Patient Safety

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Patient Safety

Patient safety news, including recalls and safety alerts, important consumer information and updates on safe medication practices.

Should We Begin Implementing Preconception Care Counseling Among Women of Childbearing Age, 18 to 45 Years, Within the Community Pharmacy Setting?

By Mollie M. Reidenbach, Pharm.D., pharmacy practice resident, SpartanNash, Byron Center

 

Preconception care is defined as a set of interventions that work toward identifying and modifying biomedical, behavioral and social risks to women’s health or pregnancy outcomes through prevention and management.1,2 It refers to the healthcare a woman or man receives during the years in which they are able to have a child and focuses on taking steps now to protect the health of a baby they might have in the future.3 Many pregnancies have good maternal and fetal outcomes; however, in the U.S., about 30 percent of women experience complications during pregnancy leading to 12 percent of babies being born prematurely, eight percent born with a low birth weight and three percent having major birth defects.2 In addition, pregnancy complications and their aftermath impart a large economic burden with direct and indirect healthcare system costs totaling over one million dollars over the course of that child’s life.2

Several studies show that almost all women who are planning to become pregnant have at least one risk factor that could adversely affect their pregnancy.4 Complications can occur at any stage of pregnancy; however, most birth defects occur within the first three months of pregnancy during fetal organ development.3 Because almost half of all pregnancies in the U.S. are unplanned, women may not be aware of pregnancy until the fetus has moved well into the vulnerable period. This results in an alarming amount of women who are not taking the necessary precautions to prevent complications.3,5 Given this information, timing of prenatal care is key.2 Preconception care should not only target patients who are actively pursuing pregnancy, but also the 62 million women of childbearing age in the U.S. who are capable of becoming pregnant.5,6 Although not all negative occurrences can be avoided, optimizing women’s health and knowledge before conception may help to reduce these risks.5

The Centers for Disease Control and Prevention (CDC) Select Panel on Preconception Care developed 14 proven interventions for preconception care: diabetes, hypothyroidism, maternal phenylketonuria (PKU), oral anticoagulation, antiepileptic medications, isotretinoin use, HIV/AIDs, sexually transmitted infections (STIs), vaccinations, folic acid, smoking cessation, alcohol/drug misuse and obesity.3,7 While much of this can be addressed in the primary care setting, many patients cannot afford routine doctor visits, and providers may find it difficult to address every need within one appointment. Pharmacists can help bridge this gap. In a study by Mager et al., select community pharmacies in Ohio implemented preconception care targeted medication reviews into the pharmacy workflow; the interventions included folic acid supplementation, hepatitis B/MMR vaccination and category D/X medication use.8 The study demonstrated the feasibility of this type of counseling within the community pharmacy setting. With 90 percent of Americans living within a five mile radius of a pharmacy, and medication therapy management (MTM) platforms providing avenues for these types of services to be implemented, pharmacists are in an excellent position to provide those services for their patients.9 Should we begin implementing preconception care-based counseling among women of child-bearing age within the community pharmacy setting? The answer should be a resounding “yes.”

If yes, what are the next steps? Preconception care services are quickly becoming a “hot topic” in healthcare, and the need for these services is well defined. In time, more research and recommendations regarding community pharmacy driven preconception care services will become available. As we begin to learn more about the need for preconception care and how it fits into community pharmacy practice, I leave you with this: where might preconception care services fit within your pharmacy workflow, and how might you implement these types of services to better the health of the patients you serve?

 

For more information, visit the CDC’s website: https://www.cdc.gov/preconception/index.html

References:

1.      Preconception care: A guide to optimizing outcomes. ACOG [internet]. 2013 Sept [cited 2017 Sept 2]. Available from: https://www.health.ny.gov/publications/2026/

2.      Proceedings: Kent H, Johnson K, Curtis M, Hood JR, Atrash H. Proceedings of the preconception health and health care clinical, public health, and consumer work group meetings. CDC, National Center on Birth Defects and Developmental Disabilities [internet]. 2006 Jun 27-28 [cited 2017 Sept 1]. Available from: https://www.cdc.gov/preconception/documents/workgroupproceedingsjune06.pdf

3.      Preconception health and healthcare. CDC [internet]. 2017 Feb 13 [cited 2017 Sept 1]. Available from: https://www.cdc.gov/preconception/index.html

4.      Poels M, Van Stel HF, Franx A, Koster MPH. Actively preparing for pregnancy is associated with healthier lifestyle of women during the preconception period. Midwifery [internet]. 2017 Apr 26 [cited 2017 Sept 1]; 228-234. Available from: https://www.ncbi.nlm.nih.gov/pubmed/28478375

5.      The importance of preconception care in the continuum of women’s health care. ACOG [internet]. 2005 Sept [cited 2017 Sept 1]; 313. Available from: https://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Gynecologic-Practice/The-Importance-of-Preconception-Care-in-the-Continuum-of-Womens-Health-Care

6.      Johnson K, Posner SF, Biermann J, Cordero JF, Atrash HK, Parker CS, Boulet S, Curtis MG. Recommendations to improve preconception health and health care --- United States. A report of the CDC/ATSDR preconception care work group and select panel on preconception care. CDC MMWR [internet]. 2006 Apr 21 [cited 2017 Sept 1]; 55(RR06):1-23. Available from: https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5506a1.htm

7.      DiPietro N. Preconception care: an overview. US Pharmacist [internet]. 2008 Sept 18 [cited 2017 Sept 1]; 33(9): 34-42. Available from: https://www.uspharmacist.com/article/preconception-care

8.      DiPietro NA, Bright DR, Markus D, Weis L, Hartzell DM, Gartner J. Use of targeted medication reviews to deliver preconception care: a demonstrative project. J Am Pharm Assoc [internet]. 2017 Jan-Feb [cited 2017 Sept 1]; 57(1): 90-94. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27838391

9.      Frederick J. By the numbers: how community pharmacists measure up. DSN [internet]. 2015 Mar 13 [cited 2017 Sept 1]. Available from: http://www.drugstorenews.com/article/numbers-how-community-pharmacists-measure

 

Posted in: Patient Safety
Curbing the Opioid Epidemic: Proper Opioid Disposal

By Katrina Capapas, Pharm.D., PGY1 pharmacy resident and  Cheryl Genord, R.Ph., pharmacy clinical specialist in pain management, St. Joseph Mercy Hospital, Ann Arbor, MI

 

Prescription drug misuse and abuse continues to be a problem throughout the United States. Particularly, the dramatic increase of prescription opioids since 1999 has resulted in unrestricted availability of unused opioids and has unlocked opportunities for abuse and addiction.1 Per the Centers of Disease Control and Prevention (CD), prescribers wrote 66.5 opioid prescriptions for every 100 Americans in 2016.2 In 2015, the total number of prescribed opioids equated to 640 morphine milliequivalents (MME), which equates to every American being medicated around the clock for three weeks.3 Additionally, Jones et al. evaluated a national survey that identified sources of opioids for non-medical use; the authors found that up to 56 percent of survey responders reported obtaining opioids from a friend or relative for free.4

At the end of 2017, Michigan lawmakers passed new legislation to help curb the opioid epidemic and promote proper prescribing and disposal of opioids.5 The policy includes a provision where a prescriber or health professional must address the patient with the following information before prescribing an opioid:

1.      The dangers of opioid addiction.

2.      How to properly dispose of an opioid.

3.      Diversion of a controlled substance is a felony.

4.      A discussion on the harm of opioid exposure to the fetus for pregnant patients.

In light of the new policy, pharmacists can help patients by providing information on how to remove unwanted or unused opioids to reduce the chance of accidental misuse. Below are ways to dispose of unwanted prescription opioids and other medications:

1.Take-Back Programs: Patients can take old, unused or unwanted medications to an authorized pharmacy for proper disposal. Michigan pharmacy locations are available online here via the Michigan Department of Environmental Quality.5,9 The Michigan Pharmacists Association also holds an annual Medication Disposal Event on the south Capitol lawn in Lansing; the next event will be held on Tuesday, Sept. 11, 2018, from 10:30 am – 1:30 pm.6 Additionally, the Michigan OPEN hosts take-back programs throughout the state.7 The last take-back event in September 2017 collected 17,500 opioid pills from consumers. Visit the website here for updates on the next take-back event.

Patients can find local law enforcement agencies participating in the "Big Red Barrel" program to dispose these medications.8 All 29 Michigan State Police posts are collecting scheduled prescription medications every Monday through Friday. To find a law enforcement agency, visit www.Michigan-Open.org/takebackmap/.

2. Disposal in Household Trash: if patients are unable to dispose their medications at a participating pharmacy or law enforcement agency, the Food and Drug Administration (FDA) provides four simple steps on how to dispose medications in the trash:11

A. Mix medicines in unpalatable substances such as dirt, kitty litter or used coffee grounds. Do not crush tablets or capsules.
B. Place the mixture in a container such as a sealed plastic bag.
C. Throw the container in your household trash.
D. Scratch out all personal information on the prescription bottle of your empty pill bottle or empty medicine package, then dispose of the container.

Deterra® deactivating system
Patients can also dispose of unwanted opioids using the Deterra® deactivating system.12 Deterra® uses a patented activated carbon technology to immediately deactivate opioids and other medications, and is available in different sizes for purchase on the internet or at local pharmacies. The packaging itself is biodegradable and will not significantly contribute to landfills.

 

3. Flushing of Medicines: Some medications can pose harmful risks if not disposed of immediately. The FDA recommends certain medications, including opioids, to be flushed down the toilet if a take-back program or other means of disposal is not available to prevent harm to other people (for more information, see the FDA Flush List).13 In light of concerns about medications in the water supply, the FDA released a study that examined ecological and human-health risks.14 Fifteen active ingredients were studied, which included buprenorphine, hydrocodone, hydromorphone, methadone, morphine, oxycodone, and oxymorphone. The study concluded that the medications were not associated with significant risks through ingestion of water or fish.

Pharmacists play an essential role in decreasing the opioid reservoir. Promoting proper opioid use and disposal is among the numerous ways they can educate patients and ultimately act as a line of defense against the opioid epidemic.

References

1. Analysis of Opioid Prescription Practices Finds Areas of Concern. NIH website. https://www.drugabuse.gov/news-events/news-releases/2011/04/analysis-opioid-prescription-practices-finds-areas-concern. Accessed December 18, 2017.

2. Annual Surveillance Report of Drug-related Risks and Outcomes. CDC website. https://www.cdc.gov/drugoverdose/pdf/pubs/2017-cdc-drug-surveillance-report.pdf. Accessed December 18, 2017.

3. Opioid Prescribing. CDC website. https://www.cdc.gov/vitalsigns/opioids/infographic.html#graphic-a. Accessed December 18, 2017.

4. Jones CM, Paulozzi LJ, Mack KA. Sources of Prescription Opioid Pain Relievers by Frequency of Past Year Nonmedical Use. JAMA Intern Med. 2014;174(5):802-803.

5. Medication Disposal. Michigan Pharmacists Association website. http://www.michiganpharmacists.org/medicationdisposal. Accessed December 18, 2017.

5. Senate Bill 0217 (2017). Michigan Legislature website. http://www.legislature.mi.gov/(S(0j3pch3hodgym1moji4sf1gp))/mileg.aspx?page=BillStatus&objectname=2017-SB-0274. Accessed January 14, 2018. 

Posted in: Patient Safety
MPA Partners with Secretary of State, MDOT and Other Officials to Provide Resources to Assist Aging Drivers

Michigan has approximately 7.1 million licensed drivers, about 1.4 million of who are 65 years of age or older. The Safe Drivers Smart Options: Keys to Lifelong Mobility Web site, officially launched on Dec. 7, provides information about driving, mobility and aging to help the fastest growing segment of our state’s population. MPA served as a partner in this project to assist in developing resources for this statewide strategy that supports the safe transportation of Michigan’s aging adults. The Web site features information that will help:

  • Aging drivers in assessing their driving skills, finding classes and training specifically for mature drivers, identifying issues that may adversely affect their driving ability, developing strategies that allow them to continue driving safely, and understanding what to do when the time comes to stop driving.
  • Families and friends talk with aging drivers about their driving and any problems that are evident, provide resources for families to assist aging drivers in retiring from driving and in finding alternate sources of transportation.
  • Connect health care professionals, law enforcement personnel and other professional caregivers that work with older adults to resources to better evaluate the needs and concerns of aging drivers, identify physical and mental health issues that impede driving and develop coping strategies to enhance mobility safely. 

For more information, please visit www.Michigan.gov/agingdriver and read a press release on the initiative from the Michigan Secretary of State online.

Posted in: Patient Safety
Michigan-based Clean Water Organization Expanding Beyond the Great Lakes Region

On Oct. 14, the Great Lakes Clean Water Organization announced that, to date, it’s Yellow Jug Old Drugs Program has collected more than 108 tons of unused, unwanted and expired medications. Proper disposal of these pharmaceuticals helps protect drinking water, lakes, rivers and streams. In addition, it keeps communities and children safe by removing these medications from households where they have the potential to be diverted.

 

The program is currently focused in the Great Lakes region; however, in January 2016 it will be expanding to additional states. North Dakota will be the first state beyond the region to participate. Due to the expanded scope of the program, the nonprofit organization is changing its name from Great Lakes Clean Water to Great Lakes Clean Water/US Clean Water (GLCW/USCW). The name of the disposal program will remain the same.

 

In addition to the growth of the program, GLCW/USCW will soon be announcing a substantial grant coming from a major pharmaceutical company. For more information, please see a news release from the organization.

Posted in: Patient Safety
President Obama Announces Efforts to Address Prescription Drug Abuse and Heroin Use

On Oct. 21, President Barack Obama held a community forum on the prescription drug abuse and heroin epidemic. A fact sheet on the public and private sector efforts to address these concerns details commitments by more than 40 provider groups that more than 540,000 health care providers will complete opioid prescriber training in the next two years. In addition, the following pharmacy-specific initiatives will be included in these efforts:

  • CVS Health will allow CVS/pharmacy to dispense naloxone without patients needing to present an individual prescription pursuant to a standing order from a physician or collaborative practice agreement in an additional 20 states in 2016 and will launch a new drug abuse prevention program called Pharmacists Teach, where its pharmacists will make 2,500 presentations in high school health classes.
  • Rite Aid will train 6,000 pharmacists on naloxone use over the next 12 months, and expand their naloxone dispensing program to additional states.
  • The National Association of Chain Drug Stores will continue to educate their 125 chain member companies (40,000 pharmacies with 175,000 pharmacists) about opioid overdose and naloxone.
  • The National Community Pharmacists Association, representing 23,000 pharmacies with over 62,000 pharmacists, will be distributing inserts to community pharmacists that highlight safe drug disposal and naloxone.
  • The American Pharmacists Association, with an outreach capability to more than 250,000 individuals, will educate pharmacists, student pharmacists, and stakeholders through a new Resource Center on opioid use, misuse, and abuse.
  • The American Society of Health-System Pharmacists will provide training and resources to 40,000 pharmacists, student pharmacists and pharmacy technicians.
  • The National Association of Boards of Pharmacy will enhance access to prescription drug monitoring program data to thousands more physicians and pharmacists in Arizona, Delaware, Kentucky, and North Dakota in 2016.

The complete fact sheet is available online. In addition, please see an article in MedPage Today for more details on the training that will be required and the Obama Administration’s partnership with the American Medical Association.

Posted in: Patient Safety
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