The Role of Community Pharmacists in Patient Safety
What is a community pharmacy?
Community pharmacies are sometimes equated to retail pharmacies, operating out of both large and small chains or grocery stores. However, what constitutes a community-based pharmacy is much broader than the traditional retail setting. Community-based pharmacies also include outpatient pharmacies found within health systems, Federally Qualified Health Centers, primary care clinics, compounding pharmacies that prepare medications for patients who require unique dosing or modified formulations,1 and specialty pharmacies where patients receive outpatient care for complex medication therapies.2 Pharmacists may pursue community-based residencies or fellowships to enhance their clinical and leadership skills, preparing them for a role in community pharmacy.3
What roles does a community pharmacist play in patient safety?
Historically, the concept of the “five rights” has been used to describe the steps that lead to safe medication use: the right dose of the right medication taken by the right patient at the right time and by the right route. However, this concept is oversimplified, as there are additional steps of safe medication use that should also be considered; steps that are dependent on the context in which the medication-related process is occurring. Each part of the medication use process may contain different numbers and types of “rights”. For example, in the community pharmacy setting, outcomes like the right education, right monitoring, right documentation, and right drug formulation may also be considered.
The modern concept of medication safety is much broader in scope than the “five rights” and the focus has subsequently shifted with an increased emphasis placed on the contribution of systems factors to medication safety. Factors not directly related to medications are considered, including how the workflow, technologies, policies and procedures, and other systems factors support the outcomes of the various rights, rather than focusing solely on completion of an oversimplified checklist.
Pharmacists in the community ensure medication safety similarly to how they would in any healthcare environment: throughout the medication-use process, including the ordering of medications to their storage, transcription, preparation, dispensing, counseling, and more. Prior to the dispensing process, the community pharmacist provides a clinical review of prescribed medications to ensure the therapies are appropriate. This review includes dosing appropriateness, interactions with other prescribed medications, contraindications, and more, while also considering that medications may have been ordered by multiple prescribers.4,5 The pharmacist also provides critical monitoring in the dispensing of controlled substances, such as consulting prescription drug monitoring programs to look for patterns that might indicate abuse or diversion and to screen for potentially fatal interactions between medications that may come from multiple prescribers.6,7 Pharmacists must identify patients at risk for fatal overdose and facilitate access to the emergency opioid reversal drug Narcan® (naloxone) as well as substance abuse treatment services when appropriate.
A clinical review is essential for all prescriptions and can help ensure that any errors occurring as a result of the care transition process are caught and corrected before the medication is dispensed.8 For example, in the discharge process, the inpatient providers may have an incomplete history of the patient’s existing prescriptions when formulating the treatment plan. In addition, medications that may have been appropriate during the inpatient stay, but inappropriate for home use, may inadvertently be carried over into the patient’s outpatient treatment plan.
In addition to the dispensing process, the community pharmacist plays a critical patient safety role when it comes to ensuring that patients appropriately understand their medications.4 Community pharmacists are equipped to provide education and counseling to patients to address questions they may have regarding factors such as dosing, administration, storage, potential side effects, and how to taper medications for acute events. Similarly, community pharmacists are an invaluable resource for supporting public health initiatives. One study found that patients visited a community-based pharmacy 35 times per year, as compared to a primary care physician, which occurs, on average, 4 times per year.2 This frequent contact with patients makes community pharmacists optimally positioned to support public health initiatives and triage concerns. Numerous studies have proven the positive impact of pharmacists on preventative care such as health screenings and immunizations, opioid management, smoking cessation efforts, and management of chronic diseases such as diabetes.9
What supports community pharmacies in providing patient safety?
Patient safety is best achieved in organizations that have a strong culture of safety. Organizations with a strong culture of safety are not only better positioned to ensure patient safety from the outset, but also more likely to recognize the importance of dedicating the time and resources to tracking, understanding, and appropriately addressing patient safety events or near-misses. Surveys such as the Agency for Healthcare Research and Quality Community Pharmacy Survey on Patient Safety can help pharmacies assess the current state of their safety culture and identify any areas for improvement.
In addition to a strong culture of safety, open communication with, and ease of access to, prescribers can support community pharmacists in the prevention of errors.10,11 Interoperability between data systems, notably electronic health records and state-based health information exchanges, facilitates this open communication by ensuring consistency of information and seamless sharing of patient data between the pharmacist and the prescriber. Ease of access to providers enables the pharmacist to efficiently address potential concerns discovered upon clinical review of the patient’s treatment plan.
Finally, fostering relationships between patients and pharmacists can support safe continuity of care by helping patients develop trust in their pharmacists, increasing their likelihood to seek counseling, address concerns regarding their medication therapy, and provide a more comprehensive medical history.
Georgia Galanou Luchen, Pharm. D.
Director, Member Relations
Section of Community Pharmacy Practitioners and Section of Pharmacy Educators
American Society of Health-System Pharmacists
Kendall K. Hall, MD, MS
Managing Director, IMPAQ Health
Kate R. Hough, MA
Editor, IMPAQ Health
- Compounding. National Community Pharmacists Association. Accessed June 25, 2021. https://ncpa.org/compounding
- Moose J, Branham A. Pharmacists as influencers of patient adherence. Pharmacy Times. August 21, 2014. Accessed June 25, 2021. https://www.pharmacytimes.com/view/pharmacists-as-influencers-of-patient-adherence-
- American Society of Health-System Pharmacists, American Pharmacists Association. Guidance document for the accreditation standard for postgraduate year one (PGY1) community-based pharmacy residency program. Updated March 2021. Accessed June 28, 2021. https://www.ashp.org/-/media/assets/professional-development/residencies/docs/ashp-apha-pgy1-community-based-standard-guidance.ashx
- Goode JV, Owen J, Page A, Gatewood S. Community-based pharmacy practice innovation and the role of the community-based pharmacist practitioner in the United States. Pharmacy (Basel). 2019;7(3):106. doi:10.3390/pharmacy7030106
- Messerli M, Blozik E, Vriends N, Hersberger KE. Impact of a community pharmacist-led medication review on medicines use in patients on polypharmacy--a prospective randomised controlled trial. BMC Health Serv Res. 2016;16:145. doi:10.1186/s12913-016-1384-8
- Doong KS, Gaccione DM, Brown TA. Community pharmacist involvement in prescription drug monitoring programs. Pharmacy Times. December 13, 2016. Accessed June 25, 2021. https://www.pharmacytimes.com/view/community-pharmacist-involvement-in-prescription-drug-monitoring-programs
- Upton C, Gernant SA, Rickles NM. Prescription drug monitoring programs in community pharmacy: an exploration of pharmacist time requirements and labor cost. J Am Pharm Assoc (2003). 2020;60(6):943-950. doi:10.1016/j.japh.2020.07.002
- Tetuan CE, Guthrie KD, Stoner SC, May JR, Hartwig DM, Liu Y. Impact of community pharmacist-performed post-discharge medication reviews in transitions of care. J Am Pharm Assoc (2003). 2018;58(6):659-666. doi:10.1016/j.japh.2018.06.017
- Strand MA, DiPietro Mager NA, Hall L, Martin SL, Sarpong DF. Pharmacy contributions to improved population health: expanding the public health roundtable. Prev Chronic Dis. 2020;17:E113. Published 2020 Sep 24. doi:10.5888/pcd17.200350
- Botross A, Botross E, Ho C. Communication is key to medication safety. Hospital News. Accessed June 25, 2021. https://hospitalnews.com/communication-is-key-to-medication-safety
- National Healthcareer Association. Effective communication in vital for pharmacy technicians. Pharmacy Times. May 7, 2021. Accessed June 25, 2021. https://www.pharmacytimes.com/view/effective-communication-is-vital-for-pharmacy-technicians