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When patients say the infamous “there wasn’t any in the bag!”

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  • When patients say the infamous “there wasn’t any in the bag!”

    So I’m sure all of you fellow pharmacists will have come across a similar scenario at some point. You’ve dispensed multiple items, assuredly put ALL the items into the bag and handed the parcel over to the patient - for the patient then to contact the pharmacy to adamantly say that they never received it!

    Just wanted your take on how you’d approach the situation.

    scenario 1) its biddy 87 year old Mrs. Smith who has Alzheimer’s - in this case i can accept that she may have misplaced it and you have a certain degree of sympathy with them

    scenario 2) its someone who’s just trying to play it on and get an extra pack of sildenafil (or whatever it may be) from you when you know for a fact that you’d checked and placed it in the bag.

    in such circumstances i know some of my collaegues’s response would be to ask the pt to return ALL meds back to do a in-branch check and for reporting purposes. I have interestingly found that Rather than pts having to deal with this palava, that they then contact the pharmacy back to say they miraculously found the item {DISCLAIMER} its not often that happens though

    but often its a case of thier word agains ours, how do you respond/what steps do you take?

  • #2
    You've got no chance in a 100 hour pharmacy as anyone who's worked in one knows. Not so bad in a non-100 where surgeries more aligned hours and more consistent staff.

    The predatory patients leave it till 6pm or the weekends or when that nice but helpful dippy member of staff is around and will pounce.

    With the genuine ones of type 1, we've had discussions with the surgery so people know where we're at. That's usually fine, what tends to torpedo its effectiveness if there are clueless relatives who want to meddle and come in all bolshy with the wrong story or trying to sort out problems when they don't exist. I can think of one MDS where the patient's child came in hassling for weeks trying to get a month's MDS even though the surgery said no chance mate and at a more lucid time the parent was saying no I'm only supposed to have one week at at time!

    scenario 2, we've even had people cutting the blisters how we wouldn't cut them and claim it was like that and we still give the goods out. Another fantastic one was someone scrubbing off the date off bottle of paracetamol to get another one done on minor ailments (by amazing coincidence the bottle was finished and they'd had another item that month).

    Funniest one was we used to have a patient come in who hated going to the surgeries and would give this spiel that got amazingly ranty but sounded half genuine. Really pushy, she'd feign being upset and then get an emergency supply and get us to order 3 months meds at a time (which the doctors did to get rid of her). She'd then come back a week later at a weekend and claim she'd only been given one month. As we didn't see her very often she got away with it for a long time. When I met her the 2nd time I cottoned on and on the third time I met her at a weekend I told them you're rumbled mate, we refused to do anything till Monday until we could contact the surgery. Patient got unbelievably angry and the pharmacist got them to admit yeah they had months and months of spare. After that they dare not show their face and a neighbour now orders their medication for them, collects the script and collects the meds. No trouble any more.

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    • #3
      Will this become more common when patients can pick up their prescription from the out of hours locker?
      Notice it is always something with some value that goes missing, sildenafil, Benzodiazepines etc.
      47 BC : Julius Cesar : Veni Vidi Vici : I came, I saw I conquered.
      2018 AD : Modern Man : I shopped, I clicked, I collected.
      How times change.

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      • #4
        It's yet another habit of retail and the returns culture.

        Same thing happens all day long on customer service desks around the corner from the pharmacy. People do it there, so it'd work in pharmacy right?

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        • #5
          This never happened twice. Would check out items with pt and get them to sign for.
          johnep

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          • #6
            Sadly it's usually very hard to know if they're lying or not. If you have a patient that has a history of ringing in with these claims, then obviously that would draw out our suspicion, especially it's for medicines that can misused.

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            • #7
              We, as part of our sop's always third check the bag against the script just before handing it to the patient, Then if something is missing it is usually the patient not ticking the repeat properly or the surgery missing an item from the script.

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              • #8
                Originally posted by Qwerty pharmacist View Post
                in such circumstances i know some of my collaegues’s response would be to ask the pt to return ALL meds back to do a in-branch check and for reporting purposes. I have interestingly found that Rather than pts having to deal with this palava, that they then contact the pharmacy back to say they miraculously found the item {DISCLAIMER} its not often that happens though
                I come across A LOT of patients who fall into this category. From what I can surmise, said patient simply does not want to bother looking for the meds (which are probably sitting in a glove compartment in their car) or the spouse has helpfully picked it up and stored it away without their knowledge. I recently did a 4 month long stint as a locum in a pharmacy and became remarkably good at remembering who received what and when. Some of my helpful tips would be to:

                1) Ask the patient to return all the meds, just like what you said.

                2) Mentally train yourself to recall what you put in the bag. This is easier than it sounds. When bagging I take a few seconds to think about how I will arrange the items in the bag to fit as neatly as possible and I always bag starting with bulkier items at the bottom. This subconsciously lets me remember at least some of the items. Patients with unusual names also stand out in my mind, as do less commonly dispensed lines (some of which might be ordered in only as required).

                3) For deliveries, I often use delivery sheets on which I note down how many items were in the bag, plus a space for the patient to sign, also a space for us to make notes of interest e.g. if the bag contains diazepam.

                4) Keep a log of dosette boxes being handed out, for people to sign when collecting.

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