The Pharmaceutical Journal Vol 267 No 7157 p87-88
July 21, 2001

  Self-checking
  Consent
  PGDs
  CPD

Self-checking

Need for independent accuracy check

From Mr J. Hall, FRPharmS

I am concerned that self-checking is being promoted by certain members of the Royal Pharmaceutical Society’s Council. I take issue with Andrew Burr’s assumption that operating procedures somehow remove the risk of errors associated with self-checking (PJ, 7 July, p10). Having read the “Broad Spectrum” article by Anthony Cox and John Marriott (PJ, 16 June, p814), I had hoped that pharmacists would accept that an independent accuracy check should form a central part of the dispensing process regardless of the status of the “dispenser”. I welcome the fact that we are debating the subject of supervision and ways in which pharmacists’ time can be released to use their skills but I believe that the recent debate has taken on an impetus that could lead to unsafe practices and a leap into the dark. It is clear from the discussion in “Broad Spectrum” that there is evidence that independent checks act as a defence against errors. This evidence has come from comparisons of errors in pharmacist dispensing. No evidence is being cited to assert that the situation is any different with self-checking by technicians. How can we contemplate self-checking in the light of this evidence?

Somehow the argument for the “checking technician” role in community pharmacy is being interpreted as a cry for self-checking by technical staff. The article by Zoë Gross (PJ, 7 July, p10) would suggest that this is being actively considered by the Society. We need to develop this new role to release pharmacist time but not at the expense of safety. We should be honest and accept that errors can happen, whoever is dispensing, and that if independent checks minimise errors then they should form an important part of our standard operating procedure for dispensing.

The challenge is to document the professional check in such a way that we are not involved in checking and rechecking repeat prescriptions month after month with no end-point. This will be facilitated by better IT and more disciplined electronic record keeping. This will allow us to organise work better and we will be better equipped to review medication as part of a structured programme rather than at the time of dispensing. Hospital pharmacy moved forward when problems were solved at source (ie, ward level) rather than in the dispensary. Many clinical governance issues surround the dispensing process. Some will be better managed by technicians, others will require a pharmacist’s input.

The debate has just begun. Do not let us pretend that any of us have the solution. I would encourage members to complete the questionnaire (PJ, July 7, p11) on self-checking and opt to make an independent accuracy the rule rather than the exception.

John Hall
Director, Dixon and Hall Ltd,
Stanley, Co Durham

A question of professionalism

From Mr P. R. Rodwell, MRPharmS

I fully support the suggestion that we delegate more to our technicians. I try to do this as much as possible. However, one thing that stops me delegating a task which may lead to injury to a patient if carried out incorrectly is a fear of loss of my livelihood because of someone else’s actions. I am happy for a technician to deal with a dressings prescription with no input from me, but I would not allow a medicine to leave the dispensary without me carrying out the final check. Why? Because if the drug is wrong the patient could die and I could be struck off.

If we allow technicians to self-check, is it right that we are the ones accountable for their actions? If so, is it wise for a pharmacist to allow a prescription for a medicine to reach the patient without a final check by a pharmacist? Anyone can make an error, but if I as the pharmacist do not have the opportunity of finding that error before it reaches the patient then I would feel very uncomfortable and would question my professionalism.

By all means allow technicians to self-check their work if they are capable, but make them accountable and liable for their actions, not the pharmacist.

If we are not careful we will delegate ourselves out of a job, allow others to check their own work and still have to take the legal liabilities for someone else’s actions (if that is possible).

Paul Rodwell
Wallingford, Oxfordshire

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