Pharmacy choices

Dear Editor,

In reference to the proposed pharmacy chances at Hillcrest Nursing Home and the medication deficiencies that are of concern, I feel compelled to educate the public on the definition and nature of a "medication deficiency." It seems as though many do not have a complete understanding of such.

So what is a "medication deficiency" anyway and why does Hillcrest have so many? In simplistic terms ... if a medication is delivered late, is labeled incorrectly, or contains the incorrect drug or dose there is a "deficiency."

All of these are a concern and not a problem to be taken lightly. However ... what the public should understand is that while pharmacists do not claim to be perfect, sometimes they are not the culprit of the deficiency.

For example, with the advent of Medicare Part D insurance, which was implemented by the federal government in 2006, about 99 percent of all senior citizens now have a Medicare Part D prescription plan. These plans include Humana, Blue Cross and Blue Shield, Advantra and many others. Each of these plans has a "formulary" or a list of medications that they will cover. If a prescribed medication is not on their "list" they will NOT pay for it.

In which case, the pharmacy has three options: 1.) ask the family to pay for the noncovered medication 2.) ask the doctor to prescribe a different medication 3.) ask the doctor if s/he will send a "prior authorization" request to the insurance company.

Unfortunately, non-covered medications are an everyday occupance in a pharmacy. Pharmacists, nurses, and physicians nationwide can tell you about their quandaries with such. Regardless, unless the family volunteers to pay for the non-covered medication, there is going to be a deficiency, because that medication will more than likely be delivered late.

Getting medication orders changed or obtaining a prior authorization takes the physician time. This isn't anyone's "fault" it is merely a fact. As healthcare costs continue to soar this problem will continue to plague nursing homes everywhere as formularies become more and more restrictive.

Wrong labeling is also a reason for a deficiency. I do not want to discount this problem. At the same time, I can only recall one time in recent months that I was called back in on a wrong label. It was a time when we had typed, "Take one tablet by mouth twice daily" on the label, and it should have read "Take one tablet via G-tube twice daily." The medication was correct, the dose was correct, I am sure the nurse knew how to give the medication, yet nursing home regulations define this as a "deficiency." Of course, the label was corrected and no harm came to the patient.

An incorrect dose or medication would obviously cause a medication deficiency. Now this IS a concern. Pharmacists everywhere do make an occasional mistake ... as do nurses, physicians and others in the healthcare field.

However that mistake is sometimes not always made at the pharmacy level; in fact your pharmacist catches more mistakes than you will probably ever realize. Before the medication leaves the pharmacy it is checked against the patients' allergies and the patients' other medications.

The prescribed dose is evaluated to make sure that it is appropriate for the patient's age and weight. Even so, medications can be ordered and filled incorrectly. While I do not think this is a common problem, it certainly is a concern. This situation can originate at the doctor's office or at the nursing home. Obviously if the order is called into the pharmacy incorrectly, there is a high likelihood that the home will receive the incorrect order. Again ... another deficiency.

I am not one to make excuses nor cast blame. If I make a dispensing error, I will be the first to "'fess up to it." However, we keep our own records and I just do not see many issues. Likewise I do not see any problems that can be solved by using an out-of-town pharmacy. Pharmacists nationwide must all graduate from an accredited university. There aren't magical pharmacists anywhere who can eliminate every deficiency. We all strive for perfection, but some situations are beyond our control.

I applaud Peggy Rogers' decision to offer contracts to pharmacies. I hope these contracts will be written in a language such that we can all work together to better serve the residents of this area. Giving people pharmacy choices is a good thing.

As one family member pointed out at the nursing home board meeting, "If my pharmacy is making these mistakes ... I want to know about it ... at this point I can then choose a different pharmacy."

Hence is the backbone of this country ... choices! Once we force our citizens to waive their right to chose, that is when deficiencies will run rampant, as citizens will have no place to turn.

This country was founded on democracy and allowing people the freedom of choice. Again my hope is that we will continue to be able to work together to serve the residents of our community.

Angela Langan, RP

McCook