Keeping Patients Safe: Bringing Pharmacists to the Bedside
Brian Marden, Pharm.D.
Patient safety is at the forefront of health care initiatives nationwide.
Nationally, data suggests that up to 33% of patients with new prescriptions may never get them filled and 75% of patients may fail to take medications as directed, according to the National Alliance of State Pharmacy Associations.
Often, the biggest reasons cited for these statistics are a lack of education or a lack of timely, convenient access to necessary medications.
Dr. Brian Marden (Guest): Well, great, and certainly a pleasure to be able to tell the story. We’re looking forward to be able to bring more service to our patients and just help them have a smoother transition back to their home, and along the way, make it easier for them to have a healthy outcome. What we’re doing is pretty soon, in a few months, hopefully in January of 2015, we are going to open up our first ever community pharmacy in our hospital. The plan there is that our patients who are well enough to leave the hospital and have prescription needs, they’ll be able to get their medicines that they need going home right from us in the hospital. It’s more than just getting their medicines. It’s really about bringing pharmacists and pharmacy technicians closer to that patient so those patients can really learn about what those medicines are for and how those medicines can helpfully produce the healthy outcomes they’re looking forward to achieving.
Melanie: That’s amazing, Dr. Marden, as someone who looks to my pharmacist to answer a lot of questions. Doctors don’t always have time or you can’t reach your doctor when you need to, but your pharmacist is such a reliable, smart source where medications are concerned. Because you’re going to have the pharmacy right there, you’ll have all the records. So you will know if they’re on more than one medication and whether these medications will interact with each other?
Dr. Marden: That’s very much true. I think the beauty of this model is that today, when patients are leaving the hospital and they need some new prescriptions when they go home, one thing we know is they have to go somewhere and get those. A study has actually revealed that almost a third of patients may not even pick up those medicines. That’s one major issue we have today. By having our prescriptions available in the hospital for those patients to go home, one nice thing is that we should hopefully be able to help every patient along their way get those medicines they need. In addition is that we really see ourselves as not just a separate pharmacy. The pharmacy team here at Maine Medical Center is truly integrated into the patient’s care team. We all look at the same information. We all talk to each other as healthcare professionals. At the end of the day, the plan is very comprehensive and is done all together so that we truly know what’s in the best interest of the patient. Then third is that a lot of folks today aren’t able to spend time with patients when it comes to medications. Our pharmacists are set up to be able to sit down with the patients, really talk to them about what their concerns might be, and spend that valuable time so those patients, when they leave here, they really know what those medicines are for and they know what to look out for.
Melanie: Speak a little bit about medication adherence and the importance of it, Dr. Marden, because some people forget to take their blood pressure medication or their heart disease medication, their cholesterol medication. Are there consequences to skipping your meds for a day or a week and then, “Oops, I forgot in getting right back to them”?
Dr. Marden: Yeah, I think that’s probably the biggest challenge we hear from patients is just remembering to take them or not really understanding what the consequence might be if I forget to take them today or tomorrow. What we will be doing with our pharmacists is really talking to those patients about what are their concerns about being able to be successful in taking them each and every day. One of the things we find out from patients is that sometimes they don’t take them every day because they just don’t truly understand what will happen if they don’t. If you have a patient with high blood pressure, for example, if they don’t take their medicine a few days a week, they may not feel any difference. Over time, those medicines, for them to work best and produce the healthy outcomes that they hopefully want to get, then they really do need to be taken on a routine basis. Data suggest that upwards of 75 percent of patients that are on medicines don’t take them routinely. That’s pretty scary because we’re really trying to get the best outcomes for these patients. In order to get that, we really have to have those conversations to understand what the barriers might be and then work with them individually so that we can help them have strategies and plans so that they can be successful in taking them every day.
Melanie: When you’re discussing the medications with them, how do you convince them of a certain time or a certain way to take their medicines? What’s the best reminder, Dr. Marden, that you give patients on ways to remember to take them?
Dr. Marden: Yeah, that’s a great question. I think it has to be very individualized. Everybody in their own life has a very different daily schedule, and folks like to have different strategies. I think one of our jobs as pharmacy professionals is that when we sit down and talk with the patient, is that we have to understand what their core concerns are and that we don’t look to motivate them. At the end of the day, their success in taking their medicines every day is going to be about how much they motivate themselves to take them. And so we try to partner with our patients so that they know exactly why they are taking them, what it’s going to do if they take them every day, and then what strategies can they put in place, tools that they can put in place in their daily schedule to make it effective. It’s not always going to be the same solution for every person. I think what pharmacists do really well is they hone in on that and they really work with that patient to individualize a game plan so that they can be successful.
Melanie: What about older individuals, Dr. Marden, if they are living alone? What advice do you have for them or for their loved ones on making sure that they adhere to their meds?
Dr. Marden: That’s a great question, and sometimes when it comes to someone who is elderly and they have trouble remembering that we really need to hopefully have some involved family members that can check in on them that we can use different strategies like pill boxes that we fill once a week that are assigned different dates and certain pills by the time they have to take them. But we really have to be most careful about our folks in the elderly population who sometimes can’t always be successful on their own every day. If it gets to a point where they can’t be successful on their own every day, we have to look at what healthcare resources are available to have people come help them be successful. It’s important to bring up that population of the patients because that’s the population that has the most chronic disease and that’s really where we need to pay better attention to to help them be more successful with their medications.
Melanie: Give us your best advice about self-advocacy for managing your medications. And using MyChart at MaineHealth is one way that they can do that. So how can they best keep track of their own meds and when they need refills and such?
Dr. Marden: Well, I think first of all, probably one of the most important things that patients can do is just keep an accurate list, a complete list of the medications they are on. With each medication, list down exactly what the dosage is, how they take it, and when they take it. That’s critically important. I consider that foundational so that other things can happen successfully. Once they have that, one of the most important things they can do is communicate that to every healthcare provider that they see along the way. Because we realize today that not every patient may see just our own providers in our system at Maine Medical Center, so they may be going to see other providers that don’t have access to our medical record. What can happen over time is that the list can actually become a little bit confusing and sometimes not accurate. So it’s really important for every patient -- I can’t stress this one enough -- every patient to be empowered to really keep their own list and bring it with them every time they come in to a medical facility. I often suggest they keep a list on them just in their wallet or in their purse or somewhere on there in case they’ve had a medical emergency, that it would be available when they are admitted to a hospital.
Melanie: It’s pretty easy these days to even buy a little zip drive and put your meds on there and keep that with you and then you go to a hospital or an emergency room, they just plug that in and it keeps updating, but I’ve seen those lists looking pretty old with something scratched out so I think it’s very important what you said to keep them updated and clearly written what medications you take and what you have taken. Dr. Marden, in just the last minute, please give your best advice for adherence to medication, the new pharmacy at Maine Medical Center, and why people will be so happy to see this there.
Dr. Marden: Well, once again, thank you for allowing me the opportunity to share this great story and really this long-term partnership we’re hoping to set up with our patients. One thing we’re trying to do upfront is we’re just trying to provide a convenient space in which a patient can access medications, what they might need going home. Because we know that there are barriers to maybe getting those medicines once they leave our door. They might have to make an extra stop. Some of our patients drive a long way to get here. It’s just one thing that folks shouldn’t have to worry about doing on their way home since they just got out of a hospital. We can provide convenient access to them. I think that will really be seen as a good thing in the eyes of our patients in terms of their experience. In addition to that, it’s not just getting the medications. It’s making sure that they get the right medications. Having our pharmacists involved with that care team, reviewing their medication list, making sure that the medications that they are prescribed and are going home on are really the best medications for that patient to have a healthy outcome. Third—and I think this is the most important element—is that our pharmacy services will provide a lot more what I consider high touch service than what they might be getting today elsewhere, which means that our pharmacists will be spending the time with our patients that they need—because they all need something individually in terms of time and need—that they really go home feeling empowered and educated about what their medications are for, what particular things to look out for in terms of side effects, and then who to call if something happens. Really, it’s all about education and empowerment and providing convenient access so that they can have healthy outcomes after they leave us here at Maine Medical Center.
Melanie: What great information, Dr. Marden. Thank you so much. You’re listening to MMC Radio. For more information, you can go to mainemedicalcenter.org. That’s mainemedicalcenter.org, mmc.org. This is Melanie Cole. Thanks so much for listening. Have a great day.