Food for Thought...

[kl06229]

Here's an interesting scenario that illustrates some of the unusual things that happen to pharmacists. Food for thought...

A locum checks a prescription for co-dydramol 30/500 tablets that have been prescribed for a patient. This script was handed in late in the afternoon following a visit to the surgery. Later on, the locum by chance notices that this patient previously received this painkiller, to be supplied in daily instalments (on a now finished script).

Curious about this, he contacts the prescriber and compares the current script at hand to the prescriber's computer records. It turns out that this new script was to be dispensed as daily instalments. The words "daily dispense" had been lightly ripped away with what may have been sticky tape, a detail that had not been obvious to the eye.

Both pharmacist and prescriber are taken aback by this and are unsure if the script was deliberately tampered with or simply an accident. They agree that the 2 greatest problems are:

1) Patient may abuse and end up overdosing

2) Patient may sell the tablets to others

Problem 1) is considered less likely, as patient is known to prescriber and this is not a known issue in the past. The patient is not to receive any more.

Interested in hearing other peoples' thoughts. Has due diligence been made to ensure the script was genuine and untampered? Without dispensers highlighting an issue, would a locum on that day have readily known/suspected that the tablets were to be dispensed daily? Is a pharmacist expected to have near psychic powers and be able to anticipate everything? In the environment of a busy pharmacy, should the pharmacist be expected to refer to the PMR every time?

[johnep]

Prescriber at fault. If to be dispensed daily should be on blue form. Green forms are for single supply (one fee).
On a blue form you would get a daily fee. With regards to print being removed by sticky tape. This could open the door to all sorts of fraud.
johnep

[andrew paxton]

Not in Scotland though, and that is where Co-dydramol can be done in daily instalments. The answers so far aren't really answering the question

[johnep]

Sorry, you did not say where, and I would not have known there was a difference anyway. Point re use of sticky tape still valid and I will investigate myself. EPS might be a consideration. Also bar coded script.
johnep

[LeftArm]

Has due diligence been made to ensure the script was genuine and untampered?
As you say that the alteration was not obvious to the eye I would guess that as far as that is concerned yes.
Without dispensers highlighting an issue, would a locum on that day have readily known/suspected that the tablets were to be dispensed daily?
Depends on how common this is locally.
Is a pharmacist expected to have near psychic powers and be able to anticipate everything?
Probably
In the environment of a busy pharmacy, should the pharmacist be expected to refer to the PMR every time?
When this came up before the answer seemed to be Yes in order to do the clinical check the pharmacist should check the PMR. However in my experience this is not always the case.

As johnep says EPS would have should resolve this but the system is different in Scotland so i don't know.
Was the script printed on a laser printer?

[Gordon Mackenzie]

In Scotland if the prescription has been scanned in to the pharmacy computer the change should show up as the bar code would put the full instructions of the prescriber on to the screen. Of course if the prescription has been hand written this protection is lost.

[sparkybw]

There is a third alternative - the patient may not want to trail down to the pharmacy everyday and that's why they tampered with the script. I must admit if I was in pain I wouldn't want to have to keep going out especially when it is as cold as it is currently.

[tinx25388]

A locum checks a prescription for co-dydramol 30/500 tablets that have been prescribed for a patient.

I thought Co-dydramol is 10mg/500mg?

[andrew paxton]

Probably a mis-type for Co-codamol 30/500

[Pharmanaut]

Hard to say unless we saw the prescription.
ePharmacy would help the situation - harder to tamper with the prescription