knowing where you stand

[hibernia]

If an airline pilot refused to take off because of safety issues he would not lose his bonus, face disciplinary procedures and be criticised and bullied. He would also have support for his decision from government, the public, his union and the media.

Now many people are in hospital tonight as a result of plane crashes? Possibly a few from light aircraft accidents.
How many as a result of medication issues? Certainly hundreds.

When are we going to start treating medicines seriously? If pharmacists don't, who will?

[SolomonQ]

"So in what situations do you say 'No'?"

What happens in such cases is that these are handed to you when the patient comes in, at a busy time, and you are pressurised to just check them.

What's basically happened is some pharmacy manager out there has not done his/her job properly and you can't really blame the dispensers for this.

Even as a locum I've refused to do many of these, or had them redone from scratch but i've got the impression that many locums just "check" them. I regularly locum at a pharmacy that doesn't keep boxes because "they don't have space", they know each time I will have the tray re dispensed except for (bulk pack tabs such as aspirin), no ones complained about me doing this to the people on top. i've given my reasons and they know I will do it.

The way I look at it is i'm doing my job by prioritising patient safety, the cost is the lost revenue of the DOOPed tabs from such trays but the pharmacy is providing and CLAIMING PAYMENTS for services for which they cannot properly cater, so this is their responsibility not mine.

Other things as changed doses, new meds etc.. also come under the same category i.e. change of dose from the normal Rx, or warfarin without instructions from hospital. The answer is same for all of these, nothing without a Rx

"So it's sod the patients - just cover your back?"

In all cases covering their own backs for the pharmacists is the same as looking out for the patient....In all cases. quote me on that if you want. Tablets don't have expiry dates imprinted on them only the boxes do, and as seen from other posts on this forum some pharmacies have a habit of using expired tabs in trays. But this is not the only reason.

[medical6969]

You can say NO if...
1 ... you are presented with a new script with an overdosage, and have contacted the doctor and he/she insists the dosage is correct.
Tell the patient 'Im not happy to dispense the medication because according to the textbook I have it is not normally taken at this dosage.'
Would you be able to contact a drug information centre at a local hospital to verify the weird dose?
note: consultants will prescribe medication for unlicensed diseases, but the dose should at least be reasonable, or else you need evidence to back it up. Maybe the GP can send you a letter from a hospital specialist.

2 ...the script isn't signed or dated (unless you know the patient well and they have the medication at your pharmacy regularly, and they will run out before you can get it signed).

3 ...your given liquid to check without the original container it came from (don't take the dispensers word for it)

4 ...a script comes near closing time and it will take a long time to dispense. 'I'm sorry we cant do this now, because we are closing. We can get it ready for tomorrow morning'.
If they kick up a fuss that there is still 2 minutes until closing time...'Yes the pharmacy is open until 5.30pm, but we do not dispense prescriptions until that time.'
Direct them to another pharmacy if required.

5 ...your asked to have a word with a customer and your busy with 2 million other jobs. Tell them it will take about 5-10min or they can come later in the day.

[johnep]

Regarding dosage. I had script for metronidazole 2grm dose. Took me some time before satisfied myself that this dosage is used in certain conditions.
However, I was at a pharmacy with three pharmacists so able to check properly.
johnep

[SolomonQ]

"1 ... you are presented with a new script with an overdosage, and have contacted the doctor and he/she insists the dosage is correct.
Tell the patient 'Im not happy to dispense the medication because according to the textbook I have it is not normally taken at this dosage.'
Would you be able to contact a drug information centre at a local hospital to verify the weird dose?
note: consultants will prescribe medication for unlicensed diseases, but the dose should at least be reasonable, or else you need evidence to back it up. Maybe the GP can send you a letter from a hospital specialist."

sounds easy, but has anyone tried telling a patient they won't pick a box of tablets off the shelf and give it to them. Had a patient this saturday who said he's run out of med and from the PMR he shoudn't have, tried asking him a few routine questions before supplying the meds e.g. "Rx says take one or two, have you been taking 2 every day?" he said oh forget it and walked out saying he was going to "write a letter" then 10 mins later walked back in requesting the same med again. Asked him if he wanted to apologize for his attitude, he did it in a very patronising way. Stood there thinking wtf (sorry). with regards to the ES asked him the same question, reply: "What right have you got to ask me what or how i'm taking it". Med wasn't an addictive med just a PPI, so said to him ES was a private Rx so i can ask him anything I want, 'cos I was prescribing it. He said ok to that but was still being really difficult. (He was a repeat Rx patient, the type the corporates love, but I needed info off him to find out what and how many to give him as he was on a few diff meds). Another thing I remember is, I said to him I 'll have to charge him for it, because it was a private Rx I was prescribing, he said no way he had a pre-payment certificate. So I refused saying I'm not going to do it because if he really needs it theres no Rx and he can buy it OTC. he said he wasn't going to leave until he got them and he wasn't paying anything.

Lucky it was a quiet pharmacy and I knew the staff etc... otherwise as a locum........

[johnep]

Even though the SOP for one multiple states clearly that all ES have to be paid for, found in practice that 'loans' still made as no mention of 'loans' in SOP.
johnep

[kl06229]

Here's a piece of advice (coming from my own experience) if you're a locum or relief:

DON'T ANSWER THE PHONE!

Or at least answer and pass to regular staff. It's too easy to get caught up talking to an irate customer about something e.g. dispensing error; who then pins the blame on you, the guy who picked up the phone. He/she won't give a toss if you actually made the mistake. One call to head office of whatever multiple you work for and you're landed in trouble.

[johnep]

All too true. The pt has a complaint at the pharmacy and then suddenly it is all your fault. no wonder the staff hide in the dispensary and are keen for you to deal with queries.
johnep

[El-loco]

Here's a piece of advice (coming from my own experience) if you're a locum or relief:

DON'T ANSWER THE PHONE!

Or at least answer and pass to regular staff. It's too easy to get caught up talking to an irate customer about something e.g. dispensing error; who then pins the blame on you, the guy who picked up the phone. He/she won't give a toss if you actually made the mistake. One call to head office of whatever multiple you work for and you're landed in trouble.

I agree in general about not answering the phone because if you're a locum you will probably have to hand over to a member of staff anyway.

But I absolutely disagree with you when it is a dispensing error.

These should ALWAYS be dealt with by the pharmacist personally whether they made the error or not. The patient may have taken some of the wrong medicine and you cannot leave it to a member of staff to deal with as they may be unaware of the potential harm it might cause. Protecting patients and the public from the harm that medicines can cause is one of a pharmacist's fundamental responsibilities and if you are not prepared to shoulder that responsibility then what use are you?

If the patient blames you personally simply inform them that there is a log of which pharmacist was responsible at which time and that it will be possible to determine who made the error. Then follow the incident form and use your professional judgement in the patient's interest. Apologise for the upset that they have suffered but do not admit to anything - neither on your own part nor on behalf of anyone else.

You should be the one to contact the head office (or superintendent's office) and they will not criticise you for it (unless they are completely insane) because prompt action will reduce harm and will reduce the size of any compensation their insurer will have to pay out.

Sometimes I do wonder ...

[kl06229]

I agree in general about not answering the phone because if you're a locum you will probably have to hand over to a member of staff anyway.

But I absolutely disagree with you when it is a dispensing error.

These should ALWAYS be dealt with by the pharmacist personally whether they made the error or not. The patient may have taken some of the wrong medicine and you cannot leave it to a member of staff to deal with as they may be unaware of the potential harm it might cause. Protecting patients and the public from the harm that medicines can cause is one of a pharmacist's fundamental responsibilities and if you are not prepared to shoulder that responsibility then what use are you?

If the patient blames you personally simply inform them that there is a log of which pharmacist was responsible at which time and that it will be possible to determine who made the error. Then follow the incident form and use your professional judgement in the patient's interest. Apologise for the upset that they have suffered but do not admit to anything - neither on your own part nor on behalf of anyone else.

You should be the one to contact the head office (or superintendent's office) and they will not criticise you for it (unless they are completely insane) because prompt action will reduce harm and will reduce the size of any compensation their insurer will have to pay out.

Sometimes I do wonder ...

I was speaking from a bad experience involving a mistake made by another pharmacist which ended with me at a disciplinary hearing. Thanks to the PDA the outcome was pretty mild, but it's an example of the poor policies laid out by multiples and utter lack of respect or consideration for pharmacists. My employer happens to insist that we should apologise at the start of the conversation no matter what, ridiculous in my opinion.

However you make a good point El-loco, it'd be irresponsible to shrug your shoulders and leave a patient hanging even if you were not directly responsible for what happened. Yet, in this litigious society of ours we do need to watch our backs. And following this experience, I will watch my back, very, very carefully...