Team-based approach to addressing simvastatin safety concerns

Objective : To describe acceptance of systematic and organized pharmacist interventions to address simvastatin safety concerns. Setting: University of Utah Redwood Health Center and Pharmacy, June 2011 to February 2012. Practice description: Redwood Health Center is an outpatient multispecialty clinic associated with University of Utah Health Care with approximately 85,000 annual visits between primary care and specialty practices. In addition to filling approximately 175,000 prescriptions per year, pharmacists provide disease management and education under collaborative practice agreements. Practice innovation: All patients identified as being treated outside the revised simvastatin labeling were included (n = 158). After pharmacist review, recommendations were made to providers via the electronic medical record to promote adherence with the June 2011 Food and Drug Administration (FDA) safety guidelines. In addition to recommendations regarding the FDA guidelines (n = 76), additional recommendations were made to optimize treatment based on low-density lipoprotein cholesterol goal or laboratory evaluation (n = 25). Main outcome measures: Acceptance rate of recommendations and resources needed to provide pharmacist interventions. Results: Recommendations were accepted 92% of the time without modification and 7% of the time with modification. Total pharmacist time to conduct the interventions was 21.5 hours, and 3.9 hours of technician time were spent contacting patients. Conclusion: Targeted pharmacist interventions were effective in promoting adherence with this complex medication safety alert. A standardized, comprehensive approach to patient assessment, including use of evidence to support pharmacist recommendations, resulted in a high level of acceptance by prescribers.