Reporting ADRs

[alex]

I was just reading this article, and remember reading an almost identical one last year too.

I'm still only a student (just!), so won't know anywhere near as much as you lot, but does it come across as being a big problem when you're practicing?If you have any concerns with a drug, does it ever warrant you taking any action? It seems like this has always been a problem, that is widely acknowledged. If you do have concerns and take it up with a doctor, what sort of response do you get from them?

[admin]

Alex

I don't do much practicing myself.....pretty much perfect...........sorry I couldn't resist............

If you have any concerns you always have to ring the Dr. I used to listen to patients, but now I always ignore them and ring. For example yesterday I had a guy who had been previously taking 40mg daily of citalopram. His new script was for 10mg citalopram and 10mg escitalopram. I told him I was concerned this was a mistake, but he swore blind it was correct. I said I needed to ring the Dr anyway. He got really angry about me wasting his time etc and insisted his Dr was correct. It turned out it was an error and he had been switched from 40mg citalopram to 10mg escitalopram.

On my part I couldn't get past the receptionist, and was told by her to just not dispense the citalopram, after she had spoken to the GP. No thanks for stopping this error, not from the patient or the Dr. The annoying bit is if I had dispensed a wrong item the patient would go mad, but because the Dr has done it it's understandable.

The really annoying part is if I had believed the patient, and not contacted the Dr, then I'd probably be held about.....er.....100% responsible if anything went wrong.

You always have to ring the GP if you have concerns. I also stopped a diclofenac overdose yesterday, but again no thanks, and this time I spoke to the GP.

The really hard part is if you can't contact the prescriber. If it's from a hospital consultant for example and it's after 5pm you won't get hold of them. You then have the problem if what's going to happen if you refuse to dispense the prescription. If the patient again tells you that the unusual drug or dose etc is correct, and they have rang the surgery to check it is, again if it goes wrong you will be about....er....100% responsible.

A lot of this has to do with the "no win no fee" culture we are in today. Patients are told to go after the pharmacist/company because Dr's are so protected. That's why I'd recommend you take out insurance once qualified. At least by doing that you will have someone in your corner to fight with you. You could find that if it goes wrong, you have the Dr blaming you, the solicitors, the patient and probably the pharmaceutical society.

The best response I ever got was from a cardiologist (hospital consultant) who apologised profusely for an error he did and thanked me a lot. This guy was a senior consultant yet was really grateful I had helped him and his patient.

It seems to me that the GP's who could really do with our input (i.e. the ones who make lots of mistakes) are the ones who are least happy to accept it. I wonder if it's a defense thing, or they are just plain arrogant.

So the moral is always check as much as you possibly can if you have doubts. If you can't get hold of the Dr then it's up to you to decide what to do, i.e. dispense it or not. I know of a few pharmacists who just tel the customer they don't have that in stock so the problem goes away.

[Zoggite]

Here's another nice one most of you will be able to relate to: it's friday, 5.15pm, surgeries are now closed until monday morning. Man walks in with handwritten script for 56 tabs MST-Cont 20mg, 1BD: his wife is in agony, she has no pain relief medication in the house apart from paracetamol.
MST-Cont tablets do not exist in a 20mg-strength, but because all MST tabs are controlled drugs (Morphine sulphate...), I have no latitude whatsoever, I can't just double up on the 10mg-tabs or give capsules instead; I can't contact the prescriber because the weekend has kicked in; SO what do I do? Phone a friend? 50/50? Ask the audience?

[Pharmanaut]

Alex

I don't do much practicing myself.....pretty much perfect...........sorry I couldn't resist............

If you have any concerns you always have to ring the Dr. I used to listen to patients, but now I always ignore them and ring. For example yesterday I had a guy who had been previously taking 40mg daily of citalopram. His new script was for 10mg citalopram and 10mg escitalopram. I told him I was concerned this was a mistake, but he swore blind it was correct. I said I needed to ring the Dr anyway. He got really angry about me wasting his time etc and insisted his Dr was correct. It turned out it was an error and he had been switched from 40mg citalopram to 10mg escitalopram.

Generally, I explain to the patient that if a pharmacist has a concern about a prescription he/she has a duty to the patient to query the prescription and that you are not messing around for the sake of it. Examples of this are patient on methotrexate and ibuprofen (also on folic acid as well). It was also saturday at 3:00pm. It was the patients husband, so I had a good chat with him about my concerns without causing a panic. Most people do not get bothered. Generally if I want the surgery staff to check records etc, I ask them. If you want to speak to a Dr - generally saying so gets you through.
I think the trick is to 'read' the patient and talk to them before they have had a long wait.

Involving the patient in the process works for me - almost all the time.
Mind you - have have been doing it for 25 years and are still learning.

I'll end with my usual mantra - Pick the right staff, train them, create a team spirit and you will all have time to do the job properly.

[admin]

Pharmanaut

I did all the nice chat to the patient, and told him I was concerned about HIM but he still got angry. Maybe it's the places I work, but people here tend to be aggressive if they have to wait, for whatever reason. Of course this is not all people, but it does seem to be a lot of them.

As for training staff I have no control over that. All the majors just seem to be cutting staff down to a very basic minimum, even if their business suffers because of it.

Saying you want to speak to a Dr gets you throught about 30% of the time. They are always in surgery and won't be disturbed. Threatening to go the PCT usually gets you through, but then you're on a bad relationship from the start.

[Linnear]

Pharmanaut

I did all the nice chat to the patient, and told him I was concerned about HIM but he still got angry. Maybe it's the places I work, but people here tend to be aggressive if they have to wait, for whatever reason. Of course this is not all people, but it does seem to be a lot of them.

I call it the watchdog generation.

Watchdog has taught everyone that if they shout and scream they can get all they want and there's nothing the shop staff can do about it.

I can see their point of view to some extent. If Shop X is prepared to bend over backwards to make sure their pavlova is absolutely perfect then their medicine should be treated with much more seriousness than that.

I do sympathise with people but it doesn't give them the right to be rude from the start.

If I ever have a problem I go back and ask the staff to put it right or explain where I've gone wrong. If they don't do anything then stand back!

But they always get one chance. Everyone else seems to revel in shouting and screaming from the outset

[admin]

I call it the watchdog generation.

Watchdog has taught everyone that if they shout and scream they can get all they want and there's nothing the shop staff can do about it.

I can see their point of view to some extent. If Shop X is prepared to bend over backwards to make sure their pavlova is absolutely perfect then their medicine should be treated with much more seriousness than that.

I do sympathise with people but it doesn't give them the right to be rude from the start.

If I ever have a problem I go back and ask the staff to put it right or explain where I've gone wrong. If they don't do anything then stand back!

But they always get one chance. Everyone else seems to revel in shouting and screaming from the outset

I find that people are only concerned with one thing - how long will it be. If the answer is over two minutes they get funny, and I don't mean ha ha.

Why are people prepared to wait 10 or 15 minutes for a pizza or kebab but not five for drugs? I just don't get it.

[Linnear]

The ones I like are the people that bring in a 3 week old Rx that is suddenly so urgent that they can't wait ten minutes for it!


Or the Rxs that are so urgent that a ten minute wait is too long!


I had a woman kick up over having to wait ten minutes for an Rx who then met a friend and stood five yards from the counter and yapped to her for over an hour!

"general public" = generally arseholes!

[Pari]

the same here! they are always in hurrywhen they come to pharmacy! and it makes me sometimes angry! they never thank you because they had waited long time acoording to them and I just can't concentrate sometimes when they insis telling me "what are you doing? where is my meds etc"
oh, God! I thought it was only my problem! so just happy to know I am not alone!!!

[admin]

Pari

You are not alone. I think every pharmacist who works in retail has the same experiences if they admit to it.