While the process of sending prescriptions to pharmacies via electronic health record systems is increasingly the norm, notifying pharmacies about discontinued medication remains a challenge and increases the risk of safety events in patients. A study presented as part of ACC Quality Summit Virtual, by Intermountain Healthcare in Murray, UT, explores why pharmacy communication on canceled medications is not occurring and looks at ways to better communicate these changes.

"Currently there is no ideal way to notify a pharmacy that a clinician has discontinued medication for a patient, often leading to a discontinued medication or incorrect dose to be refilled and causing confusion for the patient," said Jeffrey A. Goss, FNP-c, MSN, APP, director of Heart Failure for Intermountain Healthcare, and one of the study authors. "Patients are at risk for taking a medication that is no longer indicated or at the wrong dose, which has important medication safety indications."

According to Goss and colleagues, Intermountain Healthcare had a number of safety events occur involving discontinued medications being taken along with new medications, resulting in hospitalization. Initially, the team at Intermountain Healthcare tried temporary fixes, including clinical staff (registered nurses or pharmacists) personally calling the pharmacy to alert them of medication changes and requesting the medication be removed from the patient's profile. Clinicians were also asked to document medication changes in the "comments" box of a prescription being sent electronically to alert pharmacy staff about medication changes. This included documenting information such as, "this prescription replaces...," but not all pharmacies see this information and it was not a reliable method of communication.

The CancelRX study explored a more permanent option using the CancelRX functionality on Intermountain Healthcare's electronic medical record system coupled with phone calls to pharmacies. Over the course of 60 days, 16 advanced practice providers at the Intermountain Medical Center Advanced Heart Failure/Transplant team turned on the CancelRX functionality in their electronic medical record system. All told, providers tracked at total of 558 discontinued medications and avoided 196 potential safety events during the 60-day period.

Researchers did note that the CancelRX feature is not seamless and that error messages do occur. They also highlighted that the feature also requires that pharmacies have the functionality enabled on their end. However, they stressed that better outcomes are inherent if the correct medications are being dispensed to patients based on clinician recommendations. They recommend health systems review how their electronic medical record system interface with their local pharmacies to ensure one less area of potential error in patient care.

"Effective communication between the clinician and the pharmacy is paramount to ensuring patients only receive medications they require. In addition to the safety implications, this will also reduce the likelihood of a patient purchasing a discontinued prescription, resulting in cost savings for patients and insurance payers," said Steven Metz, PharmD, BCPS, Advanced Clinical Ambulatory Care Pharmacist.

Clinical Topics: Cardiovascular Care Team, Heart Failure and Cardiomyopathies, Acute Heart Failure

Keywords: Quality Summit, Pharmacists, Electronic Health Records, Pharmacies, Cost Savings, Pharmaceutical Services, Pharmacy, Ambulatory Care, Qualitative Research, Heart Failure, Prescriptions, Hospitalization, Delivery of Health Care, Insurance, Nurses, National Cardiovascular Data Registries

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