Proposal to Amend WAC
246-869-220 in an Effort to
Improve Pharmaceutical Care in
Washington State
Group LUCKY 7 – Pharm 543
Beth Walter, Thang Tran, Geoff Kozu,
Robert Kahns, Erin Alldredge,
Quynh-Anh Nguyen, Ruby Soleimani
Pharmacist’s Role
Pharmaceutical care defined pharmacist’s
role as patient-centered, outcomesoriented, pharmacy practice
Does mail-order pharmacy provide optimal
care for our patient?
Answer: We’ll let you decide it.
Why should you CARE ?
Sentinel event concerning a mail-order prescription medication error that
resulted in a non-diabetic patient having a near fatal episode from taking a
sulfonylurea that was intended for someone else
A 64-year-old-male was diagnosis of profound hypoglycemic
Causes:
– Wrong Patient, wrong drug
– Lack of direct counseling
– Ineffective form of counseling (written instructions and/or package
insert)
Consequences:
– Lethargic, diaphoretic, and incontinent of urine
– Admit to ICU
– Cost of hospitalization
What is the PROBLEM ?
Written forms of counseling are inadequate because patients do not gain a
sense of security with therapy.
A written drug information sheet with all possible side-effects and warnings,
while educational, can work to frighten the patient out of compliance
A survey of 351 elderly subjects living in 2 retirement communities in
Arkansas reported that
– 73.8% stated that they felt most protected when they received either face-to-face
consultation or face-to-face consultation as well as written drug information
“Even with face-to-face counseling, establishing patient comprehension can be
difficult; with mail order pharmacy, counseling becomes even more challenging.”
PROBLEM Continues to Grow….
Data about missed/inadequate/lack of counseling and
med errors
– Annually there are 777,000 of medication errors in the United States
– 44,000 to 98,000 Americans LIVES are LOST each year as a result of
medical errors
– 25% of medication errors (194,250) are due to
1. Lack of patient information
2. Lack of patients’ understanding of their therapy
– 1-4% of all visits to the ER are due to inappropriate use of medications
that is no fault of the patient’s.
THE PROBLEM is still growing….
Medication errors CANNOT be directly attributed to RXs
sent by mail
Counseling issued when prescriptions are sent through
the mail is less than optimal, it is below the minimal
allowed for an in-person prescription pick-up
Currently there is NO published data on medication
errors caused exclusively by mail-order pharmacies
Data has shown mail-order pharmacies’ lack of
counseling requirements are a potential source of
adverse outcomes.
Why do People Choose Mail-Order
Services?
Patients who are unable to leave their home
Those living in remote areas without access to
newer, more expensive drug
Patients who just don’t have time to come into
their local pharmacy
Reduced monthly co-pay
Our Current Law
Our current law: WAC 246-869-220(1)(2), Patient counseling
required:
For patients who come into a pharmacy to get prescriptions
filled, it is the duty of the pharmacist to directly counsel the
patient on their medications, but for prescriptions mailed to
the patient, counseling is only required to be given in the form
of a standard drug information sheet with the pharmacy’s
phone number in case the patient has any questions or
concerns about their therapy.
We believe that mail-order service doesn’t provide optimal
pharmaceutical care for our patients
That’s why we came up with our proposal
OUR awesome Proposed Law
Patient counseling required. The purpose of this counseling
requirement is to educate the public in the use of drugs and devices
dispensed upon a prescription.
(2) For prescriptions delivered outside of the pharmacy either by
mail or hand delivery, the pharmacist shall make a reasonable
attempt to contact the patient or patient’s agent via telephone, to
provide direct counseling and information about the drug. Including
information on how to contact the pharmacist.
(a) For prescriptions delivered outside of the local calling area, the
pharmacy or the pharmacist must provide a toll-free means for the
patient or patient’s agent to contact the pharmacist. If the pharmacy
chooses to provide a toll-free number, the pharmacy shall disclose
this toll-free number on a label affixed to each container of drugs
dispensed and delivered to patients.
Alternatives
Do nothing to current law
Make mail order prescriptions illegal
Add yearly BOP inspection of mail order
procedures (Board in favor, would like a
standardized inspection procedure)
Alternatives (Continued)
Technical
feasibility
Political
Viability
Political
Operability
Impact of positive
therapeutic
outcomes
Do nothing
(+)
(+)
(+)
(-)
Make
mailing rx’s
illegal
(+)
(-)
(-)
(-)
Make
yearly BOP
inspections
(-)
(+)
(-)
(~)
Evaluation Criteria
How do we intend to TRACK outcomes for
changes in Patient Safety and Education ?
Two ways to evaluate impact of new law
for Washington State Pharmacies:
• Establish an Experimental Site
• Monitor quality of care after law is
implemented
ANALYZE THIS…………..
Experimental Site
Interesting data to record & evaluate:
Pharmacist intervention with patients using mail order
pharmacies.
Recording and monitoring the causes of Adverse Drug
Reactions and Events.
The Stakeholders, Their two cents
Patients – Favor it
Pharmacists - (Private and Chain)
Have mixed feelings, but are mostly in favor
AARP – Possible support, no opposition at this
time
Oh yeah…… THE END
By changing the law as it now stands, we hope to
bring mail-order pharmacy, an important and emerging
form of pharmacy practice, up to the standard of care
that patients in Washington State deserve.
Thanks for Listening
Just a friendly reminder
Finals start in just a day
and a half from NOW!
If you have not started,
we are sure you are not
alone!
GOOD LUCK From
Group “Lucky” 7