From Mr J. S. Fawdry, MRPharmS
SIR,-As a pharmacist responsible for a specials manufacturing company, the recent peppermint water case (PJ, March 11, p390) is very close to my heart. I feel sorrow for the parents who lost a child and have reminded all my staff why we have our procedures and the vital necessity of following them. I also have great sympathy for the two professionals who made a mistake.
With the current emphasis on clinical governance, the resulting debate over extemporaneous dispensing has touched a very raw nerve across the profession with comments over what our training should cover, what competences we should expect from practising professionals and pleas for recognition that we all make mistakes.
Kylla Patterson (PJ, April 1, p512) says we must learn from these mistakes and I agree strongly with this. However, she also observes that a correspondent might need to consult his Martindale rather than use a specials manufacturer. I would point out that the current Martindale contains no formulae, unlike predecessors, and hence would be of little help.
As to using a specials manufacturer, there may be a few Drug Tariff lines where this may be inappropriate. However, a huge number of pharmacists use us as an ethical alternative to DIY, especially following this case.
As a professional I would defend the right of the pharmacist to dispense extemporaneously. As a patient and consumer, I would expect current practice to ensure:
If surgeons, in the light of the Bristol Royal infirmary cases, are now prepared to refer on unusual surgical procedures to specialist centres, we as a pharmacy profession need to think very carefully over how we deal with items that are out of the ordinary. We must be confident that we have dependable procedures in place to deal with them, whether taking the route of delegation to a specials manufacturer or the option of checking in the text books. Nostalgia is not an option.
Jonathan Fawdry
Director and General Manager, Eldon Laboratories, Newcastle upon Tyne