Deficiencies in Virtual Pharmacy Services in the Care of a Patient

Veterans Affairs Office of Inspector General (OIG) sent this bulletin at 06/18/2020 06:06 PM EDT

Bookmark and Share

Having trouble viewing this email? View it as a Web page.

You are subscribed to Oversight Reports for Veterans Affairs Office of Inspector General (OIG). This information has recently been updated, and is now available.

Given VA's need to focus on the COVID-19 response, the OIG has developed interim measures for releasing oversight reports. At this time, the OIG is generally releasing only those reports relevant to the COVID-19 pandemic; statutorily required or responsive to congressional requests; or that involve compelling circumstances related to the welfare of veterans, the safety of patients and VA personnel, or pose significant risks to VA resources. 

 

The report Deficiencies in Virtual Pharmacy Services in the Care of a Patient highlights a patient safety issue related to the role and oversight of contract clinical pharmacists who provide services for a large number of VA medical facilities. Providers at facilities who use these pharmacy services should be aware of these potential problems. VA officials received the report in December 2019 and provided initial responses to the OIG recommendations in March 2020. Publication at this time would not pose an additional burden on VA.

 

Deficiencies in Virtual Pharmacy Services in the Care of a Patient
06/17/2020 08:00 PM EDT

The VA Office of Inspector General (OIG) conducted this inspection to evaluate concerns related to a Virtual Pharmacy Services (VPS) pharmacist’s discontinuation of an antidepressant medication for a patient of the Minneapolis VA Health Care System, which resulted in the patient not having prescribed antidepressant medication for approximately six weeks before dying by suicide. The OIG found the VPS pharmacist did not access the patient’s electronic health record or notify the psychiatrist when discontinuing an antidepressant medication order. Although the facility granted the VPS pharmacist access to the patient’s electronic health record, the pharmacist reported not being aware of this capability. The discontinuation of the patient’s medication may have contributed to increased depressive symptoms, including suicidal ideation, in the six weeks following the patient’s scheduled completion of the medication. The OIG was unable to determine that the medication discontinuation contributed directly to the patient’s death; however, the possible worsening of the patient’s underlying depressive illness may have been a contributing factor. The OIG identified discrepancies between VPS pharmacists’ duties outlined in their functional statement and duties actually performed. VPS pharmacists’ inability to fully execute certain functions may contribute to decisions that are not fully informed and patients may not receive medications as prescribed. The VPS productivity measure of 95 prescriptions processed per hour might be an unreasonable target and may contribute to increased risk for pharmacist error. Further, Pharmacy Benefits Management leaders did not ensure VPS prescription processing was adequately monitored for accuracy. Pharmacy Benefits Management leaders failed to clearly outline program management and quality assurance monitoring objectives and processes leading to deficiencies that can contribute to adverse patient outcomes. The OIG made five recommendations to the Under Secretary for Health related to standardizing software menu options, revising functional statements and performance metrics, and establishing certain quality assurance objectives.