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Patients’ confidence in their pharmacists is an essential part of community pharmacy. It is this trust which plays a significant part in reducing some of the life threatening and circumstantial dispensing errors. The key to this confidence depends upon communal respect, courtesy, close working relationships and good counselling techniques (PJ,
14 August, p220). Counselling, where pharmacy staff provide patients
with appropriate
information about their medicines and about disease prevention, encourages
patients to have confidence in their pharmacist. When patients’ confidence
in their pharmacist is low, compliance problems may result which may
increase hospital admissions.
Recently a serious error was highlighted when an 88-year-old woman brought
back nine Subutex tablets to the pharmacist, whom she confided in. These
tablets had been wrongly dispensed to her by a distracted pharmacist.
She waited four days to talk to her usual pharmacist because he only
worked part time. This woman lived with her daughter-in-law and six grandchildren;
two of her grandchildren were drug addicts and one of them was on Subutex
for treatment. This patient suffered with asthma, hypertension, diabetes
and high cholesterol. She said that she found the Subutex 8mg tablets
larger than her normal tablets for the above ailments and waited four
days to consult her trusted pharmacist before taking them. Due to the
patient’s reliance on her pharmacist’s advice she prevented
the Subutex tablets falling into the wrong hands, for example her grandchildren.
If she had swallowed a few of the Subutex tablets she could have died
due to respiratory failure caused by a reaction with her hypertensive
drug. This is a prime example of how dispensing errors can have serious
and sometimes tragic consequences and these errors may occur frequently
in a busy pharmacy.
Another classic source of errors is the doctor’s surgery. An error
of this sort was brought to my attention when two patients of the same
name, similar age and ethnicity, who lived in the same area, had their
repeat prescriptions mixed up. The two patients even had similar ailments
which were diabetes, hypertension, etc, and both received seven drugs.
There was only one drug which was different between the two patients,
one patient was taking Ikorel and the other was taking Persantin. The
patients were issued with their repeat prescriptions within three days
of each other from their doctor’s surgery. One patient went to
his regular pharmacy where he had developed confidence in his pharmacist
and the other patient chose to pick a pharmacy at random. It is interesting
to note that the patient who stuck to his regular pharmacy went back
to his pharmacist to enquire why he had received Persantin instead of
his usual Ikorel tablets. The pharmacist who dispensed his medicines
was working as a locum and could not sort out his problem; he sent him
back to his doctor’s surgery saying that he had dispensed the prescription
correctly. In this difficult situation it was fortunate that the regular
pharmacist returned from his holiday and solved the problem by informing
the respective surgery that they had given the wrong repeat prescription
to the patient concerned.
To conclude, patients’ confidence in their pharmacist is important
in reducing the risk of dispensing and circumstantial errors. We should
adopt a standard operational procedure to ensure safety, accuracy and
efficiency when dispensing medicines to our patients. This may be achieved
by avoiding unnecessary distractions.
— Contributed
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The
Pharmaceutical Journal