dispensing thought provoking situations

[howe928]

1) this is a regular repeat prescription for this patient and staff told you the pharmacist manager checked the unusual dose prescribed with the prescribing doctor but no record can be found anywhere that you have searched

what would you do?

2) an interaction between two medicines, you rang one of the manufacturer and they strongly advice you not to use it, you spoke to doctor and doctor still wants to go ahead because patient needs it

what would you do?

3) a doctor told a patient who is here for a family visit trip to come in for emergency supply, the patient has not got any proof of medical record e.g. repeat slip, old medicines box with recent date on (is there a limit for this? e.g. must be recent e.g. dated within last 3 months), you checked your computer and found it was a few months back last time the patient was here and the the medicine requested is on the list of medicines supplied

(edited: basically how would you satisfy yourself that the patient is still on the medication they said they are on if your computer medical record said the patient last had this item from you was 3 or 7 months ago?
-- will you make an emergency supply if the patient last had it 6 months ago and if that's the only solid information you got?
-- doctor said they take the words patient told them and prescribed what patient told them and pharmacy should just take the patient's words and give emergency supply without refering to doctor and doctor sure it is right because doctors meeting concluded that, is doctor correct?)

what would you do?

[cymru72]

1) this is a regular repeat prescription for this patient and staff told you the pharmacist manager checked the unusual dose prescribed with the prescribing doctor but no record can be found anywhere that you have searched

what would you do?

2) an interaction between two medicines, you rang one of the manufacturer and they strongly advice you not to use it, you spoke to doctor and doctor still wants to go ahead because patient needs it

what would you do?

3) a doctor told a patient who is here for a family visit trip to come in for emergency supply, the patient has not got any proof of medical record, you checked your computer and found it was a few months back last time the patient was here and the the medicine requested is on the list of medicines supplied

what would you do?

1. You would have to check again. I am amazed by the number of times I have been to pharmacies where weird doses have been met with the response 'it's ok - they've had it before' - Then if dose is indeed correct - anote the PMR and/or intervention book.

2. Don't trust manufacturer - info they usually give is useless -try asking them if their product is safe in pregnancy or whether the drug can be deblistered into a MDS device - answer is NO and NO regardless of any information they hold!!!

Best to use good old Stockleys or a hospital drug information line. Make a sound clinical decision and do NOT be influenced by the GP saying "that is fine - I am aware of that". Never forget the Migril case as you will be equally liable if the interaction resulted in harm and you were aware of that possibility. If you are convinced harm may arise, then refuse to dispense, explaining your reasoning to the patient. I have once refused on these grounds, for a addict presenting a script for co-proxamol - at a dose of FIFTY tablets daily.I checked with clinic as I thought it was a typo - but no it was for real!!!! When I explained to patient they begged me to dispense, claiming that this was a reduction in dose from what they normally received!!!

3. Not quite sure what your issue is here. Do you mean there was an emergency supply made the last time??? I am always reluctant to do emergency supplies for repeat offenders. I always charge £8 for an emergency supply of salbutamol inhalers as I believe there are some people who see emergency supplies of salb as being cheaper than a script and will do the rounds.

[medical6969]

1. Just check with the patient if they are aware of the unusual dose. If so, then dispense. Doctors use medicines in unusual ways. Its not our job to stick our noses in, if we can confirm its as expected by the patient or doctor.

Also if they have been having it for many months/years why would you want to be a hero trying to prevent the patient from receiving their medication !

Be reasonable, sensible, practical.

2. There are many many interactions which are highlighted in the BNF which are in practice fine. Ringing the manufacturer is pretty useless because they are only interested in not getting sue. Just discuss the issue with the Dr and ensure they are aware of the outcome of using the 2 drugs together.

Endorse PC. Dispense. Again don't be stiff. Be practical.

3. Tell them to go to the emergency doctor for a script. I hate it when people abuse the emergency supply service.

Inhaler for £8! Not high enough to discourage. Charge £10.