Unintended Consequences

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Your patients are adherent to their medication protocol, now you have to ensure they don’t wash the pills down with grapefruit juice or use an over-the-counter (OTC) herbal supplement that could unintentionally dilute or alter the benefits of their prescribed drugs.

Adverse Drug Reactions (ADR) and Drug-Drug Interactions (DDI) are prescribing issues that can be avoided. Three chronic diseases – diabetes, high cholesterol and high blood pressure/heart disease – are so commonplace in today’s healthcare environment that patients often overlook warning labels on their medications. Statistics show 13 percent of Americans living with one or more of these conditions do not realize they are putting themselves at risk by not understanding the basics of their condition and treatment.1

ADR Stats and Facts

  • Over 2 million serious ADRs yearly
  • 100,000 deaths yearly
  • ADRs are the fourth-leading cause of death ahead of pulmonary disease, diabetes, AIDS, pneumonia, accidents and automobile deaths
  • Nursing home patients’ ADR rate – 350,000 yearly2

Costs Associated with ADRs

  • $136 billion yearly
  • Greater than the total costs of cardiovascular or diabetic care
  • ADRs cause one in five injuries or deaths per year to hospital patients
  • Mean length of stay, cost and mortality for ADR patients are doubled that for control patients
  • Drug interactions are important contributors to the number of ER visits and admissions
  • Drug interactions represent three to five percent of preventable in-hospital ADRs3

With ADRs so widespread and some extreme, pharmacists need all the tools in their arsenal to combat unintended consequences. These consequences can negatively/drastically affect the health of patients, as well as significantly increase the financial burden for all involved: patients, providers and society.

The Pharmacist Challenge

People have a tendency not to read directions, and those who do often skim for highlighted and bolded phrases. Additionally, more than 500,000 Americans misinterpret instructions on labels every year, as reported by Consumer Reports.4

Consumer Reports ran a “Spot Check” to compare different drug labels, bottle warnings and consumer drug information leaflets. Take an opportunity to review the results and see how it might relate to your patients’ understanding of their medications.

According to the study, there is no nationwide standard for prescription drug labels other than the Food, Drug and Cosmetic Act, which requires the patient’s name and exact doctors’ dosage instructions. Other details can vary by state. Labels are not monitored by the Food and Drug Administration; rather, each state’s board of pharmacy is responsible for their content.5 This results in confusion and raises questions on whether patients understand the terminology. There are also instances where one doctor may prescribe a particular brand drug and another prescribes the same drug in its generic form. Due to complex drug names, the patient does not know he is actually taking the same drug twice under two different doctors’ orders.

Pharmacists should use a two-prong approach – communication (customer interaction) and technology (behind the counter/workflow). This ensures patients accurately understand their medication regimens and accompanying instructions, know the drugs they are taking (generic or brand) and understand the side effects of each. This includes outside influences, such as OTC items, food and even environmental elements, like sun exposure.

The QS/1 Approach

QS/1 has a feature in its NRx® Pharmacy Management System, released in Service Pack 19.1.19, that is becoming a customer favorite. The Rx Alert Note works in conjunction with QS/1’s Point-of-Sale (POS) system and incorporates customer service into transaction processing. Rx Alert Notes, which are entered on the Prescription Record signal technicians and cashiers that a specific prescribed drug has information that needs to be brought to the patient’s attention at checkout. It could be as simple as prompting the staff to offer counseling, reminding the patient of an upcoming clinic or something more specific like warning against drinking grapefruit juice or taking aspirin with the medication.

Another practical use for Rx Alert Note is to remind technicians or cashiers to update patient profiles. It is a good idea to update patients’ files at least twice a year with pertinent information that may affect their prescriptions. Are they taking any medications not on file with your pharmacy? Are they taking any OTC drugs, such as vitamins, allergy medication or pain relievers?

To take advantage of this feature, your pharmacy must be on QS/1’s POS Service Pack 19.1.19, and the pharmacist must check Display in POS on the Rx Alert Note window.

Other services available in your QS/1 arsenal to combat ADRs and DDIs are Clinical Updates and Nutri-Link™. Both of these tools are workflow necessities.

Clinical Updates offer real-time or quarterly updates from First Databank (FDB®) and provide clinical information for contraindications, drug interactions, allergies, geriatric and pediatric warnings, drug-food interactions and more. Updates are available in English, Spanish and French.

Nutri-Link, provided through the QS/1 vendor partner Healthway Solutions, Inc., provides patient handouts on potential drug/nutrient depletions, advises about possible interactions with herbs and natural products and integrates with QS/1 without additional hardware or software requirements. Nutri-Link is available with NRx and PrimeCare­®.

To enroll in Clinical Updates or Nutri-Link, email databaseservices@qs1.com or call 800.845.7558, ext. 1424.

Customer Service Behind the Counter

Your staff should be trained to observe and ask questions to ensure patients receive conversational customer service at checkout. For example, a patient picks up her high blood pressure medicine; at the same time, she purchases an OTC cold medicine. Do staff members know to bring this to the pharmacist’s attention in case the OTC medicine is not compatible with her prescribed medication?

Encourage staff members to ask the following questions at the register:

  • Do you understand what medicines you are taking?
  • Would you like to take a moment to read the warning label and instructions to clarify any information?
  • Did you notice the warning labels?
  • Are you taking any medications that we don’t have in our profile, including vitamins or OTC items?
  • Do you have any questions for the pharmacist?

Make the Difference

Reduce ADRs and DDIs or prevent them altogether, when the tools, suggestions and simple steps mentioned are implemented. Engage patients to be active participants in their healthcare and aid in circumventing unintentional consequences that can result in sickness, emergency room visits, hospitalization or even death. Use the Rx Alert Notes feature and examine the benefits of incorporating Clinical Updates and Nutri-Link into your workflow. Hold staff meetings to review checkout procedures. With a little tweaking and the desire to make a difference in patients’ overall health outcomes, you and your staff can make a huge impact.


1 “Dangers of Drug Interactions.” Express Scripts. April 28, 2015. Web. 23 Nov. 2016. http://lab.express-scripts.com/lab/insights/drug-safety-and-abuse/dangers-of-drug-interactions

2, 3 “Preventable Adverse Drug Reactions: A Focus on Drug Interactions.” U.S. Food and Drug Administration. March 14, 2016. Web. 23 Nov. 2016. http://www.fda.gov/Drugs/DevelopmentApprovalProcess/DevelopmentResources/DrugInteractionsLabeling/ucm110632.htm#Types of Drug Interactions

4, 5 “Can You Read this Drug Label?” Consumer Reports. June 2011. Web. 25 Nov. 2016. http://www.consumerreports.org/cro/2011/06/can-you-read-this-drug-label/index.htm?video_id=1020889176001

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