PHARMACY CONNECTION ARTICLE

Focus on Error Prevention: Limited Duration of Therapy

Published on: February 1, 2017 Senior man taking medication

By Ian Stewart B.Sc.Phm., R.Ph.

Following an acute coronary syndrome event, patients are usually placed on a long-term platelet aggregation inhibitor to minimize the risk of recurrence. Pharmacists should be reminded that in some instances, the duration of therapy for a specific platelet aggregation inhibitor may be limited.

Case:

Rx: Brilinta® 90mg
Sig: One tablet twice daily
Mitte: One year

A sixty-six year old patient received the above prescription upon discharge from hospital following an acute coronary syndrome event. The prescription was taken to the patient’s regular community pharmacy for processing. The correct medication was dispensed to the patient.

At the end of the twelfth month, the patient called the pharmacy for another refill of the prescription. The original prescriber was contacted for authorization to refill. The prescriber’s secretary asked that the family physician be contacted.

Three days after the patient’s initial request, the pharmacy had not received a response from the patient’s family doctor and the patient was now out of medication and concerned about the implications of stopping his drug therapy abruptly. The pharmacist therefore made the decision to renew/extend the prescription for Brilinta® 90mg and dispensed the medication to the patient. The physician was also informed via fax. The following day, the physician contacted the pharmacy to indicate that the patient should not be taking Brilinta® 90mg beyond the initial one year.

The pharmacist consulted the manufacturer’s product monograph and learnt that the recommended dosage for Brilinta® 90mg is twice daily for one year only following an acute coronary syndrome event1. The Ontario Drug Benefit Formulary also limits coverage for Brilinta® 90mg to one year2. The patient was therefore contacted and asked to discontinue taking the Brilinta® 90mg tablets.

Possible Contributing Factors:

  • Delay in contacting and communicating with the initial prescriber and the patient’s family doctor.
  • The patient was unaware of the recommendation that Brilinta® 90mg be taken for one year only following an acute coronary syndrome event. It appears that they did not receive this information when counselled initially.
  • The dispensing pharmacist who renewed/extended the prescription was also unaware of the dosing recommendation.

Recommendations:

  • Contact your software vendor to discuss the addition of system alerts to identify medications where the duration of therapy is limited. A hard stop mechanism may be implemented to prevent the dispensing of these medications beyond a specific date.
  • Ensure patients are appropriately counselled when receiving these drugs for the first time. Suggest that the patient record the end date on a calendar at home. Ensure that these patients understand next steps when the specific drug therapy ends.
  • Educate all pharmacy team members regarding the limited duration of some drug therapies and the potential for error.

References:

  1. Brilinta product monograph available at:
    https://www.astrazeneca.ca/content/dam/az-ca/downloads/productinformation/BRILINTA%20-%20Product-Monograph.pdf
    Accessed January 11th, 2017.
  2. Ontario Drug Benefit formulary available at:
    https://www.formulary.health.gov.on.ca/formulary/limitedUseNotes.xhtml?pcg9Id=201200088
    Accessed January 11th, 2017.

Please continue to send reports of medication errors in confidence to Ian Stewart at: [email protected]. Please ensure that all identifying information (e.g. patient name, pharmacy name, healthcare provider name, etc.) are removed before submitting.

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