Development of guidelines for high-risk medication dispensing

Abstract

High-risk medications can cause an increased risk of significant harm to patients when misused or used in error. The aims were to evaluate whether high-risk medications are treated differently to non-high-risk drugs during dispensing and to develop guidelines for pharmacists dispensing high-risk medications. A high-risk documentation sheet (HiRisk) was developed and validated by four community pharmacists and two general practitioners. The tool captures the frequency of high-risk medication dispensing. Fifty observational studies using the HiRisk developed tool assessing the most common high-risk medication being dispensed were conducted in five community pharmacies chosen by random sampling from five different districts. Patient interview questions were developed and validated by the same panel. Fifty patient interviews were conducted on a separate cohort of patients in two community pharmacies chosen by convenience sampling aiming to assess patient knowledge and level of awareness of the high-risk medication being dispensed. From the fifty observational studies carried out using the HiRisk documentation sheet, thirty pharmacists being observed have been practicing community pharmacy for more than ten years. From 50 prescriptions observed using the HiRisk documentation sheet, the direct oral anticoagulants rivaroxaban and apixaban were the most commonly dispensed (n=20) high-risk medications followed by warfarin (n=11) and insulin (n=7). Throughout the dispensing process, all pharmacists (N=50) ensured that patients understood well how to administer the high-risk medication and if they are experiencing any issues. All pharmacists repeated major key points during the dispensing process. From the fifty patient interviews conducted, the direct oral anticoagulants were also the most commonly dispensed high-risk medication (n=16), followed by warfarin (n=13) and zolpidem (n=11). Guidelines to improve the dispensing process were developed for the three most commonly dispensed high-risk medications namely the direct oral anticoagulants, warfarin and insulin. A focus group consisting of four general practitioners and four community pharmacists was set up to validate the developed guidelines. Observing the commonly dispensed high-risk medications and implementing strategies to reduce high-risk medication-associated side-effects through proposed guidelines makes dispensing a streamlined process contributing towards enhanced patient safety.