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Dispensing
Who is responsible for supplying dispensed medicines?
From Mr R. Gartside, FRPharmS
Jackie Giltrow’s article (PJ, 3 July, p35) is excellent in explaining
the current state of the law on accountability and responsibility for
dispensed medicines. However, it takes no account of the changes in practice
needed to cope with ever-increasing prescription numbers and increasingly
complex treatment regimens. What works well at 100 prescriptions per
day may be completely impracticable at five or 10 times that level of
activity.
It is commonplace for a locum pharmacist to come into a pharmacy first
thing in the morning and find several hundred prescriptions bagged up
and ready for collection by patients. It simply is not practical to open
all these bags and carry out clinical and accuracy checks. Indeed, it
is arguable that the clinical check can only be carried out with full
access to the patient’s medication record.
The alternative is to have technicians put up the prescriptions without
reference to the pharmacist and then for the pharmacist to carry out
the clinical and accuracy checks at the moment that the medicine is handed
to the patient. Promising trials of such an operating procedure are under
way in a number of areas. There remains, however, the problem that patient
flow is not uniform through the day and that at some periods this procedure
may involve the patient in a wait of an extra quarter to half an hour.
If the patient has left the prescription for later collection this extra
delay is simply not acceptable but carrying out the clinical and final
checks in expectation of the patient’s return may well result in
the medicines remaining on the shelf for handing out under the supervision
of tomorrow’s pharmacist — the very situation this operating
procedure is intended to avoid.
There are also severe problems with “owing” prescriptions
where good practice is presently to make these up as the remainder of
the medicine becomes available, since delaying this until the patient
arrives for the remainder results, again, in delays that are unacceptable
to the patient and interfere with the smooth flow of work by the staff.
The conclusion is inescapable. If we are to cope with the ever-increasing
torrent of prescriptions there must be provision for them to be completed
at a steady pace throughout the working day and for the approved medicines
to be stored ready for collection. This must mean the invention of a
mechanism by which the dispensing pharmacist takes full responsibility
rather than the present, frankly unworkable, position where the pharmacist
who happens to be present when the medicines are handed to the patient
takes full responsibility for medicines that they have not dispensed.
It cannot be beyond the wit of man to devise a system in which sealed,
tamper-evident, packs of prescribed medicines are produced under the
supervision of a professional who takes full responsibility for the clinical
and accuracy checks on the contents. If this means a change in the law,
then that must be obtained and one would hope that this would be easier
for a body which is both the regulator and the representative of the
profession.
Bob Gartside
Caernarfon,
Gwynedd
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The
Pharmaceutical Journal