It's a topical subject in the week that a London pharmacist was given a suspended jail sentence for being the pharmacist in charge of a pharmacy where a dispensing error occured and whilst the coroner ruled that the taking of some tablets which were dispensed in error did not contribute to the patient's death, the pharmacist was nevertheless prosecuted, I came accross a story of where a dispensing error improved a patient's health and well-being.
The story goes that a patient who always used the same pharmacy had been refused a repeat prescription by their surgery on the grounds that they should still have another month's medication. The patient insisted they had run out of the medication and further discussion led to the suggestion that at the time of dispensing, a dose reduction to half the previous dose had been made on the prescription, but missed whilst dispensing and the former dose had been repeated from the pateint medication record.
The surgery had reported the incident to the pharmacy, who verified that the medication had been incorrectly labelled at the former dose. Meanwhile, the patient was checked out by the doctor, who carried out blood tests and examination of the patient. The doctor's conclusion was that the patient was far better on the higher dose of medication, despite the dispensing error, and forthwith the patient was to remain on the higher dose after all.
The patient declared themselves very happy with the outcome and even thanked the pharmacist concerned for their error, which had resulted in an improvement in their wellbeing. This is a true story. The circumstances have been left vague to protect identities of all concerned.
Should the pharmacist be prosecuted, jailed, fined or given a pat on the back? As many a collegaue has echoed their feelings this week, there but for the grace of God go I.
Thursday 16 April 2009
Wednesday 15 April 2009
Is that a date, then?
I recently worked a Saturday at a pharmacy that had a branch close by - let's just say it was one of the many multiples. There were only the two pharmacies in the town. The afternoon became fairly quiet and the staff decided to have a grumble about the previous week's events. It seemed that they had been provided with a second pharmacist from abroad (European Union national, to narrow it down a bit), who had been trained up to what was deemed UK standard and was taking over the other branch as pharmacist/manager the Monday following.
The pharmacist had taken it upon herself to completely rearrange the dispensary (which had been in it's existing layout for some years) so that "it would be easier to find things" and that "any locum will be able to find stock easily". This included moving a set of shelves containing "fast moving lines" from immediately next to the computer and main dispensing area and arranging a shelf five inches deep and with around four inches clearance between it and the shelf above as a "checking area". Now either the locals get very small sized items round there, or it had escaped the pharmacists' notice that rarely used items e.g. 500ml Lactulose, 500g Aqueous Cream etc, would not fit in this gap. No matter, no contingency plan, no sense, no point. Apparently, soneone at head office said it was they way to do things, so that is how things were to be done. It didn't work, but that was not the point.
For most of the day, nobody could find anything in the drawer system, despite the improvement aimed at making my (the locum's) life easier, it was a nightmare trying to find anything at all. That applied equally to myself as well as the staff who had worked there for some years.
What did concern me most was not that the pharmacists concerned had carried out this wholesale rearrangement of the dispensary oblivious to the concerns of the staff who would have to continue to work with the mess she'd made after she'd gone. That was just plain bad manners and arrogance. No, the worst bit was that during the course of he day I picked out from this recently handled stock over two hundred (yes, 200) different items, all of which were out of date. This pharmacist was supernumary, there had been locums in all of the week, so she had not had to bother getting involved in the day to day work.
Now, if you've taken it upon yourself to move every single pack, bottle or item of stock during the whole of the previous week, yet managed to "overlook" so may out of date items (that ignores items which would become out of date very shortly, since I didn't have the time to be as thorough as I would have wished), what on earth is your checking process for dispensed items like? Don't you check the expiry date when checking, don't you have a date checking rota and/or matrix to assist, don't you simply take the job seriously enough to do some of the basics?
By now, this pharmacist, whom I have never met and do not know, is running a fairly busy pharmacy wihtout any scrutiny other than the RPSGB inspectorate making their routine visits. If she doesn't pay attention to date checking, what else does she not pay attention to? This is surely a fundamental failure of training as well as attitude - do you really need the length of training we now require to understand the importance of expiryr and use before dates on medication? It's not rocket science, after all. But then, there lies the nub of it - if the building blocks are not in place, what happens when the rocket tries to lift off?
The pharmacist had taken it upon herself to completely rearrange the dispensary (which had been in it's existing layout for some years) so that "it would be easier to find things" and that "any locum will be able to find stock easily". This included moving a set of shelves containing "fast moving lines" from immediately next to the computer and main dispensing area and arranging a shelf five inches deep and with around four inches clearance between it and the shelf above as a "checking area". Now either the locals get very small sized items round there, or it had escaped the pharmacists' notice that rarely used items e.g. 500ml Lactulose, 500g Aqueous Cream etc, would not fit in this gap. No matter, no contingency plan, no sense, no point. Apparently, soneone at head office said it was they way to do things, so that is how things were to be done. It didn't work, but that was not the point.
For most of the day, nobody could find anything in the drawer system, despite the improvement aimed at making my (the locum's) life easier, it was a nightmare trying to find anything at all. That applied equally to myself as well as the staff who had worked there for some years.
What did concern me most was not that the pharmacists concerned had carried out this wholesale rearrangement of the dispensary oblivious to the concerns of the staff who would have to continue to work with the mess she'd made after she'd gone. That was just plain bad manners and arrogance. No, the worst bit was that during the course of he day I picked out from this recently handled stock over two hundred (yes, 200) different items, all of which were out of date. This pharmacist was supernumary, there had been locums in all of the week, so she had not had to bother getting involved in the day to day work.
Now, if you've taken it upon yourself to move every single pack, bottle or item of stock during the whole of the previous week, yet managed to "overlook" so may out of date items (that ignores items which would become out of date very shortly, since I didn't have the time to be as thorough as I would have wished), what on earth is your checking process for dispensed items like? Don't you check the expiry date when checking, don't you have a date checking rota and/or matrix to assist, don't you simply take the job seriously enough to do some of the basics?
By now, this pharmacist, whom I have never met and do not know, is running a fairly busy pharmacy wihtout any scrutiny other than the RPSGB inspectorate making their routine visits. If she doesn't pay attention to date checking, what else does she not pay attention to? This is surely a fundamental failure of training as well as attitude - do you really need the length of training we now require to understand the importance of expiryr and use before dates on medication? It's not rocket science, after all. But then, there lies the nub of it - if the building blocks are not in place, what happens when the rocket tries to lift off?
Wednesday 1 April 2009
CPD (Childish Piffling Details)
Don't misunderstand me. I think it's right and proper that we all keep our skills and knowledge up to date and constantly assess our performance on a regular basis. Hey, I'm no saint, the halo slips from time to time, and I don't do every single CPPE course that comes along, as they don't always have relevance to my area of work.
I have a friend/colleague who works in such a rare area of pharmacy that there is no formal CPD to work from. His area is so specialised that if anyone was to write a course on it, it would have to be him because nobody else does what he does. Who would mark it, assess it or verify that it was appropriate to his needs? Well, maybe his clients and customers. If they were dissatisfied with his performance, they would vote with their feet (well, to be precise, their orders and cheque books).
The CPD isn't the issue. It's how to record something which has no rule book? It's easy to record how you've had a bright idea and discussed it with Mary, your regular locum over a coffee break, and realised that you should make some notes to bring up at the next meeting. If someone wants an answer right now or you are going to lose your order and therefore your income, you need to find out the answer correctly, first time and quickly. Otherwise, kiss your order goodbye! So how do you record it?
The problem seems to be with those who are charged with regulating us. They need to be able to tick the boxes which say "Evidence submitted? Y/N". It's a pass or fail with no quality control built in. Are you really a better pharmacist because you've done a course about "Getting your 5 a day" when you don't work in a sector which deals with patients at that level? I don't think so. What do you think? Answers allowed to the Blog, or why not start a thread on the Forum? Go to the web site www.locumpharmacistuk.com and click on the link to The Forum. Have your say instead of grumbling to yourself like I do on this blog. I'm not always right, just most of the time!
I have a friend/colleague who works in such a rare area of pharmacy that there is no formal CPD to work from. His area is so specialised that if anyone was to write a course on it, it would have to be him because nobody else does what he does. Who would mark it, assess it or verify that it was appropriate to his needs? Well, maybe his clients and customers. If they were dissatisfied with his performance, they would vote with their feet (well, to be precise, their orders and cheque books).
The CPD isn't the issue. It's how to record something which has no rule book? It's easy to record how you've had a bright idea and discussed it with Mary, your regular locum over a coffee break, and realised that you should make some notes to bring up at the next meeting. If someone wants an answer right now or you are going to lose your order and therefore your income, you need to find out the answer correctly, first time and quickly. Otherwise, kiss your order goodbye! So how do you record it?
The problem seems to be with those who are charged with regulating us. They need to be able to tick the boxes which say "Evidence submitted? Y/N". It's a pass or fail with no quality control built in. Are you really a better pharmacist because you've done a course about "Getting your 5 a day" when you don't work in a sector which deals with patients at that level? I don't think so. What do you think? Answers allowed to the Blog, or why not start a thread on the Forum? Go to the web site www.locumpharmacistuk.com and click on the link to The Forum. Have your say instead of grumbling to yourself like I do on this blog. I'm not always right, just most of the time!
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