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Letters to the Editor
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Standard operating procedures
Our patients deserve no less
From Mrs K. F. Marriott, MRPharmS and Dr D. M. Naylor, MRPharmS
We write on behalf of the Yorkshire hospital pharmacists medication
safety group, a working group that carries out research and development
into safety of medicines on behalf of chief pharmacists in Yorkshire.
The Broad spectrum
on standard operating procedures by Peter Armstrong
(PJ, 4 March, p262) cannot go unchallenged. Our research into dispensing
errors that are made in hospital pharmacies invariably shows that these
errors would not have been made if SOPs for dispensing medicines had
been followed. Errors are analysed according to set standards and measures
taken to re-educate ourselves and other staff on good practice. Safe
dispensing practice will be achieved by creating a culture in which we
all adhere to standards for dispensing processes documented in SOPs that
are continually updated and revised as a result of learning from error.
This is the lesson to be learnt from the airline and pharmaceutical industries,
which have transformed their safety records by implementing universal
working practices in accordance with SOPs.
It is a fortunate pharmacist who has never had to deal with the consequences
of a dispensing error. A target of zero error may seem impossible but
would be achieved if everyone played their part in drawing up, following,
reviewing and revising SOPs. Our patients deserve no less.
Kay Marriott
Chairman
Deirdre Naylor
Secretary
Yorkshire Hospital Pharmacists Medication Safety Group
Bradford Teaching Hospitals NHS Foundation Trust
Not suitable for the non-linear, interactive dispensary process
From Ms U. A. Patel, MRPharmS
At last a community pharmacist has the courage to publish his views
on standard operating procedures (PJ, 4 March, Broad spectrum, p262).
SOPs are not suitable for the non-linear, interactive process that takes
place in the dispensary. SOPs or checklists have a place in an environment
where there is a rigid linear process, eg, on the flight deck of an aircraft.
A pilot will use checklists for various tasks to do with starting the
engine, taking off and landing, etc. These checklists are used for the
mechanical set-up of instruments and equipment on board. Even in this
environment, investigation of malfunctions using checklists has caused
spectacular crashes. There is no checklist for the actual process of
flying. That is learnt and is in the pilot’s head.
Similarly in the dispensary we can have a checklist for checking equipment,
etc, but the actual process is learnt and is in the pharmacist’s
head.
Is the dentist obliged to have a SOP for pulling out a tooth and does
the surgeon have a SOP for removing an appendix?
Uma Patel
Cranford,
Middlesex
Are SOPs good for the profession?
From Dr I. Ab I. Davies, MRPharmS
I have been wondering how long it would be before the subject
of standard operating procedures would be aired in the PJ (4 March, p262).
In the mid 19th century, Jacob Bell saw fit to dissociate the compounding
and dispensing of medicinal preparations for the treatment of human ailments,
from the practice of physicians and founded the Pharmaceutical Society.
During the succeeding century or so, the Society defined the syllabus
and monitored the pharmaceutical chemist qualifying examination which,
together with a suitable apprenticeship, were the sole requirements for
registering as a member of the Society. During those years, pharmacists
would frequently be asked to “make up a bottle” to treat
an ailment (counter prescribing). After suitable interrogation of the
patient to ascertain the nature, severity and duration of the symptoms,
the pharmacist would concoct an appropriate preparation from basic materials
(tinctures, extracts, powders, etc).
In the mid 1960s, the Society decided that pharmacy should be a graduate
profession and made an undergraduate degree, together with preregistration
training, the sole requirement for registration with the Society. Subsequent
events saw the demise of counter prescribing and the response to remedies
is now reduced to the recommendation of an appropriate proprietary preparation.
I do wonder how much of the placebo effect, relative to counter prescribing,
is lost in this change. The preparation of individual, unique pharmacy
preparations is now frowned upon, if not proscribed.
In the late 1990s the academic requirement for registration was elevated
to what has hitherto been regarded as a postgraduate qualification: a
master’s degree in pharmacy. Despite this high academic qualification,
it would appear that the professional qualities of pharmacists can no
longer be relied upon. Extemporaneous dispensing would appear to be taboo.
Every activity must now have an appropriate SOP to which pharmacists
and their staff should adhere. No doubt, deviation from these SOPs will,
in the fullness of time, incur a penalty.
I wonder how long it will be before SOPs are required to be attached
to the inside of the toilet door to ensure that normal bodily functions
are carried out in a standard, regulated and assured manner.
Iolo Davies
Ballygowan, Northern Ireland
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The
Pharmaceutical Journal