CLINICAL PRESCRIPTION REVIEW
Clinical medication prescription review is the current method pharmacists follow to review prescriptions inside pharmacies before dispensing drug products to patients. For these reviews, pharmacists assess the safety and potential efficacy of new prescriptions.
Not enough is known about how pharmacists actually do clinical medication prescription reviews. What is known is that pharmacists do many of these reviews, often very quickly. And because so many prescriptions need to be reviewed during every shift, the total time spent by pharmacists on this key task is substantial. Still, not all safety and efficacy issues get identified and resolved by pharmacists’ clinical medication prescription reviews.
Pharmacists’ current approach to doing medication prescription review involves a complex method of clinical prediction resulting in dual predictands and their corresponding interpretations.
In pharmacies, after electronic medication prescription intake, clinical medication prescription review begins. The first thing pharmacists do to initiate the review process is to predict the likelihood that the medication as prescribed will be safe for the patient.
Next, pharmacists predict the potential that the prescribed medication will be an effective treatment. As conceptualized here, this second prediction reflects a combined assessment of drug efficacy for a medical condition and the clinical utility of the prescribed drug product, including its dosage form, the intended duration of therapy, and other attributes of a medication prescription.
In practice, pharmacists may think of these dual predictions as if they were determinations of fact, but since they involve speculations about the future, they are truly predictions.
If a pharmacist finally decides that the therapy prescribed in a medication prescription will NOT be safe, or does NOT have the potential to be effective, then they are obliged to intervene and engage the prescriber on behalf of the patient. Public Health Codes throughout the United States generally hold pharmacists accountable for prospective clinical medication prescription review and give pharmacists the authority, albeit limited, to refuse to dispense a prescribed medication when they believe exposure to a medication is unsafe or has no potential to be effective for the patient.
To do these clinical medication prescription reviews prior to dispensing, pharmacists may proceed in the usual clinical way by applying their medication and drug product knowledge and practice experience to the task. This knowledge and experience will sometimes be augmented by insights, impressions and other data collected from talking to the patient or prescriber.
As a minimum standard of practice, the dual safety and potential efficacy predictions made and interpreted as part of the clinical medication prescription review task will be informed by the contents of the medication prescription itself and by previously collected data gleaned from the medical history, medical record, and longitudinal medication profile for the patient.
The combination of the pharmacist’s knowledge and experience with these other data enables them to form a prediction regarding the safety of the medication if used as prescribed. With respect to safety, predictions of harm that will likely occur account for certain reasonable expectations as to the medication’s effects and the course of external events. Depending on the degree of harm predicted, pharmacists then interpret their prediction in binary fashion to decide whether it is relatively safe or unsafe to expose the patient to the medication prescribed in the prescription. (This safety prediction and its interpretation are always relative since all medication exposures engender some risks.) Of course, exposures to certain medications engender more and greater risks of harm than others, and pharmacists have a good sense of these relative medication risks. Also, it can be the case that NOT being exposed to a prescribed medication would cause great harm too.
Next, either by being told what the indication and therapeutic goals of the medication prescription are or by inferring the indication and therapeutic goals of the medication prescription from contextual cues (as pharmacists often must do) the process of clinical medication prescription review goes on to combine data and knowledge to form a second prediction about the potential efficacy of the medication if it is used as prescribed. Depending on the degree to which the reviewing pharmacist anticipates the medication, if used as prescribed, can bring therapeutic benefits to the patient, they predict its main therapeutic effects and interpret their prediction considering the indication and therapeutic goal, accounting for the varied time horizons relevant to each case.
This dual prediction method, as pharmacists do it, is loosely called the clinical medication prescription review method. This same method has also been called medication prescription verification, medication prescription checking, medication prescription perfection, medication prescription processing, or evaluation of medication prescription appropriateness.
This clinical method is a method of combining data to arrive at dual predictions that are interpreted using some implicit thresholds for deciding. This is the ONLY method of prescription review used in pharmacy practice today, making it the established and incumbent method.