Dispensing Medications and Offering Vaccinations: How Brown Bagging Can Bring Clarity

Brown-bag consults can be essential educational and safety tools to measure and ensure quality care. By asking patients to bring in all their current medications, including OTC, mail-order, specialty, and herbal products, pharmacists can guarantee appropriate and up-to-date care.

• Pharmacists are key providers in the continuum of care, consistently helping to identify potential problems and concerns that may require follow-up with prescribers or a medication therapy management (MTM) session. It is essential that a pharmacist’s workflow allow for brown-bag consults, which can do the following:
• Develop the pharmacist-patient relationship to help create better individualized service, forge patient loyalty and trust, and prevent medical errors
• Provide insight into a patient’s lifestyle and quality of care
• Show how well patients understand their conditions and medications

Dispensing medications and offering proactive medical services, such as vaccines, to patients can be challenging and complex.

Many barriers prevent patients from following up with providers, taking their medications as prescribed, and taking charge of their health. The complications may be lessened by the community pharmacist. Establishing strong relationships with patients, monitoring drug utilization for proper use, suggesting preventive care, and creating a communicative atmosphere in the pharmacy can overcome barriers.

RS is a 78-year-old woman who is a returning customer. She stops in at least once every other week to refill medications, shop in the store, or ask questions at the consult window. RS lives alone but is selling her large, empty home and moving into a senior apartment in a few weeks. Her husband died many years ago, and her adult son lives in a neighboring town. RS is internet savvy and tries to stay up to date with basic technology. Even though she looks up medical questions on her smartphone, she still relies on the pharmacy and her medical team for trusted health-related information. RS stops in to pick up a few prescription refills. You make note of the medications she recently refilled. You notice that RS is not acting like herself and appears disorganized. You ask her how she is doing, and she asks you to repeat the question. RS is unable to explain how she is taking her medications or what conditions they treat. You briefly review her adherence issues, acknowledge she is on multiple medications, and conclude that she would be an ideal candidate to participate in a medication review. You ask RS if she would be interested in bringing in all her medications and reviewing them for proper use. She is happy to have your attention and admits to feeling lost looking at all her medication vials. RS wishes she could get all her medications filled at the same time every month to avoid some of the confusion. Her eyesight is also failing, and she cannot read the vial print. RS asks if you could recommend an optometrist near her new apartment. You promise to help her try to sequence things for clarity and enhance the font on her medication vials. RS sets up an appointment to meet with you later in the day when you have some overlap coverage. To prepare for the session, you pull up her pharmacy profile, so you can compare it with what is in her “brown bag.”

• Alendronate, 70 mg, weekly
• Ativan, 0.5 mg, 1 to 2 times daily as needed
• Clopidogrel, 75 mg, daily
• Duloxetine, 30 mg, twice daily
• Omeprazole, 20 mg, daily
• Rosuvastatin, 20 mg, once daily at bedtime
• Valsartan, 80 mg, daily

RS arrives for the appointment. You have some recommendations ready, such as the name of a new optometrist who works at a clinic inside your pharmacy, and a schedule to help get her medication refills sequenced. RS empties her brown bag, and you notice these additional medications:

• Calcium citrate, 500 mg, twice a day
• Adult multivitamin with iron, once daily
• Enteric aspirin, 81 mg, daily
• Expired brand Crestor samples, 40 mg
• OTC brand Tylenol PM (acetaminophen/diphenhydramine), 500/25 mg, as needed
• OTC famotidine, 20 mg, twice daily
• OTC ibuprofen PM (ibuprofen/diphenhydramine), 200/38 mg, as needed for sleep
• Vitamin D, 1000 IU, 3 times a day

As you review the medications for accuracy, RS asks about the various immunization signs around the pharmacy. She says she is specifically worried about pneumonia and shingles and wants to get vaccinated. RS knows that living in an apartment closer to neighbors may put her at an additional risk for germs. She wants to be proactive to avoid serious illness. You offer to give RS the vaccines because she never received them from her primary care provider and, given that it is flu season, you also offer to give her an influenza vaccine.

She has not renewed her eyeglass prescription in more than 4 years, and she says she has trouble reading the newspaper and bag session, RS says she is very interested in participating in the other fine print. You suggest that RS make an appointment for an eye exam as soon as possible. You ask about her health-related goals. RS says she wants to maintain a good quality of life: seeing friends, going out to lunch, and walking. She also longs for a full night of sleep because she feels anxious and restless around bed-time. Most important, RS wants to stay out of the hospital. You discuss her depression, diet, and memory loss and nonpharmacological ways to help prevent sleeplessness. RS is taking many OTC medications, including some duplications, and has not disclosed these to her providers. She should be referred for proper diagnosis and treatment to someone who can regularly care for her. RS says she no longer sees a regular primary care physician because her previous provider retired. She says there is a different physician or nurse every time she goes for an appointment. You give RS a list of providers you recommend, and you offer to make her appointment because she is alone and requests assistance. After your brown-bag session, RS says she is very interested in participating in the the MTM session you offered and thanks you for your help, support, and time.

Jill Drury, PharmD, is a clinical pharmacy specialist in Chicago, Illinois, and Milwaukee, Wisconsin. She earned her doctor of pharmacy degree from Midwestern University College of Pharmacy.

Editor’s note: Case is not based on an actual patient.​​​​​​​