Deficiencies in Virtual Pharmacy Services in the Care of a Patient

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.