To report or wait..?

[Nightwatch]

Huge relief, got copy of Rx back and it's the Dr that wrote bisoprolol 10mg so his fault thank goodness.

[Defblade]

Huge relief, got copy of Rx back and it's the Dr that wrote bisoprolol 10mg so his fault thank goodness.

You did refer to the PMR when dispensing and query the change of dose with the patient, to check they were expecting the increase?

Playing Devil's Advocate here, or maybe Ambulance Chaser.... but if the patient was minded to take this further, you would be asked these questions and almost certainly be held partly responsible if you couldn't say "yes" (and possibly even then if you hadn't noted it down at the time....).

Welcome to a life of crossing fingers and hoping it never happens on your shift, while you try and keep up with the 1,001 things we're supposed to do which would make getting through more than about 120 scripts a day impossible if we actually tried to do them all "properly"...

[Nightwatch]

You did refer to the PMR when dispensing and query the change of dose with the patient, to check they were expecting the increase?

Playing Devil's Advocate here, or maybe Ambulance Chaser.... but if the patient was minded to take this further, you would be asked these questions and almost certainly be held partly responsible if you couldn't say "yes" (and possibly even then if you hadn't noted it down at the time....).

Welcome to a life of crossing fingers and hoping it never happens on your shift, while you try and keep up with the 1,001 things we're supposed to do which would make getting through more than about 120 scripts a day impossible if we actually tried to do them all "properly"...

That's one thing i checked straight away, she'd never had bisoprolol dispensed from us before so it's not like i missed a huge dose increase as she's not a regular customer, so probably going wherever's convenient at the time.

And yes I find I can hardly ever sleep at night anymore because of thinking of possible mistakes that are going to come back, i don't know if i can be in this job the next 35+ years as things seem to be getting worse as it is!

Does anyone know, or think which company has the best support with dispensers? I'm in an understaffed branch and end up being the only one dispensing, labelling and checking everything alot of the time, not safe at all. Company has no budget for more staff of course.

[Merlyn]

Immediately after you've read this, get onto the PDA website and join. Your present place of work sounds like an accident waiting to happen, and as someone else said, if it comes to you or the company, their lawyers are going to look after their client. Not you!

[DavidS]

as i've already made another error a few months back, and now this.. how serious would it have to be, to be struck off? =/

We all make mistakes.

I have seen the error rate quoted at 1% of dispensed scripts, but I think/hope they were talking about near misses, which would be about right in my experience - I pick up about three or four non-serious near misses a day.

A more accurate figure of errors, quoted here Pharmacy Errors – Avoid Prescription Dispensing Mistakes | Highlight HEALTH is 1 clinically significant error per 2500 items, but I suspect that we would all hope we do a lot better than this.

A useful way of avoiding being struck off is to prioritise the known accident black-spots.
These are the prescriptions where errors will almost always result in significant harm to a patient, and you.
1. CDs. If you make a mistake with a CD you will usually get the book thrown at you. Check, double check, check balances before and after, check patient history, and lastly, check again.
2. Prednisolone: I recall reading that most fatal script errors are a result of mistakes involving prednisolone. If I managed a business again i would probably keep a running balance of prednisolones, treat them like CDs in other words, with an unofficial register.
There are several reasons for this, amongst which are:

• It is commonly used as a one-off, so PMR checks are less effective at showing it up
• the sick patient not getting prednisolone when they need it can itself be disastrous
• the fact that the dose is often six tablets at once means that if another drug is given out instead then the already sick patient will get a huge overdose,like as not.

3. Methotrexate mistakes. Many possibilities here but patients will invariably check their own, and be on it regularly
4. Gliclazide etc. doesn't seem to be much of a problem in practice.

[johnep]

CDs. If you make a mistake with a CD you will usually get the book thrown at you. Check, double check, check balances before and after, check patient history, and lastly, check again.

All too often pt just come in and says car parked on yellow line, left kids alone at home, bus to catch etc. You are being pressurized to just say OK. I know, I know but then staff will report you as slow.
johnep

[Nightwatch]

Hmm that's not good to hear about CDs, does this apply to all schedules or mostly schedule 2? A friend of mine is in a bit of a state for giving the wrong strength of buprenorphine a couple of months back, she reported it straight away but hasn't heard anything yet, apart from line manager at the company saying they had handled it from their end and the case was closed. What else will happen? As far as i know not yet heard from society/accountable officer.

[DavidS]

Hmm that's not good to hear about CDs, does this apply to all schedules or mostly schedule 2? .... but hasn't heard anything yet, apart from line manager at the company saying they had handled it from their end and the case was closed.

It applies mostly to CDs requiring records to be kept. So long as the patient wasn't harmed, and doesn't complain (and most patients taking buprenorphine for pain relief are so grateful for something that works that they won't be inclined to make vexatious and spurious complaints) my guess is that will be the end of it.

Johnep, the point you make is a good one. Particularly with those on substance-abuse regimes. It is quite common for those patients all to come in at once and noisily peck the pharmacist's head like a herd of malevolent geese to try and provoke a hasty mistake in their "favour".

[johnep]

Yep. Did early locum and knew nothing at all about addicts until they trooped in at 5.25pm (we were supposed to close at 5.30pm). I was fortunate that one of the girls stayed while I prepared, handed out and put in register. got away about 6pm. After that always asked so could get ready first thing in the morning.
johnep