The Pharmaceutical Journal
Vol 280 No 7487 p118
2 February 2008

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• Clarke Inquiry (2)
• New professional body
• The Society (2)
• Community pharmacy (2)
• Pharmacy practice
• Technicians
• The industry
• WCPPE
• Drug addiction
• Research

Letters to the Editor

Community pharmacy

ETP and possible sources of error

From Mrs S. D. Roberts, MRPharmS

Since going live with electronic transfer of prescriptions it has become obvious that the doses and instructions entered on the prescription by the prescriber are often ambiguous, inelegant or wrong and need to be edited by the dispenser before labelling the medicines. Traditionally, with a repeat prescription, pharmacies would make this correction once and then repeat the corrected label at each dispensing.

With ETP the dose recorded on the spine is that entered by the prescriber and cannot be altered permanently by the dispenser. Hence changes have to be made at each dispensing, slowing down the process and creating a potentially new source of errors.

Examples of instances where changes have to be made are:

• Dose written in figures not words, eg, “5” instead of “five” could easily be misread as a 6 or 8 and could be potentially serious (best practice is always to write numbers on labels as words)

• Dose or instructions are ambiguous and may confuse patient

• Dose is clinically inappropriate, eg, furosemide: one to be taken at night

• Spelling and typographical errors

We recently conducted an audit on the number of such changes which needed to be made over one week. Twenty-six per cent of all ETP prescriptions needed to be altered in some way, a figure which reduced to 20 per cent on reauditing after sending the GPs copies of each prescription that had to be changed. Most changes were trivial, but still time consuming and a source of irritation and possibly a new source of errors.

At a conservative two minutes to deal with each change this represents an increase in workload of eight hours per week in this pharmacy, negating gains made by running the electronic system. (Strictly speaking each change is an intervention and should be recorded and the prescriber notified, but that way madness lies.)

Why is the system only one way? Could the prescriber not be contacted via the spine and told, for example, “dispenser has changed dose from ‘1n’ to ‘One to be taken each morning’, do you agree?” so that the actual dose on the label of the dispensed medicine is recorded. This would then be changed on the patient record so that repeat prescriptions would not compound the error and pharmacy would regain some control over dispensing.

Sarah Roberts
Roberts Chemists Ltd
Wareham, Dorset

100-hour pharmacies mean bleak outlook for independents

From Mr J. R. Ahmed, MRPharmS

I have recently been informed by Birmingham East and North Primary Care Trust that there are now, or are ready to open, seven 100-hour pharmacies in this area. This proves how ridiculous the legislation is that has brought about this situation.

The PCT is helpless to stop them opening and frustrated that it is not able to maintain and enhance the existing pharmacy outlets to the betterment of the local communities because of the problems in sorting out these unnecessary 100-hour leapfroggers.

Those opening these establishments know full well that they are not needed or desirable but are taking advantage of our Pharmaceutical Services Negotiating Committee “negotiators”, who should have known the consequences of their failure to stop the supermarkets from pressuring the Government and bringing about these unsettling changes to a once stable pharmacy market.

I cannot and will not invest more of my own money into my business knowing that I have little control on where my prescriptions are coming from; I have no secure long-term financial future. My practice payment is under threat if I fall below the threshold, so is the PSNC going to look at this or am I going to be thrown to the dogs (or, more appropriately, the frogs)? Some patients will put convenience ahead of loyalty so anyone expecting not to be affected by a 100-hour pharmacy had better wake up.

With the supermarkets expanding their 100-hour pharmacies, with internet pharmacies touting for business ahead of the next phase of electronic transmission of prescriptions, my local and independent status is looking bleak. Gone are the days of “support your local pharmacy” and not only is “Alice does not just reside in Wonderland” (PJ, 19 January 2008, p53), and all those organisations that “look after my interests” are living in cloud-cuckoo-land.

I am not a dinosaur, I have invested in a consultation room, I undertake medicines use reviews, and blood pressure, diabetes and cholesterol monitoring. I am accessing bar coded prescriptions, I do prescription collection and delivery, etc, but events are unfolding over which I have no control. So what more can I do?

Another problem is the lack of resources available for the PCT to invest in services. I have been overlooked for funded schemes such as smoking cessation, pregnancy testing and minor ailments. Funds are being given to my competitors and I am left with a diminishing income. (For example, I am no longer able to sell nicotine replacement patches because others are giving them out free.)

Multiples have the resources to promote themselves to PCTs and I cannot compete with them. I know PCTs has limitations on the funds available but a level playing field would be a start.

Jawaid Ahmed
Birmingham

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