A few more specific questions to ask before handing out scripts?

[stawberry]

I would like to check if anyone has always checked if patients do not have specific problems like renal/liver problems or pregnant/breastfeeding before handing out a script in community settings?

Might sounds a daft question but I recently queried a script that are having few meds change for a patient, not knowing why meds like simvastatin been stopped until was informed the patient had renal problems. In this case the patient has a nurse following through his meds and they will review and change meds as needed, but would they not need to inform the regular/community pharmacy that the patient has renal problems because pharmacist needs to clinically check the scripts? I would always think that the surgery has done a great job, but in the end of the day pharmacist is still the one who clinically checks (this also reminds me of a recent blog in pharmj about the confused roles between pharmacist and GP). This case makes me think a bit further.

Sometimes when a script is clinically checked in the community, it is easily assumed that the patient is 'healthier' (not forgetting that elderly is more susceptible and has reduced renal function as well). I know experienced pharmacist will have intuitive judgment most of the time but for a newly qualified, I am actually quite worried that some ignorance would have harmed the patient. I am thinking if anyone has implemented a better or a robust system in place to identify and check the specific problems stated above. Sometimes a script might be put in by someone else other than the patients themselves, and they might have thought hospitals/GP would have always checked before prescribing and so might not giving the information when putting in a script.

I might be over cautious but I am sure pharmacists will always be bound with the responsibilities. So does it make any sense to query patients or their reps if patients have specific conditions before handing out scripts? I would appreciate if anyone could provide any kind of constructive comments from previous experiences. Also I would appreciate if anyone can give valuable information where you normally obtain more comprehensive information about dosage reduction of drugs in renally or hepatically impaired patients apart from the 'Renal and Hepatic Impairment' section in BNF. Would you resort medicines information as the first place to go? Thank you.

p/s: I do always check the maternity box from back of script and see if patient is pregnant while handing out scripts.

[LeftArm]

This would have been the kind og issue that could have been resolved if Pharmacists could have access to the "Summary care Record".
This has now been put on hold at least as far as pharmacy is concerned. What is likely to happen is that software suppliers will link PMR to Surgery records (RxSystems and EMIS, Pharmacy Manager(Cegedim) and InPractice). The problem with this is that the level of care or quality of service will be dependant on the surgery amnd pharmacy haveing matching systems with no national protocol.

[Web Ferret]

Do they have any allergies to nuts or soya or any other excipients? What about aspartame or neomycin?
What if they are a female of childbearing age? Should you do a pregnancy test before giving out a teratogenic medicine because you assume that the patient is not pregnant or they say that they aren't?

For additional information use the SPC - There is a massive amount of information in the SPCs that isn't in the BNF - Compare any BNF monograph to the SPC and you will find something that the BNF doesn't mention that may be important.

Try that in a 500+ a day pharmacy!

The doctors used to be responsible for their prescribing now the pharmacist carries half the can.

Summary care record isn't dependant on your PMR. Most out of hours and hospitals have read only access to GP records. Summary care would work in your pharmacy tomorrow if the right software was installed. Oh I forgot. You do 500 items a day on 2 machines and to view the SCR stops the labelling/ordering process.
Its IHR in Wales and it works.

[Asterix]

so if patient harm occured, it would be our fault although we have no info, fantastic

[Asterix]

also when can a pt apply for a maternity cert?

[Web Ferret]

so if patient harm occured, it would be our fault although we have no info, fantastic

Been there, PDA defended me.

[Web Ferret]

also when can a pt apply for a maternity cert?

When the Dr/Midwife has signed the FW8

Help With Health Costs FAQs Maternity Exemption Certificates NHS Business Services Authority

[Asterix]

Been there, PDA defended me.

any chance of the story

[Web Ferret]

any chance of the story

Its a long long one that dragged on for 6 stressful years.
In Summary:
Exactly what was on the computer printed signed script was dispensed. Dose high but feasible. The prescription was re-checked by telephone with the surgery and the BNF and the patients PMR. Intervention was recorded.
Script was wrong due to failings at surgery.

4 hours in police station being interviewed under caution for gross negligent manslaughter (PDA solicitor present). No charges, no CPS action.
3 days in Coroners court (PDA solicitor present for 16 days that it took for this complex case - every day of entire hearing)
Warning received from GPhC saying further checks should have been done (PDA not present as infringements committee closed hearing/decision (not a FTP) but representations sent in)

As I said, this was not a dispensing error.

If you aren't a member of the PDA join now. I've seen the PDA and the NPA side by side...