Communication is key to medication safety

By Amy Botross, Ereny Botross, and Certina Ho

Communication is an integral part of the numerous patient interactions that pharmacists have in a typical workday. It is essential at prescription drop-off where critical medical/medication information can be clarified with the patient and potential errors can be intercepted early on. It is also important during patient counselling when the prescription is being picked up, the step that serves as the final opportunity for pharmacy professionals and/or staff members to catch any errors before the medication leaves the pharmacy. Thus, knowing the right questions to ask and how to ask them is crucial to ensure those interactions are efficient, effective, and safe. Although this might seem straightforward, a busy work environment can make it easy to miss simple, yet, key communication points. It can be quite tempting to shorten the patient-pharmacist interactions by simply asking several “yes/no” questions, which may pose significant threats to patient/medication safety. In this article, we will be highlighting some important considerations for patient-pharmacist interactions and discuss why it is essential to go beyond a simple “yes/no” dialogue.

Confirming patient identityAny patient-pharmacist interaction will typically begin with a confirmation of the patient identity. It has become common practice in a pharmacy that pharmacy professionals and/or staff members will use two unique patient identifiers (e.g. name and date of birth) to confirm patient identity, thus ensuring the right medication is going to the right patient. It is particularly important to have patients “offer” the information, rather than just responding with an affirmative (or negative) answer. This is because there are multiple factors that may lead to miscommunication, for instance, language barriers, hearing problems, confusion or altered state of awareness, and the possibility that some identifiers (e.g. patient names) may sound alike (particularly among family members). In extreme cases, such miscommunication may lead to incorrect or potentially high-alert medications dispensed to the wrong patient. Therefore, by asking patients open-ended questions, patients can then verbally share their information, and pharmacists will, thereby, accurately confirm patient identity and ensure that the right medication is given to the right patient.


Confirming medication indicationIt is equally important to inquire patients about the indication of their prescriptions/medications to ensure safe and effective medication use. Pharmacists should avoid making assumptions about the indication, no matter how “obvious” it might be. Therefore, instead of asking patients if they are using a medication for a specific purpose, pharmacists should ask what the purpose of the medication is. Again, expecting the patient to give a simple affirmative (or negative) response can be misleading. Being open-minded and inquiring patients about the indication of their prescriptions/medications can be helpful in two ways. First, it helps pharmacists gauge patients’ understanding of their medications or medical conditions. Second, some medications may have multiple indications, and some may be prescribed for an off-label use. Therefore, reminding or inviting patients to “offer” their pharmacists the indication of their prescribed medications will be extremely helpful for pharmacists to assess the appropriateness and accuracy of the medications and their associated dosing instructions, etc.

Opportunity for questionsTowards the end of a patient-pharmacist conversation, checking in with patients to see if they have any further questions is another common practice. Since the patient is a part of and a key member of the circle of care, they should always be encouraged to ask questions to their healthcare providers. The “5 Questions to Ask About Your Medications” (https://www.ismp-canada.org/medrec/5questions.htm) is a framework that patients can use to ask questions to their healthcare providers and learn more about their medications. By prompting patients to share their thoughts and concerns, instead of simply asking if they have any further questions (Table 1) is more inviting. The latter questioning style may discourage patients from sharing their views with the assumption that pharmacists are rushing to conclude the conversation, while the former is more engaging, as it encourages questions by implying that pharmacists are expecting questions, ready to answer them, and are willing to address any of the patients’ medication concerns.

Conclusion

In conclusion, shortcuts are appealing to save time (especially during a busy workday), but can be risky in critical tasks such as patient-provider interactions. Effective communication is essential for patient/medication safety. Pharmacists should do their due diligence to ask the appropriate questions to minimize chances of miscommunication and reduce the risk of errors.

Amy Botross and Ereny Botross are PharmD Students at the Leslie Dan Faculty of Pharmacy, University of Toronto; and Certina Ho is an Assistant Professor at the Department of Psychiatry and Leslie Dan Faculty of Pharmacy, University of Toronto.