The Pharmaceutical Journal
Vol 280 No 7503 p624-625
24 May 2008

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• New professional body
• Fitness to practise
• Medicines use reviews (MURs)
• Workload
• Disciplinary procedures
• Ergocalciferol
• Furosemide
• Ophthalmology

Letters to the Editor

Disciplinary procedures

Who is responsible for errors induced by excessive workload?

From Mr M. R. Sadak, MRPharmS

In its comment on referral of pharmacists to the Society’s Investigating Committee the Guild of Healthcare Pharmacists (PJ, 3 May 2008, p528) stated it should occur in cases involving “recklessness, harm or financial gain”. It would be nice if the guild elaborated its stance further.

We are aware of staff shortages and working time directives being violated in the NHS and staff being forced to or bullied to work without proper breaks, with no overtime payments or time off in lieu, to meet budgetary targets.

If dispensing errors were to occur in this environment and patients harmed, would the pharmacist who made the error or the chief pharmacist who could be said to knowingly and recklessly allow this to happen be held responsible and referred to the investigating committee?

With regards to financial gain, most hospital pharmacies have formularies in place to restrict the use or supply of high-cost drugs. Changing the therapy of an inpatient could occur without full knowledge of the patient’s clinical history and could be used to justify cost savings by senior pharmacy managers exceeding budgetary targets.

If such changes were forced on staff, would senior managers be held accountable as, arguably, this constitutes financial gain?

In addition, following the High Court decision to overturn the National Institute for Health and Clinical Excellence’s refusal to supply dementia drugs, could drugs and therapeutics committees or members and formulary pharmacists be held legally responsible for decisions not to supply medicines on the basis of cost and where this means patient care is compromised?

The guild wants referrals for not supplying patient information leaflets, but we live in a technological age where these can be accessed online. If patients are referred to this website how could not supplying an information leaflet automatically trigger referral?

One could argue that not all patients know how to access the internet but how many patients know how to read or are bothered about reading leaflets? In addition, if less paper were generated would this not bolster pharmacy’s “green” credentials?

The referral on “refusal to supply an emergency supply of a POM” needs clarification because refusal might not always result in patient harm. But it could result in abuse by senior pharmacy managers who might expect on-call pharmacists to respond to each call for medication, even though not justifiable.

This could result in violation of the European Working Time Directive and potential dispensing errors through tiredness. Who will be held responsible then?

Mohamed Riza Sadak
Milton Keynes, Buckinghamshire

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