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Out of hours
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Out of hours
Is it good or bad for pharmacy?
From Mr K. M. J. Tull, MRPharmS
A caller rings the out-of-hours service at 6.10pm and connects to the
Birmingham call centre, which, in theory, contacts the local doctor in
Hereford. However, recently, this service was busy so the “prime
objective” of the out-of-hours service came into force, which is
to get a doctor to speak to the patient as soon as possible. The call
was then diverted to a less busy out-of-hours doctor, based in Southampton.
The caller needed advice on the fact that her son had run out of his
anti-schizophrenic medicines, on which he had just been stabilised.
The doctor then had to find a pharmacy open at this time in Hereford,
succeeding at 8.10pm in locating us. The drugs in question were a tricyclic
antidepressant and olanzapine. An exchange then took place between the
experienced locum and the Southampton doctor: “Who are you and
how do I know that you are a doctor?”
They came to a compromise and decided that an emergency supply could
be dispensed, provided the patient’s mother came back the next
day with a prescription for the medicines. Luckily, she did, even though
this required two journeys of 40 miles each. The next day a standard
operating procedure was developed to deal with this scenario in future.
From now on if the out-of-hours service rings us, we require a fax to
prove the existence of a prescription. However we still have a few problems:
1. How do we know that the doctor is who he says he is, since we do
not have proof of signature? Do we now have to have a copy of every doctor’s
signature in the country to confirm this?
2. How do we know if an out-of-hours service prescription pad has been
stolen, since a prescription could now come from anywhere in the country?
3. The ‘Medicines, ethics and practice’ guide (Number 27,
p11) states that the original of a faxed prescription must be at the
pharmacy in a short period of time? What period of time is that?
4. Now that the prime objective of an out-of-hours service is to get
a doctor and patient together as fast as possible, does the emergency
supply at the request of a patient discontinue? Do I just give the patient
the NHS number and tell them to ring it?
I think all late night pharmacies should be aware of the legality of
these prescriptions in order to protect themselves.
Jethroe Tull
Hereford
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Lynsey Balmer, pharmacist adviser, professional standards directorate,
Royal Pharmaceutical Society, replies:
I will deal with each of
the issues Mr Tull has raised in turn:
1. Pharmacists are expected to take steps to confirm the credentials
of any practitioner not known to them. Pharmacists can telephone
the General Medical Council on 020 7915 3630 to confirm that a
doctor is registered. This number provides a 24-hour automated
fax back service; the doctor’s GMC number is required.
2. Pharmacists should take all reasonable steps available to satisfy themselves
that a prescription is genuine. It is recognised that it may be more difficult
to conduct relevant checks outside the normal working day and in the absence
of evidence to suggest a prescription is not genuine, pharmacists may decide
to dispense it in good faith. Pharmacists should not, however, dispense any
prescription that they believe to be forged.
3. Pharmacists should only supply prescription-only medicines against a legally
valid prescription or in an emergency, provided certain conditions are satisfied.
A fax is not a legally valid prescription since it is not written in indelible
ink or signed by the practitioner. A fax can, however, confirm a valid prescription
is in existence. If a pharmacist decides to supply a prescription-only medicine
before receiving a valid prescription, the supply would need to satisfy the
requirements of an emergency supply and a record should be made in the prescription
register. An emergency supply at the request of a practitioner requires the
prescriber to furnish a prescription within 72 hours.
4. There is a provision in legislation for pharmacists to make an emergency
supply of prescription-only medicines at the request of a patient. Pharmacists
would need to make a professional decision as to whether it is in the patient’s
best interests to make an emergency supply or to refer him or her to a medical
practitioner. The decision would depend on factors such as the medication required
and accessibility to a medical practitioner. |
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