From Mr N. P. Stidolph, MRPharmS
SIR,—I have two problems of ethics or at least prudent procedure which may be of interest to other members and which may therefore warrant an answer from the legal department in your columns.
First, there is a practice among a small number of general practitioners to write the name of a proprietary product on a memo slip and give it to the patient with the advice to "go over to the pharmacy and buy a bottle". When presented with such a demand I have got into the habit of retaining the memo and writing it in the prescription book, together with the date and the patient's and the advising doctor's name. It is also entered on the patient medication record. I ask the patient: "Is it for you personally?"
What do readers think the legal position would be if there was a suspected adverse drug reaction and what would the legal department's position be?
Second, in the Portsmouth area the local drug addiction unit has interpreted its funding for "needle exchange" to mean one of "needle supply".
Many of the local community pharmacists have the impression that they are instructed (even obliged) to supply free needle packs on demand without insisting on (or even mentioning) the return of the used needles. When acting as a locum in such establishments I try to insist on the dirty needles being brought back or at least giving the miscreants a long lecture, then listening to the rambling yarn about how they carefully put all dirty needles into a beer can and seal it and put it out of reach of even the most agile child.
This usually has the effect either of them returning dirty needles in future or sneaking in and getting new needles from the assistant while I am counselling another patient. There seems to be no requirement to supervise needle exchange.
Once again, what are we to suppose would be the legal position if a child pricked itself on a dirty needle in a rubbish bag or in an alley and the parents decided to sue the nearest "needle exchange" station, probably the local pharmacy?
What comments has the law department to make regarding the legality and ethics of these situations?
N. P. Stidolph
Portsmouth
Mrs SUSAN SHARPE (the Society's director of professional standards) replies: The pharmacist cannot rely on simply asking the person presenting the memo slip from the general practitioner "is it for you personally?". The pharmacist has an independent professional role to perform, and circumstances relevant to the patient and the medication should be taken into account by the pharmacist when deciding what information he or she needs in order to assess the suitability of the medicine. The same advice would apply where patients visit the pharmacy having contacted NHS Direct. The pharmacist makes the decision whether to supply the medicine requested in these circumstances and should therefore comply with Standard 12 of the Code of Ethics.
Standard 17.5 of the Code provides: "Clients must be encouraged to return used contaminated equipment but clean equipment must not be refused if they omit to do so." The pharmacist's practice relating to supply of needles is therefore entirely consistent with the Code.