Common medication mistakes to avoid with virtual primary care

The increase in virtual primary care brings with it an opportunity to increase medication safety—and its own unique risks. A recent Safety Bulletin released from the Institute for Safe Medication Practices Canada (ISMP) highlighted lessons learned during COVID-19 about how to optimize medication safety. The ISMP Canada reviewed 58 incidents reported from January 2020 to March 2022 related to virtual primary care to find common areas where issues arose. It found three key areas of vulnerability: The virtual assessment During the virtual assessment process, not having an updated medication list can cause errors in medication reconciliation. For example, one patient renewed their prescriptions with their doctor through a phone appointment, and received those medications from a pharmacy. However, the patient noticed they had been given a diuretic, which was an outdated prescription form years ago. When the patient told the pharmacy this, they reached out to the physician, and discovered that they had been accidentally given an outdated medication list to renew. The report suggests that before appointments, patients could ask their pharmacist for a virtual medication review, thereby getting a current medication list, or that virtual appointments could include a virtual waiting room where a pharmacist or nurse could collect a best possible medication history, and update a medication list. It also says primary care providers should confirm their medication use before prescribing or renewing medications, and that a medication reconciliation form or checklist could be completed before appointments. Read: Is virtual care about as good as an in-person appointment? Half of Albertans think so Prescription transmission issues Problems with the accurate transmission of prescriptions are common: The bulletin says that in a recent survey, 28% of patients said they had had an issue with a prescription that was sent directly to a pharmacy. One problem is that a prescription could not be received at all. In one incident, a doctor was supposed to fax over a prescription for an antibiotic after a phone appointment with a patient, but by the time the patient went to the pharmacy and asked for it, it hadn’t been received, and their starting the antibiotic was delayed because of this. Another issue is that prescriptions can be unclear. Miscommunications do happen, and have been covered in other ISMP Canada Bulletins. One example led to a patient almost taking the wrong medication after a doctor called in a prescription by phone, and the pharmacy staff misheard the medication name. They dispensed the incorrect medication, and fortunately the patient noticed the medication wasn’t correct, and asked their prescriber about it, who confirmed it was incorrect. Read: Safety not convenience needs to guide use of virtual care: CMPA Another weakness was patients being left out of the loop. When prescriptions are sent directly to pharmacies, patients aren’t given a copy and can be confused. In one case, a patient was given a tapering regimen of corticosteroid, didn’t realize it was supposed to be refilled as part of that, and stopped their medication abruptly—which caused a flare-up so severe they needed to be admitted to the hospital. To help fix these issues, prescribers could provide patients with a summary of medication changes and renewals after their virtual appointments; they should confirm the patient’s pharmacy using two identifiers before sending prescriptions over; prescribers and pharmacists should make sure to use strategies to make sure prescriptions are accurately transmitted, such as repeating back the prescription to the prescriber; and pharmacies can better communicate with patients using things such as auto-text services that can let them know when their prescriptions have been received and filled. E-prescriptions, which have been recommended by both the Canadian Association of Chain Drug Stores and the Canadian Pharmacists Association, can also help avoid many of these issues. Read: Gotodoctor.ca to offer e-prescribing through PrescribeIT Medication delivery Finally, when it comes to home delivery of medications, there are two areas of weakness. One is identifying the patient: One pharmacy contacted two patients who were on the same medications, and only one responded. They accidentally sent both patients’ medications to the single respondent, and found out when the second called to arrange his booking. Another issue is delivering to the wrong place, such as a case where a pharmacy delivered medication to an old address. This is a breach of privacy for the patient, and can lead to medical harm if both to the person who doesn't have their medication, and to the recipient, if they take the pills. Mistakes in delivery can be avoided by confirming two patient identifiers at the pharmacy and upon delivery; telling delivery teams that medication needs to be delivered to the person and not left at the doors, and returned if the person isn’t there; and creating a process that flags new prescriptions that need to involve patient counselling. Read: Rexall teams up with UberEats on delivery initiative

Common medication mistakes to avoid with virtual primary care

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