A Patient Safety Program & Research Evaluation of U.S. Navy Pharmacy Refill Clinics

Historically, pharmacists have been safety consultants for patients with minor illnesses and have assisted in important decisions regarding medication refills. Time constraints are considerable for all medical personnel and using the pharmacist's medication knowledge in clinical practices produces greater efficiency in crowded clinics, while addressing potential adverse events and medication contra-indications. A pilot project was designed for pharmacy refill clinics in the summer of 1999 at the Bremerton Naval Hospital and the Everett Naval Clinic, in Washington. The Pharmacy Refill Clinic Pilot Study led to development of a “standard package” refill authorization program to better serve patients. The pilot project identified patient safety issues, cost savings, provider time saved, documentation issues, and the increased benefits to the patients. Using the pilot project as a model, the pharmacy refill clinic at the U.S. Naval Hospital at Keflavik, Iceland, was established in January 2001. The Keflavik Pharmacy Refill Clinic was designed to maximize patient safety when chronic medications were renewed, through the use of 89 drug protocols intended to provide safe continuity of prescribing for stable patients. Patients are asked consistent questions by a pharmacist that address the safe consumption of medications and determine whether they are experiencing adverse reactions or suboptimal disease therapy. In order to avoid harmful or persistent side effects, it is imperative that patient safety be explored thoroughly as medications are renewed The pharmacist reviews the patient's medical record, laboratory values, prescription refill history, and talks to the patients to uncover issues that may compromise their safety. The Pharmacy Refill Clinic identifies patients that were not properly dosed and had high or low laboratory values; this is paramount for patient care as, for example, long-term high cholesterol and hypertension can lead to stroke and heart attack. Using a pharmacist to dispense renewal medications resulted in an overall cost savings, while reducing physician workload. This approach also opened up more appointments for acutely ill patients, further expediting the identification and treatment of their clinical conditions.