urgently need advice - CD, lost script....

[pharmer7]

oh the wonders of working as a locum... Chaotic first day, no regular staff, all off sick, bereavements,etc. A CD script for a dosette box (yes MST goes into box), looks to have gone missing. Cannot find anywhere, and there is a remote possibility it was just filed. In which case it has now been sent off to the pricing bureau... Reason I'm up so late is I'm dreading going back into that store and dealing with more problems, just cannot get to sleep. Will try nicely asking surgery to reprint, but got a feeling they would not do it, because its basically due to the stupidity of someone at the pharmacy. Box will be due to go out soon, but should have that MST inside. What can be done in this situation?

Secondly, another irate woman saying her mother "needs assessed for a dosette box"?? I have never done this before, don't even know where to start and neither do the other staff. It was left to a couple of members of the regular staff, who don't look like they're returning any time soon. Would the surgery even authorise me to do something like this, as I have undergone no training and they don't know me?

[roper]

It is a bad situation but the GP should be prepared to respond to the patient's need and therefore reprint. I presume that the script had already gone missing before you started there today - so you have never seen it? All you can do is explain to the surgery. A regular locum or manager might be tempted to bend rules to keep regular patients happy (they shouldn't) but the arguement that "they told me the manager always did it this way" isn't going to save your neck. If necessary, suggest that the patient or representative contacts the surgery so that the doctor who gets the job of writing a new script can at least assess the appropriateness for the patient. At least it is MST rather than Methadone; if it was a substance misuse client then you would often find less sympathy for the patient and a degree of suspicion that they had somehow managed to get the item dispensed elsewhere.

I wouldn't know where to start with assessing eligibility for a dosette box either. I would be interested if you report back on what you decide to do there. I might need to do some CPD.

[johnep]

Eligibility? If the surgery will provide 7 day scripts, they are OK. Otherwise could start with just a MAR sheet, boxes marked 1,2,3 etc. If multiple, then they will do dosettes for free. Otherwise could be a fee. prospect of having to pay will concentrate the carer's mind wonderfully.
johnep

[pharmer7]

the way I was thinking was that you have to ask things to the patient like if they are forgetful, difficulty with bottles,etc. Another problem is i think they want it done at their house, and as I'm a locum staying for few days with no transport I don't understand how i am meant to do this? Plus, i won't exactly be allowed to leave in the middle of the day and go to their house. Nor will I be compensated for doing this service in my own time. at least if head office could actually do something useful and get more staff to cover, its getting ridiculous now.

[johnep]

If the patient has their own box then usually a relative/carer should do. I have had boxes brought to the pharmacy along with the script and am then prepared to do. Naturally, they will then need two boxes. You have raised a very good point re CDs in dosettes. If the surgery will only issue monthly scripts then do not put into weekly dosettes unless issued all together. If want weekly, then must have 7 day script. Practice where I have worked is NO CDs in dosettes.
A monthly script retained for weekly issue, will not correspond with register entry and in danger of being lost. I do not think the inspector or PCT CD lead will approve. They will deal with surgery if necessary.
johnep

[pharmer7]

The problem, as far as I know, they have never had dosette boxes before, and they want to get assessed to start using them. I really don't feel I should be doing it, but what options are there for them? I thought this would be the responsibility of the surgery.

[roper]

I think that you are talking about a DDA assessment. I have never done one and I am interested so I googles and found a PCT toolkit Disability Discrimination Act - A Resource Kit - NHS Primary Care Commissioning

Of course, multiples will have their own rules and policies. Some will want any business they can get and others only the profitable. I think it is a job for the regular manager but if it is a shop continually run on locums then someone has to address the issue. You meet a few more problems visiting a patient at home. When to do it is only the first one. I would not expect to do this without clear guidance (maybe even a SOP) from the company.

[johnep]

Before visiting a pt at home you will need a CRB check. A home visit from a tradesman costs minimum of £90 before any work done.
What will be your charge?
johnep

[Defblade]

Before visiting a pt at home you will need a CRB check. A home visit from a tradesman costs minimum of £90 before any work done.
What will be your charge?
johnep

I don't think you can charge (potentially) disabled people for your compliance with the DDA.

However, the DDA demands reasonable adjustments to your business practises, and shutting down the whole shop (or dispensary under allowed absence) in order to visit one patient is not very reasonable IMO.

OP:
The surgery have no say in who you assess. Best if the patient can come to the store, or it may never happen. Whole thing probably carer-led anyway ("we can't give tablets not in a tray"). Grrrr. The assessment of the patient's needs may not come out as a tray anyway - many would be OK with, basically, a MAR chart so they can see what to take when and whether they've had them already. This answer tends to upset the "care" people tho....


As for the MST, I would politely and with many apologies insist on a script before issuing the tray. If I hit a real stone wall, the surgery could at least confirm the script was printed; the shop's PMR and systems may suggest it was done (eg some systems make you endorse after labelling) ..... do the staff run off the "regular" labels each time and use a blank paper over and over to endorse on, or do they stand there with the scripts in their hand as they type? In the 2nd case, I'd be happier (less unhappy) that the script had come through the system.

If you do decide to supply without sight of a script (in the patient's interests) then make good notes about what you tried to get one and why you're OKing it. I'd suggest in your diary and on the PMR, maybe in the shop diary if they've got one.

Edited to add: I'd probably inform the superintendent too just to CYA.

[johnep]

I have obtained copy of script from PPSA when a query over methadone possible error. Give them details and they could fax you a copy. Also check what was entered in the register. Have been cases where surgery staff requested issue before script 'because no Dr to sign'. Then the script doesn't arrive. Surgery staff often ignorant that they are asking you to commit a criminal offence. You could point out possible they could be implicated if things went wrong. would love to see a receptionist in court.
johnep