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How complete documentation can save lives in everyday clinical practice

The number is alarming: up to 30,000 people across Germany die every year from drug-related complications, such as overdoses or adverse drug interactions.

“Pills, those little white bits, usually look pretty harmless,” says Dr. Grit Berger, head pharmacist at the Central Clinic Bad Berka. “But once they are swallowed, it is difficult to suppress their effect. That can be very dangerous. ”The expert also knows from experience: Many people are not aware of the consequences of taking medication incorrectly.

A useful concept to prevent such problems is the so-called drug history, for which Dr. Berger is an expert. She describes the mission of her 6-person pharmacist team as follows: “The right patient receives the right drug at the right time, in the right dosage and in the right dosage form.”

What sounds simple and logical is unfortunately still the exception at many clinics. In Bad Berka, on the other hand, the concept of complete documentation is in the process of refining year after year and in this way ensuring that doctors are relieved and patients are optimally cared for.

In an interview with the RHÖN health blog, Dr. Berger talks about the pitfalls of medication plans, her own role as a “co-pilot of doctors” in everyday clinical practice and the importance of QR codes on medication sachets.

Miss Dr. Berger, why is taking medication such a problem?

Because many patients take several different drugs, they often lose track of things. Especially when the products change frequently, have constantly changing names or are packaged differently. The result is that many people no longer know when to take what. Chaos can arise very quickly. And that can be dangerous.

What is your role alongside the doctors who treat?

We in the drug history are right at the interface between outpatient and inpatient treatment. It is therefore important for us that we can tell the treating doctor exactly what medication the patient has taken at home.

Don’t the medication plans help you there?

Yes, they actually exist in perhaps 70 percent of the cases. However, some patients bring several plans with them. We then have to find out which one is the right one. Most of the time, none of them are really up to date. To make matters worse, many buy over-the-counter drugs from the pharmacy in addition to the prescription drugs. The overview can quickly get lost.

Where do you see the main problem?

Many of these drugs have a high so-called interaction potential. This means that they can cause undesirable side effects in connection with certain other drugs or therapies.

How can you counteract this?

It is our job to bring order into what is often a great chaos. Some patients bring their entire washbag with them and first dump their medication on our table. And often there are very different things in it than what is on the medication plan. This is where what I often call “detective work” begins.

How is it different from a doctor who prescribes the medication?

As a pharmacist, for example, I check whether there is an indication for an antihypertensive drug and whether it is being taken in the correct dosage. And also whether other interdisciplinary drugs “fit” with this antihypertensive agent. In my opinion, there is simply no time in most practices for such an in-depth discussion. It is also our job to make doctors aware of problems with taking medication. We in the clinic pharmacy see ourselves as a kind of copilot for the treating doctor.

What background knowledge do you need?

In clinical pharmacy, we deal with drugs and their correct application. The prerequisite for this, of course, is that we know what chemical properties an active ingredient has and how it works in a person’s body. So also how it is accepted and then eliminated. We know the approved indications and advise on the prescription. That is our job and our specialty. And in this regard, we stand by the treating physician in an advisory capacity, in order to achieve the best possible treatment result for the patient.

Does that mean that every medication prescribed in the clinic goes through your desk or that of your colleagues?

That’s the way it is. When a new patient comes to the clinic, we first discuss his medication plan with him and check that it is complete and correct. We make this so-called drug history available to our medical colleagues electronically. As soon as a change is made to the medication, we as a pharmacy check this in turn for interactions. The point here is, for example, that indivisible tablets should not be artificially divided. Otherwise the dosage could be wrong.

What if everything is ok?

If the medication is in order, our unit-dose machine comes into play, packaging each drug individually for each time it is taken. We hand out around 1.5 million of these sachets every year. Information about the content and the corresponding instructions for use are printed on each one. Recently, they have also been provided with QR codes, behind which the complete package insert is hidden. As soon as a patient has been given a medication on the ward, this is noted in the system. This enables us to achieve the so-called closed loop we are striving for: seamless documentation of the entire process – from the medical prescription, through the validation by us, the pharmacist, to the patient taking the medication.

Are you satisfied with the feedback from the doctors in the clinic?

The information we give them is very much appreciated. We notice that very well. With our advice, we can largely rule out incorrect medication intake. This is really tremendous progress and not only gives my team and me the feeling that what we are doing really makes sense.

Your expert for pharmaceuticals
Dr. rer. nat. Grit Berger
Head pharmacist at the Central Clinic Bad Berka

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