Under my question I expect nice answers. The most important is that our patients do not receive inappropriate prescriptions and therefore prescribing process should be highlighted and a communication between both profiles should be applied, before medical are dispensed. In many hospitals worldwide, where they do not have the clinical pharmacists there is a big lack in this process.
TX Pardis,
You mean this process is enough safe to protect patients from contraindicated drug drug combination and serious medical error?
Regards,
Mathew
If you are a healthcare worker as pharmacists are here you have the responsibility to fix any medical error on the prescription. As I see it there are three possibilities, you fix it on the spot based on your judgement, previous dispensing data on your patient or simply by talking to the patient. After you do this you could inform the prescriber about your intervention but my experience is that this is often not done.
Secondly you contact the prescriber, explain the problem and any suggestions to how to fix it. This would be for more serious and ambigious errors on the prescription where you can not be sure what is the best way forward. The prescriber either listens to you and change the Rx or he confirms what he has written, you then either write down in your system that prescriber has been contacted and you dispense or you should if you really think there is a significant risk of harm not dispense.
Third possibility would be if prescriber can not be reached and you can not resolve the problem yourself you simply deny dispensing the Rx. You of course need to explain a patient this and be service minded and offer to try again to contact the prescriber, but in the end it is your decision (this would not apply to things like insulin or antipsycotics where the patient should not be left without medicines).
My point is this: as a pharmacist you need to be aware of your responsibility to your customer/patient, and resolving medication errors of different kind is the most important thing you can do for them.
True for myself and all students I am training: we absolutely always encourage follow-up on medical errors noticed on prescriptions. This applies to calculation errors, but also to errors unforeseen by the respective prescriber, such as a drug-drug or drug-disease interaction. The prescriber may very well not be aware of another drug being prescribed by someone else, to the same patient, for a different condition. Here I very much agree with my colleague Pardis Td - it very much depends on the country system and legislation. Ideally, the pharmacist should have a database of all dispensed drugs for the same patient, assuming the patient fills all the prescriptions at the same pharmacy.
More recently, clinical approaches in continuing education allows pharmacist to improve outcomes from a huge variety of perspectives that may interfere with filling a certain new prescription. Instances like undiagnosed/untreated anemia or dehydration or noticing a lower dose of say levofloxacin (eg 250mg) can hint to potential ongoing poor renal function in a patient that otherwise is prescribed a regular dose of another renally-cleared drug. Not to mention how important is to identify early a new treatment that addresses a side effect of another drug. I encountered way too many times now the case of the levotyroxine taken (wrongly!) at BEDTIME and followed soon by over-the-counter or prescribed sleeping aids for insomnia (!!!).
Opportunities for treatment improvement are ENDLESS. There is so much more the pharmacists can and should do! To come back to the actual question: do not drop the ball, someone's live depends on what the pharmacist decides to do in that instance. Be better safe than sorry!
Thanks for this interesting talk. I highly agree with all answers. To sum up, more actions are necessary in this field, especially communication between different care providers is needed and pharmacists must not dispense medical, where medical error is evident. In many countries worldwide is seen different story, the pharmacists dispense medicals, what is prescribed (although there are several medical errors in the prescriptions). Thid process should be monitored more clearly and more teamwork should be applied.
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