By: Nicholas Ladikos, PharmD, FASCP, BCPS, BCGP, BCIDP, et al.
Tel: 561-306-6595
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INCLUDING A PHARMACIST AS YOUR MEDICATION THERAPY MANAGEMENT EXPERT IN A CASE CAN PROVIDE IMMENSE VALUE AND PERSPECTIVE TO CASES INVOLVING THERAPIES PROVIDED IN HOSPITALS, CLINICS, NURSING HOMES, AND COMMUNITY PHARMACIES.
A well-known expert hiding in plain sight, pharmacists can be a crucial addition to your practice.
Medication errors are the most common and preventable cause of patient injury. These errors typically involve administering the wrong drug or dose, using the wrong route, administering it incorrectly, or giving medication to the wrong patient. Each year in the United States, nearly seven billion prescription medications are dispensed. Preventable adverse events lead to an estimated 44,000 to 98,000 hospital deaths annually, surpassing the number of deaths attributed to motor vehicle accidents. The reported incidence of medication errors in acute hospitals is approximately 6.5 per 100 admissions. In addition, approximately 20% of all skilled nursing facility residents–about 300,000 people every week–receive some form of antipsychotic medication, while only about two percent had qualifying conditions for such drugs.
Medication errors can occur at any time during the treatment process in any setting–hospitals, clinics, nursing homes, retail and mail order pharmacies–and are defined as any avoidable event in prescribing, transcribing, dispensing, administering, or monitoring, regardless of the occurrence of injury or potential injury; such events can result from human errors or system defects. If an error harms a patient, it becomes an adverse drug event (ADE). Table 1 highlights the types and causes of medication-related errors.
|
POTENTIAL AREAS WHERE MEDICATION ERRORS MAY OCCUR |
SYSTEM FAILURES |
TYPES OF MEDICATION ERRORS |
COMMON CAUSES OF MEDICATION ERROS |
Ordering and prescribing |
Inaccurate order transcription | Prescribing | Expired product |
| Documenting | Drug knowledge | Omission |
Incorrect duration |
| Transcribing | Failing to obtain an allergy history |
Wrong time | Incorrect strength |
| Dispensing | Incomplete order checking | Unauthorized improper dose | Incorrect rate |
Administering |
Mistaking in the tracking of medication orders | Wrong dose Prescription or wrong does preparation | Incorrect timing |
| Monitoring | Poor interprofessional communication | Administration errors such as incorrect route of administration, administering the drug to the wrong patient, extra does, or wrong rate | Incorrect dosage form Incorrect patient action |
| Unavailable or inacccurate patient information | Monitoring errors such as failing to take into account the patient’s liver and renal function, failing to document allergy or potential for drug interaction | Known allergen Known Contraindication |
|
| Compliance errors such as not following protocol or rules established for dispensing and prescribing medications | Distractions Distortions Illegible writing |
The term scope of practice (SOP) refers to the limits of a health professional's ‘knowledge, skills and experience’ and reflects all tasks and activities they undertake within the context of their professional role. It is important for health professionals to be aware of their own individual SOP, as well as the broader SOP for their discipline, to ensure they are practicing ‘safely, lawfully and effectively’ and that their skill development and growth are in keeping with the expectations for their profession. SOP is also an important concept for health regulators, leaders, and managers and has long been central to system-level health workforce reform.
Pharmacists are considered medical or healthcare professionals, particularly within the field of pharmacy, and are often referred to as healthcare providers themselves. State law dictates the scope of practice for each medical and pharmacy professional.
Pharmacists are Doctors of Pharmacy, i.e., they have a terminal degree. Their coursework and training place emphasis on the medical and pharmacological management of diseases, the optimization of therapies, and the judicious use of treatment.
The scope of practice for pharmacists ranges from simply dispensing to being an integral member of the integrated health care team to being an “advanced” pharmacist/having a prescribing practice, which is commonly seen in the U.S. Department of Veterans Affairs (VA) hospitals, and several states. Versatile, knowledgeable, and approachable, pharmacists, particularly those with advanced training and certifications, improve patient outcomes by bridging the gap between physicians and patients. Pharmacists’ specific training in medication therapy management (MTM) provides them with an ability unique in the medical world, allowing them to be the singular expert in all things medication and therapy related across all fields of medicine.
Pharmacists guide therapies from all areas of medicine, including cancer, nutrition, diabetes, cardiology, surgery, and transplant. They also conduct pharmacogenomic testing and manage/optimize therapies based on a patient’s genetics.
Acid Reflux (GERD) Adverse Drug Reactions Anticoagulation (e.g., Heparin, Lovenox, Coumadin) Anti-Psychotics CBD/THC Claim Reviews Clinical Negligence Clinical Research Compounding Controlled Substances Dietary Supplements Driving Under the Influence of Drugs Drug Dispensing Drug Dose Calculations and Verification Drug Effects/Reactions Drug Infusions and Intravenous (IV) Medications Drug Interactions and Drug Contraindications Drug Labeling |
Drug Monitoring and Levels Drug Preparation Drug Safety Drug-Drug Interactions Drug-Induced Lung Diseases Geriatrics Hospital Pharmacy Infectious Diseases Insurance Claims Analysis Life / Health Claims Malpractice (Pharmaceuticals) Medical & Health Medical Chart Review Medical Utilization Review Medicare/Medicaid Fraud & Abuse Medication Administration Medication Use, Side Effects, and Errors Over The Counter Medications (OTC) Pain Management |
Pharmaceutical Negligence and Fraud Pharmacists Pharmacology Pharmacy Practice Prescribing Errors Prescriptions Professional Liability Medical Insurance Psychopharmacology Psychotropic Pharmaceuticals Pulmonary Medicine Regulatory Affairs and Pharmacy Law Respiratory Therapy Retail (Community) Pharmacy Standards of Care (Pharmacy) Supplements Teaching and Training Total Parenteral Nutrition (TPN) Vaccinations |
On medical teams, pharmacists supplement the physicians’/prescribers’ overall management of patients by providing a deep and comprehensive approach to the usage of clinical medication therapies (pharmacotherapies), the management of those therapies’ side effects, the optimal and strategic use of those therapies, the monitoring and adjusting of regimens, and the teaching, training, and education to the medical team on the judicious use of medicines. Figure 1 illustrates the clinical overlap between physicians and pharmacists.
| CLINICIAN | DEGREE | RESPONSIBILITIES |
| Physician | MD, DO | Overall management of patient, diagnosis, and procedures |
| Nurse Practitioner | ARNP | Overall management of patient, diagnosis, and procedures, usually under the guidance of a physician |
| Nurse | RN, BSN | Administration of medications and day-to-day patient management |
| Pharmacist | PharmD, RPH | Medication regimen management and optimization, clinical training, drug-drug, drug-disease, and drug-allergy management |
Pharmacists are responsible for medications (clinical medication therapies) dispensed in all medical settings–Hospitals/Medical centers, clinics, community (retail) pharmacies, mail order pharmacies, and outpatient centers. They review drug-drug interactions, drug-disease interactions, allergy validation and management, and medication regimen optimization (right drug, right route, right dose, right time, right frequency, right duration, and side effect mitigation and management). Therapies span across all clinical specialties for acute and chronic illnesses: Oncology medication and side effect management, intensive care units, internal medicine/diabetes management, cardiology/anticoagulation management, solid organ transplant/organ rejection management, pain management/addiction, infectious diseases/HIV.
Pharmacists bring to the legal arena unparalleled knowledge and insight regarding medications and their use (clinical medication therapies). They are also integral in reviewing medication and prescribing errors, morbidity and mortality conferences, medical chart reviews, education and training, and pharmacy standard of care.
Dr. Nicholas Ladikos, PharmD, FASCP, BCPS, BCGP, BCIDP, is a Clinical Pharmacist and Drug Regimen Error expert. He started and operationalized system-level programs at the Johns Hopkins Hospital and the National Institutes of Health (NIH), and is also the founder of MedOp Advisors, a concierge medication, nutrition, and health & wellness advisory company. Dr. Ladikos is a subject matter expert in several pharmacy-related areas and serves as an expert witness on a number of Pharmaceutical litigation matters. Numerous hospitals have used his skillset and expertise in medical chart reviews to identify errors in medication preparation and prescribing, drug side effect management, standard of care compliance, continuing education delivery, and personnel assessments.
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5/23/2025· Pharmacy & Pharmacology
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