From Mr S. Whitaker, MRPharmS
SIR,—I refer to the recent PJ insert entitled "Guidance for community pharmacies: planning for the millennium holiday", and written by the Professional Standards Directorate of the Royal Pharmaceutical Society.
The insert gives clear advice on action to be taken in the event that a community pharmacist receives an incompletely written prescription for a Controlled Drug. In particular, it reads: "If the patient does not have sufficient medication and where there is no ambiguity concerning the prescribing intentions of the doctor, and there is no possibility of the patient receiving a replacement form, a pharmacist may decide to dispense a small quantity of the prescription to enable the patient to receive continuous treatment until the prescriber can amend the prescription."
This flies in the face of all previous advice from the Society, and seems at last to acknowledge our position in such a situation as professionals who are expert in the use of medicinal products, rather than monkeys trained to supply.
As it happens, I was recently placed in exactly such a situation. I was presented at 1pm with an FP10 for Durogesic patches. Everything was written correctly, apart from the dosage instructions, which were absent. Of course, I know the dosage instructions for that medicine and when I explained my predicament to the patient’s representative, she immediately confirmed the instructions, responding, "Oh, apply one patch every 72 hours, the doctor told me that".
There was a nurse at the house waiting to apply the patch, the patient was desperately in need of it, and the doctor was uncontactable until 4pm. The patient’s representative was begging me to telephone the nurse for confirmation of the dosage instructions, and could not understand why I was not permitted to do so. Indeed, in that kind of situation I am always asked, "Why can’t you just phone the doctor to check?", and treated with total disbelief when I try to explain why I cannot.
Personally, I feel that leaving a patient to suffer in pain for three hours for the sake of a legal technicality fulfils neither my professional nor my ethical obligations. I assume that if I had supplied the medicine, and in view of the recent PJ insert, the Society would have fully supported my actions?
Simon Whitaker
Cardiff
Mrs SUSAN SHARPE (Director of Professional Standards, Royal Pharmaceutical Society) says: In these circumstances, if it were not possible to get the prescription amended in time, I would support the pharmacist making the supply.