Patient Safety

The pharmacy news section of the MPA Web site is designed to provide members with immediate access to timely and relevant information about pharmacy and our Association. In this section, you will find information on MPA activities, Association members, the latest issues impacting the pharmacy profession and press releases from MPA and its affiliates.

Members are also encouraged to join the conversation by following MPA on Twitter @MIPharmacists for the latest breaking news. For more information on MPA's presence on social networking sites, visit our social media page.


Patient Safety

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

Have You Accessed Valuable Patient Safety Information in our Online Resource Center?

MPA developed the Patient Safety Resource Center to provide both patients and pharmacy professionals with valuable resources and to empower them with information that will improve safety on both sides of the pharmacist-patient relationship. 

The Resource Center, accessible to members at www.MichiganPharmacists.org/resources/patientsafety, features a landing page with information on one of the most critical components to patient safety: open communication between patients and their health care providers. This encourages patients to become active members of their health care team and promotes improved health outcomes. The welcome page also includes a listing of prime questions for patients to ask their pharmacist and for pharmacists to be prepared to answer as well as Web sites for many national patient safety organizations. 

From the landing page, users can then visit additional pages with resources specific to pharmacy professionals or resources specific to patients. More information on these sections is available below.

Professional Resources:

  • Continuing Education on Medication and Patient Safety
  • Educational Resources for Your Patients
  • Look-Alike, Sound-Alike Medications
  • Medication Shortages
  • Mobile Applications
  • Patient Safety Initiatives
  • Pharmacy Practice Tools
  • Recommended Reading and Subscriptions
  • Reporting a Medication Error or Adverse Event
  • Safe Disposal of Medications
  • Senior Care Resources
  • Transitions of Care

Patient Resources:

  • Educational Resources for Consumers
  • Medication Shortages
  • Mobile Applications
  • Patient Safety Resources for Senior Citizens
  • Reporting a Medication Error or Adverse Event
  • Safe Disposal of Medications
  • Transitioning Health Care Facilities

Members are encouraged to take advantage of these materials available on the MPA Web site and share information with their patients on how to access the Patient Safety Resource Center. Pharmacy professionals play a critical role in ensuring the safety of their patients. As one of the most accessible health care providers, pharmacists are on the front-lines improving the quality of patient care and reducing costs. Through prevention of adverse drug events, reconciliation of medications and collaboration with other providers to evaluate system-wide improvement measures, pharmacists continually show that their ever-expanding role is a key factor in safe medication use and effective patient therapy.

Posted in: Patient Safety
Medications and Falls in the Elderly

by Nicole Humbert, Pharm.D., PGY1 pharmacy resident, St. Joseph Mercy Ann Arbor 

Falls in the older adult can be due to numerous factors, including physiological changes, environmental hazards and medication misuse. In the geriatric population, multiple medications are often prescribed due to numerous medical problems. With this increased medication use comes an increased risk of adverse effects, including falls. It is estimated that more than one-third of adults older than 65 years of age fall each year and more than one in six elderly Americans are taking prescription drugs that are not suited for geriatric patients. Falls in the elderly are one of the most common causes of nonfatal injuries, injury-related deaths and hospital admissions. 

Orthostatic hypotension is a common problem among elderly patients, which can contribute to falls. Acute orthostatic hypotension is usually secondary to medication, fluid or blood loss, or adrenal insufficiency. Antihypertensives, especially alpha-blockers, are common contributors to orthostatic hypotension. Titrating down the dose, if discontinuation is not an option, can help reduce symptoms and decrease fall risk. Also, ensuring that patients stand up slowly and brace themselves with a wall or chair can also limit risk of falls. 

Medication misuse can be avoided in the geriatric population by obtaining guidance from the Beers List. The Beers List is a list of medications compiled by experts whose risk of adverse events potentially outweigh the benefits in the geriatric population. There are 53 individual medications or classes of medications recommended to avoid or use with caution in older adults. Many medications such as central nervous system (CNS) depressants/psychoactive drugs on the Beers List have been associated with an increased risk of falls. CNS depressants can cause sedation and cognitive impairment resulting in falls in the elderly. Table 1 lists some of the medications that should be avoided in elderly patients based on the Beers List. The Beers List can be used to evaluate medication use and as a guide to make interventions for pharmacotherapy changes. 

Table 1. High-risk Targeted Medications

Drug Concern Alternatives/Comments
Amitriptyline (Elavil®) Highly anticholinergic and sedating
  • For neuropathy: consider gabapentin (Neurontin®)
  • For depression: consider a selective serotonin re-uptake inhibitor [SSRI] (or mirtazapine [Remeron®] if the patient also has insomnia or anorexia)
  • If a tricyclic antidepressant is required, consider nortriptyline (Pamelor®)
Benzodiazepines Prolonged sedation, dependence, depression, confusion and fall/fractures
  • Consider tapering if possible
  • Depending on indication, consider using an antidepressant.
Digoxin (Lanoxin®) Assess for toxicity due to reduced renal clearance (bradycardia, gastrointestinal disturbances, central nervous system effects, visual disturbances)
  • If evidence of toxicity, decrease dose or discontinue drug
Diphenhydramine (Benadryl®) Anticholinergic and sedating
  • For sleep: consider melatonin or trazodone
  • For allergic rhinitis: loratadine (Claritin®) or another non-sedating antihistamine
  • May still be used for acute allergic reaction
Doxepin (Sinequan®) Highly anticholinergic and sedating
  • For neuropathy: consider gabapentin (Neurontin®)
  • For depression: consider a SSRI (or mirtazapine [Remeron®] if the patient also has insomnia or anorexia)
Hydroxyzine (Atarax®) Anticholinergic and sedating
  • Alternative: loratadine (Claritin®) or another non-sedating antihistamine
Indomethacin (Indocin®) NSAID with the most CNS adverse effects, GI effects, fluid retention
  • Alternative: ibuprofen, acetaminophen
  • For chronic gout: allopurinol 
  • For acute gout: ibuprofen or alternative nonsteroidal anti-inflammatory drug, short-term use of indomethacin
Promethazine (Phenergan®) Anticholinergic and sedating
  • For nausea: prochlorperazine (Compazine®) or ondansetron (Zofran®)
  • For allergic rhinitis: loratadine (Claritin®) or another non-sedating antihistamine
Trimethobenzamide (Tigan®) Can cause extrapyramidal side effects, sedation
  • Alternative: prochlorperazine (Compazine®), ondansetron (Zofran®)


The Beers List, however, is only one tool for reducing adverse drug events such as falls in the elderly. There are many medications not on the Beers List that may also contribute to falls. It is recommended to complete a medication review in geriatric patients who are at high risk or have already experienced a fall. Although not always contraindicated, medications on the list should be used cautiously and if alternatives are available, they should be considered. Pharmacotherapy decisions should be made based on the whole patient, considering medical, social and psychological conditions, prognosis and quality of life. 

References available upon request from the MPA office.

Posted in: Patient Safety
Public Education Campaign: Medication Synchronization

The American Pharmacists Association (APhA) Foundation launched a medication synchronization public education campaign on Oct. 7. Initiated in line with American Pharmacists Month, the campaign aims to inform the public about the benefits of medication synchronization (also known as “the appointment-based model” or ABM), the issue of nonadherence and the importance of having a relationship with their pharmacist. Information, tools and resources, including a zip code locator for finding a pharmacy nearby that offers med sync services are online at www.AlignMyRefills.com. For information about listing your pharmacy, click here. Additional information for pharmacies is also available from the following organizations:

Posted in: Patient Safety
FDA Updates Chantix® Label to Remove Risk of Psychiatric Problems or Suicidal Tendencies
The U.S. Food and Drug Administration (FDA) updated the label for Pfizer’s anti-smoking medication Chantix® to include data from recent studies that found little to no evidence of psychiatric problems or suicidal tendencies in patients taking the product. Pfizer executives plan to ask the agency to remove the boxed warning from the medication’s label. The FDA is convening a panel of its outside experts next month to review the latest data on Chantix’s safety. For more information, see an article online from The Associated Press.
Posted in: Patient Safety
Strategies and Methods for More Responsible Opioid Prescribing

by Andrea Jarzynski, Pharm.D., pharmacy practice resident, and Ashley Thomas, Pharm.D., pharmacy practice resident, Aleda E Lutz Veterans Affairs Medical Center

A recent report issued by the Institute of Medicine found that 100 million Americans suffer from chronic pain. The International Association for the Study of Pain defines chronic pain as “pain that persists beyond normal tissue healing time, which is assumed to be three months.” Types of chronic pain include musculoskeletal, somatic, visceral and neuropathic. Multiple medication classes exist to treat pain, and patients may require more than one medication for effective pain control. Common medication classes include nonsteroidal anti-inflammatory drugs, opioids, tricyclic antidepressants, antiepileptic drugs and selective serotonin-norepinephrine reuptake inhibitors. Opioid analgesic prescriptions have greatly increased to more than 200 million, nearly a three-fold increase in the past 20 years. This increase in prescription count has led to a rise in patients experiencing adverse events such as falls, constipation, respiratory depression and even death.

Nationally, deaths from prescription analgesic overdoses have more than tripled since 1990, with 100 people dying every day from such an event. In Michigan alone, there are 12.2 overdoses per 100,000 people. Opioid analgesics are becoming more readily available, with 107 narcotic prescriptions written for every 100 Michigan residents. Recreational use of these medications is also becoming more popular. In 2010, more than 12 million Americans admitted to using a narcotic for nonmedical reasons. Non-opioid pain medications, like tramadol, are also being abused more frequently. In recent years, epidemiological studies have shown an increase in tramadol abuse, diversion and overdose. After many states preemptively tightened regulations on tramadol, the Drug Enforcement Administration recently designated tramadol as a Schedule 4 controlled substance under the Controlled Substances Act. This designation took effect on Aug. 18, 2014.

Because of the increased risks and consequences for opioid misuse and abuse, there are many large advocacy groups calling for more responsible opioid prescribing. Nationally, the Centers for Disease Control and Prevention proposes seven state legislative strategies to help battle the prescription drug epidemic. They include physical examination required for prescribing, patient identification (ID) required for dispensing, tamper-resistant prescription forms, pain clinic regulation, prescription drug limits, prohibition of “doctor shopping”/fraud and providing immunity from criminal charges for people seeking treatment of an overdose. Michigan currently enforces two of the seven recommendations (physical examination required for prescribing and patient ID required for dispensing).

The Michigan Automated Prescription System (MAPS) is a useful tool employed by providers and pharmacists to identify pharmacy/physician “shopping” and to prevent opioid misuse. There are currently 37 states that have a prescription monitoring system in effect. Pharmacies and dispensing prescribers are required to report any dispensed controlled substances to MAPS. Previously, the dispensing agency only required reporting to MAPS on the 1st and 15th of every month, however, on July 1, 2014, daily reporting was initiated. Health care providers and personnel have the ability to request a MAPS report after they are registered through the state of Michigan.

Chronic pain management requires a multidisciplinary approach. A comprehensive clinical pain team may include a physician with specialty in pain, along with other health care providers such as a pharmacist, mental health provider, physical therapist or substance abuse specialist. Pharmacists can play an important role in specialized pain management teams, including opioid conversions, opioid tapering, identifying and managing adverse events, and educating patients on their goals of therapy and expectations for treatment. A recent study shows that patients with chronic pain show great satisfaction with interventions and overall effectiveness of care provided in a multidisciplinary approach that includes a pharmacist.

There are many opportunities for specialty certification in pain management. The American Society of Pain Educators offer a certification as a Pain Educator (CPE) and the American Academy of Pain Management (AAPM) offers a General Credentialed Pain Practitioner (GCPP) open to all health care professionals. For CPE credentialing, a pharmacist must dedicate 10 percent of their work experience to providing pain-related education, along with 30 credit hours of pain-related continuing education (CE) credits. Obtaining a GCPP credentialing requires 100 hours of CE with 50 hours pertaining to pain. An American Society of Health-Systems Pharmacists (ASHP) Postgraduate Year (PGY) 2 residency can also be completed in the area of pain management after the completion of a PGY 1 residency. In addition, ASHP offers a tiered educational initiative for providers wishing to improve their knowledge in pain and palliative care.

With the rise of opioid analgesic abuse, health care professionals need to ensure the safe medication practices of their patients. The addition of a credentialed pharmacist to the team or the implementation of specific prescribing protocols may be first steps to effective and safe pain management. Working together as a health care team may be the best way to rectify this ever-growing problem.

References available upon request from MPA office.

Posted in: Patient Safety
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