How PIP Supports Patient Safety Kimberley Sentes and Tim Bedo

1. How PIP Supports Patient SafetyKimberley Sentes and Tim Bedo Saskatchewan Health

2. Pharmaceutical Information Program • Brief Overview of PIP • Pharmacy Practice – Kimberly Sentes • PIP Phase II – E-Prescribing Saskatchewan Health

3. VISION The Pharmaceutical Information Program will provide health care professionals with information and tools to make optimal drug therapy decisions to improve the quality, safety and management of health care for Saskatchewan residents. Saskatchewan Health

4. PIP Project PIP is a web-based application and will be rolled out to health care professionals in 3 phases. They are: • Medication Profile Viewer (current phase) • E-Prescribing – 2007 • Integration – 2008 (Enable PIP to communicate with other software such as EMR’s and Pharmacy software.) Saskatchewan Health

5. Integrating PIP into Practice Kimberly Sentes, B.A., B.S.P. Community Pharmacist

6. My PIP Experience • PIP accessed for ALL prescriptions, including new and refills, as of November 2005. • In the first two weeks utilizing PIP, 36 DRP’s were documented and resolved (most of these were multi-doctoring situations).

7. Case Study: Mr. C.O. • C.O., male, 81 yrs • Regular compliance pack patient at my pharmacy • Medication list: Nitro-dur 0.4, Nitrospray, atorvastatin, warfarin, folic acid, aspirin, irbesartan, carvedilol, clonazepam, furosemide, tolubutamide. • Patient brought in prescription for Cialis from family doctor. • Prescription cancelled due to drug interaction with Nitro patch and spray.

8. Patient went to walk-in clinic located down the street and got another prescription for Cialis from a walk-in physician and proceeded to have the prescription filled at another pharmacy that did not have access to PIP. • Patient comes back later in month to get regular blister packs and PIP is reviewed; drug interaction is caught for the second time. • Counseled patient again on the interaction and explained why he should not take the Cialis. • Patient agreed not to take Cialis dispensed from the other pharmacy.

9. What have we learned from Mr. C.O.? • Medication reviews, without PIP, can prove to be inaccurate due to patient’s lack of knowledge about current medications or refusal to disclose full medication history. • Completing an oral med review is significantly more time-consuming than reviewing PIP in patients with complicated medication profiles. • The resolution of Drug Related Problems is far more time consuming than the viewing PIP. • Did Mr. C.O. receive standardized pharmaceutical/medical care? Was patient safety jeopardized?

10. Case Study: Mrs. E.C. • E.C., female, 75yrs • New compliance pack patient from Northern SK • Current medications: insulin, allopurinol, aspirin, candesartan, amiodarone, ferrous sulfate, furosemide 40 mg, rabeprazole, metolazone, simvastatin 40 mg (from Dr. ONE) • Patient goes to FIVE different physicians located in Regina in 3 months and obtains various prescriptions that are not on current med list from previous community, while still taking compliance pack medications.

11. Mrs. E.C. (con’t) • Amitriptyline, furosemide 20 mg and Tylenol 3 from Dr. TWO • Metoprolol, metformin, nitro-dur, simvastatin 40mg, and risperidone from Dr. THREE • Amoxicillin from Dr. FOUR • Benylin DM, clarithromycin and temazepam from Dr. FIVE • All of the above filled at different pharmacies, none with access to PIP

12. What have we learned from Mrs. E.C.? • Shocking use of the healthcare system! • Significant DRP’s and therapeutic duplications (ie. patient receiving furosemide and simvastatin from 2 different doctors and 2 different pharmacies) • RESULT: refused to fill compliance pack until all medications brought to the pharmacy and provided patient with a one week supply until medication list could be reassessed. • Helped patient find a family physician accepting new patients in Regina.

13. More Case Studies (1)Patient is using a salbutamol inhaler regularly from different walk-in clinics and pharmacies, no steroid inhaler on file in the past year. PIP is EFFICIENT for viewing exact dates of dispensed prescriptions, in turn improving patient counseling and adjusting pharmacotherapy if necessary. (2)Methadone patient is multi-doctoring for benzodiazepines. PIP allows us to CLEARLY view medication histories, allowing us to deal with multi-doctoring situations before we experience another situation like the Ironchild inquiry.

14. More Case Studies (3)Patient receiving antibiotics from numerous walk-in clinics and pharmacies. PIP is EFFECTIVE for viewing antibiotic use and overuse allowing improved counseling and utilization of antibiotics. (4)Masked profiles: Two experiences, both patients consented without any issues; consent form attached to prescription and filed as usual.

15. Passionate about PIP • Patient safety and the quality of pharmaceutical and medical care is jeopardized by NOT integrating PIP into daily practice. • PIP is an amazing, life-saving tool and I can’t imagine not having access to PIP in my practice everyday. • I hope that I have inspired YOU to become passionate about the benefits of integrating PIP into your practice, for the sake of patient safety and improving the healthcare of the residents of Saskatchewan.

16. Additional Case Studies • Originally presented by Dr. Phillip Fourie in March, 2007

17. Examples of how PIP helps • Getting Medication Profiles in ER • Patients who cannot recall their medications • “That little white pill, Doc” • Unconscious/intoxicated/demented patients • Suspicious requests for controlled medications • Can’t remember the ABx from 2 months ago that caused a severe rash etc. • Getting Medication Profiles in Office • Medication compliance – Filling at right time, Filling at all • Double doctoring • Multiple Care Providers prescribing – Specialists, Seen in another town • Monitoring controlled medications

18. Case 1 – Mr Cam Pliance • 62 yr old patient known well to me with hypertension – office BP always high • Always has excuse – (had a coffee before appointment, got upset at work, ran out of pills the day before etc.) • Comes in regularly, says he is taking his medications. BP remains a challenge despite a few dose increases and med changes

19. Case 1 – Mr Cam Pliance cont’d • Filled 3 prescriptions in past year • Last prescription for 30 tablets filled 4 months ago, but “ran out of pills yesterday”

20. Case 2 – Ms Nervous • 79 yr old elderly lady with frequent ER and office visits with “my nerves bothering my stomach” • Multiple examinations and special investigations for abdomen and GI tract in past 3 years • Had “reaction to” Paroxetine – does not want any antidepressants • Has been on Lorazepam 0.5mg daily for many years. Decided to leave her on it after a long discussion about benzos. Also on several other meds for other health conditions. • Filled prescription every 30 days for 30 tablets. (Gave her a 3 month prescription with instructions to pharmacist to be filled 30 days apart.) • Would sometimes come in early for fill and always asking for more

21. Case 2 – Ms Nervous cont’d • Was filling my prescription in the first week of every month • BUT was also filling 3 similar prescriptions from 3 different physicians at 3 different pharmacies at different times in the month • AND was filling prescriptions from ER docs in between

22. Why Integrate PIP into Your Practice? Benefits to PATIENTS: • Improves Patient Safety • Standardized Care for all patients Benefits to PHARMACISTS/DOCTORS: • Medication reviews are more accurate and complete (EMR’s are not always complete as even regular patients will go to a walk-in clinic on occasion) • Ease in investigating DRP’s

23. PIP Viewer Patient Safety Features • Provides a detailed medication profile and medication history at a glance. • Faster than verbal history from patient • More detailed information • Encompasses all community-dispensed prescriptions from all providers to that patient. (not limited to local pharmacy profile) • Drug related problems are more can be detected and resolved more efficiently, improving patient safety. • Easier to confirm drug-seeking or multi-doctoring situations. • More efficient tracking of patient compliance.

24. PIP E-Prescribing Patient Safety Features • More detailed prescription information, especially specific dosage and frequency, and indications. • Allergy Profiles • Legible prescriptions • Ability to enter FYI prescriptions, including sample packs, out of province prescriptions and herbals. • Decision support tools for prescribing. (Drug-to-drug interactions, drug-to-allergy interactions and duplicate therapy checking)

25. Thank You • To Become a PIP prescriber • Approvers should contact • Camille Ponto • Phone # 787-9833 • E-mail: camille.ponto@shin.sk.ca • Provide • Name • Licensed provider number • E-mail Address • Mailing Address • Telephone Number

26. THANK YOU Questions? Saskatchewan Health