a course in healthcare risk management in the Master of Science in Pharmacy online degree program of the University of Florida. As part of the requirements for the class, each student is required to prepare a risk management case study. In the class that just ended, three of the students chose to research and prepare a report that will become part of an Oregon Board of Pharmacy inquiry into the use of pharmacist counseling as a tool to reduce medication errors. The three students have an eclectic range of backgrounds. One is a nurse with hospital risk management experience,· one is a PharmD familiar with risk management in an inpatient setting; and one is a lawyer with several years of practice as a healthcare administrative law judge.

Most pharmacists would have answered the question posed in class - "Can counseling reduce medication errors?" - with a shrug and say "Of course."

Interestingly, the students looked at the question not as practicing pharmacists might, but as risk managers. The question became not just "Can counseling reduce medication errors?" But "Why?" "What type counseling would be required?" And "What kinds of errors could be reduced?" The students also looked at possible barriers to counseling.

Two of the best-known risk management tools are the Pareto 80/20 Rule and the Fishbone Cause and Effect Diagram. Using a Pareto analysis, the students looked at which pharmacy errors were most likely to cause harm. Pareto teaches us to identify and isolate the small number of factors (usually no more than 20 percent) that cause 80 percent of the problems and to concentrate on those. With that in mind, the question can be simplified to whether counseling is likely to allow pharmacists to catch these mistakes before they are released to the patient. While the students also looked at which mistakes (quality related events = errors plus near-misses) were most commonly made in a community pharmacy, they identified "greatest potential harm" as the most significant test of value. Typically, pharmacies make more mistakes involving the wrong direction on the label, but evidence suggests the majority of these are caught before they reach the patient and, thus, before counseling occurs. "Most harm" is shown, not by the number of mistakes made, but by the number of claims brought against pharmacies and reported to insurance companies.

To isolate the most potentially harmful errors, the students used the Pharmacists Mutual claims study of 2009. …

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