EXECUTIVE SUMMARY

Specialty pharmacists can be influential with encouraging other pharmacists to improve patient safety. Those at a health system level work with many pharmacy departments.

  • Specialty pharmacists work with high-cost medications requiring special handling.
  • They can lead the way with encouraging pharmacists to report errors.
  • An error-reporting process should be simple to use and not time-consuming.

Specialty pharmacists can play an important role in patient safety. Risk managers can encourage them to embrace this part of their job, suggests Jill Paslier, PharmD, CSP, ISMP international medication safety management fellow with the Institute for Safe Medication Practices (ISMP) in Horsham, PA.

Specialty pharmacy involves high-cost, high-touch medication therapy for patients with complex disease states, according to the American Pharmacists Association. “Medications in specialty pharmacy range from oral to cutting-edge injectable and biologic products. The disease states treated range from cancer, multiple sclerosis, and rheumatoid arthritis to rare genetic conditions,” the group says. (More information is available at: https://pharmacist.com/Practice/Patient-Care-Services/Specialty.)

More so than a typical hospital or retail pharmacy, a specialty pharmacy handles expensive medications, ranging from a cost of $1,000 per month to $30,000 per month, Paslier notes. The medications often require special handling and detailed instructions to the patient on usage.

“Because of the high-cost and high-touch aspects of these medications, instead of being dispensed from a regular pharmacy, they are dispensed from a specialty pharmacy,” Paslier explains. “The specialty pharmacist has special training on all these diseases and medications, and a specialty pharmacy may provide additional medication management programs.”

It is important to focus specialty pharmacy staff members on their role in patient safety, Paslier says. Specialty pharmacies at the health system level are particularly well placed to influence patient safety because they work with pharmacy departments throughout the health system.

“The specialty pharmacist has somewhat of a position of influence. They may be managing other pharmacists or pharmacy technicians, and they have a level of professionalism that includes interacting on a day-to-day basis with patients and providers,” she says. “I think they certainly can influence a positive safety culture by encouraging others to report medication concerns, errors, or hazards.”

For instance, specialty pharmacy staff should share “good catches” that prevent a medication error from reaching a patient.

Specialty pharmacy staff can be directly involved in the quality improvement process and error-reporting process, Paslier says. They can work to promote trust among pharmacy staff in the organization’s just culture and dispel fears of being punished for reporting errors.

Error reports should be easy to file and not time consuming. Those submitting error reports should be acknowledged and praised for participating in the patient safety process. Staff also should receive feedback so they understand how their error reports are used and how they are helping improve patient safety, Paslier says.

Creating a just culture can help specialty pharmacists improve patient safety and reduce errors. Paslier, who has worked in specialty pharmacy with a health system, notes the culture of an organization is influenced from the top down.

“You start at the top to promote a just culture and a positive atmosphere that encourages reporting errors, rather than one that punishes the person or focuses only on the person making a mistake,” she says. “We need to look at the big picture and how to prevent errors with high-level strategies rather than just reminding people to be more careful.”

SOURCE

  • Jill Paslier, PharmD, CSP, ISMP International Medication Safety Management Fellow, Institute for Safe Medication Practices, Horsham, PA. Email: jpaslier@ismp.org.