Category: Fellows Posters
In recent years, medication starter packs, which are designed to simplify dosing and encourage adherence for patients, have become available. When used properly, they allow healthcare practitioners to provide immediate treatment and assess the efficacy and tolerability of the new treatment. Studies suggest they may promote safe and appropriate therapy when used as prescribed. However, a report submitted to the national Institute for Safe Medication Practices (ISMP) Medication Error Reporting Program (MERP) has highlighted concerns regarding the risk of inappropriate prescribing and dispensing of medication starter packs.
In a case submitted to the ISMP MERP database, a patient was prescribed an Eliquis (apixaban) starter pack upon discharge. The starter pack, which is indicated for the treatment of deep vein thrombosis (DVT) or pulmonary embolism (PE) during the first 30 days of treatment, provides two 5 mg tablets (total dose 10 mg), taken twice daily for the first 7 days, followed by one 5 mg tablet taken twice daily for 23 days. Following completion of the initial treatment, patients transition to the maintenance dose of one 5 mg tablet taken twice daily, adjusted as needed. Per the report, the prescription for the starter pack defaults to zero refills in the electronic prescribing system. However, the provider modified the refill field and sent the prescription to the outpatient pharmacy with refills. The outpatient pharmacy missed the error and dispensed several months of refills to the patient. The patient reported that he took one 5 mg tablet twice daily as intended for each refill and did not follow the directions of the starter pack. However, the error was finally discovered when the patient was admitted to the hospital several months later with a diagnosis of GI bleed. The reporting facility identified additional instances of the starter pack prescribed with refills, though those errors were caught and corrected prior to dispensing.