Who is responsible? Who will be prosecuted?

[howe928]

This is taken from a reference and it happened in real practice too

'Patient A had handed in two prescriptions to a pharmacy, one for herself and one for Patient B. The prescriptions were dispensed the next day by Pharmacist C. Patient A’s medicines were correctly prepared but incorrectly labelled with Patient B’s name. These items were put in the prescription bag containing Patient B’s medicines. The prescription bag containing both patients’ medicine was then put ready for collection.

A locum, Pharmacist D, who made no checks before supplying the dispensed medicines, handed the bag out the following day.'

[Pharmanaut]

Pharmacist D is just as much to blame, apparently.
You are supposed to check everything handed out again.
Is it realistic to do so?

[bobbin]

Is it realistic to do so?

Only if the pharmacy dispenses so few items per day that it wouldn't be financially viable anyway!

[DavidS]

Pharmacist D is just as much to blame, apparently.

I'm not so sure, anymore. Obviously, in reality, the first pharmacist is responsible. But it depends on the SOPs, in my opinion.

If the company SOPs, which have been written by the superintendent, and are adjudged fit for purpose by the regulator, say that the bag need not be opened - and the contents checked - before giving it out, then I don't think the pharmacist (or counter assistant) who give it out can be found to be responsible by the regulator.

Relying on the work of a previous responsible pharmacist acting within SOPs cannot be judged irresponsible, surely.

Just my opinion, of course

[The Apothecary]

Further to this debate,with reference to recent prosecution of dispenser involved in a dispensing error,would a dispensary assistant,trainee,ACT,pre-reg etc be also brought to book and prosecuted and criminalised,also counter assistant who might have given it out to patient

[johnep]

Counter assistant was apparently initially charged, but charges dropped.
johnep

[The Apothecary]

Read C & D magazine this week page 5. Original appeal against conviction was lost and conviction upheld. Big wig barristers were employed but the judge of appeal ruled the poor unfortunate was "plainly part of the system of supply". Every sensible pharmacy employee should be busy writing out their letters of resignation as I write this post.

[PHARMAC1ST]

This is a good question. I think if pharmacist C has signed in the box he takes responsiblity that the medicine is accurate and clinically safe for that patient. As long as the right bag is handed out to the right patient the blame should lie with pharm C even though pharm D is responsible on that day.

It is like saying if we sell ibuprofen 200mg tablets OTC but there has been an error in the manufacturing process or the manufacturer has put in ibuprofen 400mg instead of 200mg and the patient is told they are allowed upto 6 tablets in a day, which causes patient harm, then would you hold the pharmacist responsible?

If anyone can find info form the sop or from rpsgb on this that would be great :-)

[howe928]

it is time for the answer, you might be in for a shock!
'http://www.pharmj.com/Editorial/20040703/society/p35accountable.html

Example 1 Pharmacist E undertakes a clinical check of a prescription but fails to identify that the prescriber has ordered an overdose of a particular drug. The medicines are assembled, dispensed, checked and bagged up by adequately trained technicians. The medicines are then supplied to the patient by Pharmacist F who has the details of the prescription in front of him but who also fails to identify the overdose.

Who is professionally liable in these circumstances? Both pharmacists have a duty of care to the patient and both are professionally accountable for those parts of the dispensing process for which they are responsible. In the absence of written standard operating procedures (SOPs) defining individual responsibilities, both pharmacists are likely to be professionally accountable.

Example 2 The second scenario is identical to the first except that the pharmacy has written procedures. According to these procedures, the first pharmacist accepts responsibility for undertaking the clinical check and there is an audit trail to identify the responsible professional for each part of the dispensing process. Who is liable professionally in these circumstances?

Both pharmacists have a duty of care to the patient and both are professionally accountable for those parts of the dispensing process that they take responsibility for. Here there are clear lines of responsibility and clear audit trails identifying each professional accountable for each stage of the process. However, the second pharmacist accepts responsibility for supplying the medicine to the patient and has access to the prescription at the time of supply.

It is still likely that both pharmacists would be professionally accountable. However, the presence of written procedures identifying the responsibilities of each professional coupled with a comprehensive audit trail throughout the dispensing process may mitigate the second pharmacist’s professional accountability on the basis that he should have been entitled to rely on his colleague’s skill and competence to undertake the clinical check (see below for further comment on competence).

Example 3 The third scenario is identical to the second, but Pharmacist F does not have access to the patient’s prescription. In these circumstances, both pharmacists have a duty of care to the patient and both are professionally accountable for those parts of the dispensing process that they are responsible for.

Again, there are clear lines of responsibility and clear audit trails. However, because the supplying pharmacist does not have the prescription when handing over the dispensed medicines it is arguable that he is entitled to rely on the skills and competence of his colleague who has undertaken the clinical check of the prescription.

From the three scenarios, it is clear that responsibility and accountability is a ques-tion of degree. Sometimes responsibilities are clear but more often there is a blurring of the lines between individuals’ responsibilities.

In the case before the Committee it was decided that an advisory letter should be issued to Pharmacist D, which outlined his professional responsibilities in relation to the supply of medicines. A harsher view was taken of Pharmacist C in the light of his recent previous history of dispensing errors.

Individual cases are looked at on their merits.'

according to the above, all presciptions should only be handed out and checked with patients or carers item by item by the pharmacist on duty (dispenser or pharmacy assistant would only be allowed to retrive bagged medicines to pharmacists on duty but not giving it out to patients or carers) no matter how busy the pharmacist is at that moment ('resonable promptness' according to the NHS contract and 'now' according to patients' patience)

the outcome clearly demonstrated the current pharmacy practice needs to be overhauled if the authority wants to prevent this from happening again, e.g. release a standard operating procudere to ask all pharmacists to check bagged medicines in front of patients or carers (default automatic consent given by patients) who know about patient medications

[PHARMAC1ST]

that is shocking

No more handing out of prescriptions