Turning medication safety strategy into operational reality

by Dom Nicastro

In a recent Q&A interview with HCPro’s Patient Safety Monitor, Clearway Health's Holly Herring, PharmD, regional director of specialty pharmacy operations answered questions on how hospitals can operationalize medication safety at scale.

Holly explained the practical role of technology, data integration, and frontline collaboration in preventing errors—from optimizing EMR alerts and reducing alert fatigue to identifying early signs of nonadherence before patients are harmed.

She also addressed how medication safety shows up (or doesn’t) in daily safety huddles, how social determinants of health (SDOH) create hidden access risks, and why pharmacy leadership must be more intentionally embedded in safety and compliance structures as hospitals head into 2026. Below are a few excerpts from the orginal HCPro article.

Why medication safety breaks down at the operational level

Medication-related harm remains one of the most persistent—and preventable—threats to patient safety, even as hospitals invest heavily in technology and safety programs.

A systematic review found that preventable medication harm occurs in about 3% of patients across care settings, with more than a quarter of that harm classified as severe or potentially life-threatening. Studies also show that medication error prevalence remains high: One review reported error rates of 16%–44.4% among nurses and roughly 27.5% overall, highlighting the scale of the challenge that clinicians and safety leaders face.

The World Health Organization estimates that medication errors cause at least $42 billion in global healthcare costs annually, making them one of the leading sources of avoidable harm worldwide.

Technology alone has not solved the problem. The Joint Commission continues to cite medication management failures—including reconciliation gaps, high-alert drug handling, and incomplete monitoring—as frequent contributors to sentinel events.

Alert fatigue has additionally emerged as a major risk factor: Multiple studies have found that clinicians override up to 90% of electronic medication alerts, often because they are perceived as low value, duplicative, or poorly timed. When critical alerts are buried among noise, the safety signal is lost.

At the same time, medication-related risks increasingly extend beyond the inpatient stay. Research shows that nearly half of patients experience a medication discrepancy after discharge, particularly those on complex or specialty therapies. Delays in access, affordability challenges, and unclear education contribute directly to nonadherence, avoidable readmissions, and adverse events—issues that rarely surface in traditional error reports but carry significant safety consequences.

Q&A with Holly Herring

Q: What’s the role of EMR alerts, smart dispensing, or data dashboards in preventing errors—and how can they be optimized to reduce alert fatigue?

Herring: EMR alerts, smart dispensing systems, and data dashboards play vital roles in preventing medication errors by enabling real-time decision support, automating safety checks, and surfacing actionable insights. EMR alerts can flag drug interactions, dosing errors, and duplicate therapies, while smart dispensing ensures accurate medication selection and administration. Dashboards help track trends in medication errors, adherence, and workflow efficiency across departments.

However, to maximize their impact and reduce alert fatigue, these tools must be maintained, and hospitals need to invest in IT/EMR experts to implement best practices for optimizing alerts and applicable clinical decision support systems.

This includes customizing alert thresholds to prioritize high-risk scenarios and tailoring notifications to specific roles (pharmacists vs. prescribers). Engaging frontline teams in the design and refinement of these systems ensures relevance and usability, ultimately enhancing safety without overwhelming clinicians.

Q: You have mentioned medication adherence and patient monitoring. How can safety teams collaborate with pharmacy staff to identify at-risk patients earlier and intervene before harm occurs?

Herring: Safety teams should collaborate closely with pharmacy staff to integrate personalized medication support into daily care operations in order to identify at-risk patients earlier and prevent medication-related harm. Pharmacists have access to critical data such as refill patterns, prior authorization delays, and adherence trends that can signal when a patient may be at risk.

By combining this data with clinical insights from nursing and care management teams, hospitals can proactively flag patients who may face barriers due to cost, complexity, or SDOH.

Pharmacists participating in interdisciplinary huddles and care rounds allows for real-time identification of risks and timely intervention. Pharmacy teams can help initiate financial assistance, adjust therapy plans, and coordinate with providers to streamline access. This collaborative model not only improves medication adherence but also reduces preventable harm, enhances patient engagement, and supports equity in care delivery.

Q: Delays in filling or affording specialty medications can lead to poor outcomes. How can hospitals identify and mitigate safety risks tied to SDOH in medication access?

Herring: Delays in filling or affording specialty medications can significantly compromise patient outcomes, particularly when SDOH are at play. Factors such as financial instability, limited health literacy, transportation barriers, and complex insurance requirements often contribute to medication nonadherence and care abandonment. To address these risks, hospitals must take a proactive, systems-based approach that embeds SDOH screening and intervention within everyday clinical workflows.

This begins with implementing validated SDOH screening tools at critical points in the care journey, such as admission, discharge, and transitions of care, to identify patients who are high risk for medication access challenges.

Hospitals should then leverage multidisciplinary teams, including pharmacists, social workers, and case managers, to resolve these barriers in real time. Targeted interventions might include assistance with insurance navigation, coordination of transportation, enrollment in manufacturer assistance programs, and timely completion of prior authorizations.

Addressing SDOH within medication access strategies transforms pharmacy from a transactional service into a core component of patient safety and quality care, which helps hospitals achieve better outcomes and more equitable health delivery.

Q: What’s one change you’d like to see in how hospitals integrate pharmacy operations and patient safety programs over the next year?

Herring: Pharmacy operations and patient safety programs should be viewed as strategic partners rather than support functions within hospital systems. Over the next year, I would like to see a more intentional integration of pharmacy leadership into organizational safety and quality frameworks. Pharmacy professionals bring a unique clinical and operational perspective to medication management, risk mitigation, and process improvement, areas that directly influence patient outcomes and regulatory compliance.

Pharmacy should serve as a co-leader on safety committees and share accountability for medication-related performance metrics, error prevention, and harm-reduction initiatives. Embedding pharmacists in multidisciplinary safety teams ensures that medication-use data, adverse event trends, and process gaps are analyzed collaboratively and addressed proactively.

Hospitals could further strengthen this partnership by designating a pharmacist as a medication safety officer within the regulatory and compliance departments. This role would bridge communication between pharmacy, nursing, medical staff, and administrative leadership—ensuring that medication safety strategies are aligned with institutional priorities and accreditation standards.

By positioning pharmacy as an equal stakeholder in patient safety efforts, organizations can break down traditional silos, foster a culture of transparency, and enhance responsiveness to safety alerts and adverse events. Ultimately, this integration promotes a more cohesive, data-driven approach to patient safety that benefits both caregivers and patients.