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Pharmacies need to be safer


Back when I was young, foolish and incredibly good looking I made many dispensing errors. There you go. I’ve said it.


Pharmacy needs to be safer. And yes that might mean robots. Until then we need to work out if pharmacies are as safe as they can be, under current conditions.


If you have ever worked as a pharmacist you will know the weight of responsibility that comes with signing into the responsible pharmacist register. Just because I’m old and have basically seen it all this feeling never goes away. Step over the threshold each morning and it is your registration on the line. It was always thus for me. No pharmacist ever intends to do a bad job or make an error.


There is no greater feeling of professional vulnerability than when certain aspects of the environment within which you are working are below the standard required to conduct your professional duties safely. If you are the responsible pharmacist in community pharmacy then you are ultimately responsible for the safe and effective running of the community pharmacy on that day. If these factors are outwith your control this can make you feel the pressure acutely.


So is community pharmacy safe enough?




I have over the years been placed in many positions when self-checking was the only realistic option. The tricky thing here for community pharmacists is the relentless focus on hitting the numbers. Self-checking is quick and therefore tempting if the speed of service is being closely tracked. The various emanations of the pharmacy contract has made things tight. And it is definitely getting worse. Very tight staffing levels or errors in planning a rota can lead to occasions whereas the pharmacist you are left with the decision of either causing considerable disruption to the running of the business or just carefully self-check a prescription. In my early years as a pharmacist a million years ago, I am ashamed to say that earlier in my career I bowed to the pressure and fell into this trap, luckily with no negative consequences as a result. The balance of power sits with the employer in this example and unfortunately, they and others are waiting for the employed pharmacist to trip up and make a bad decision perhaps in haste or under pressure.


The PDA position on adequate self-checking is as follows;


“Where pharmacists are directly involved in dispensing, or other processes requiring a high degree of accuracy, a suitably trained and competent member of staff will be readily available in the pharmacy at all times to provide an independent accuracy check. An independent second check improves patient safety by preventing errors.”


I agree with this statement.


Safe staffing


Throughout my career as a pharmacist in community pharmacy staffing was nearly always a concern to me. Juggling budgets and being innovative with making those precious hours stretch beyond what I initially thought possible used to occupy most of my days and nights. Again as an employee, you are not in complete control and no political messaging, usually branded as ‘leadership’, from above about how robustly the investment is distributed can ease this pressure. There may well be community pharmacies out there that are over-resourced and have hours free to carry out important patient-facing activities but I never found them. I have had responsibility for staffing budgets with which to run the pharmacy and ‘hit the numbers’. This was always tricky. There are various models used by a number of companies to share out the investment on staffing in a fair way based basically on how busy your business was. I am no expert in these things but as a user, I always found that the model would rarely fit the locality within which it was deployed. The cliched term is of course ‘one size does not fit all’.


The great crime that happened in the ‘good times’ in community pharmacy over the years was the chronic lack of investment in employee development. The resource invested in medical colleagues, for example, is of a completely different order of magnitude to the investment in community pharmacists and community pharmacy team members. We are now reaping this missed opportunity as times get tough.


The PDA position on adequate safe staffing is as follows;


“Staffing levels will be sufficient to allow all legal, contractual and regulatory obligations to be met; to meet the workload involved in following standard operating procedures and to carry out other work in accordance with the organisation’s expectations. All staff must be suitably trained and competent to carry out the pharmacy work they are involved in. Providing enough suitably trained staff improves patient safety, quality of care and service.”


I agree with this statement.


Access to the pharmacist


The boom years for community pharmacy are long gone. Times are tough and as every day passes our paymasters cripple our network further. In recent years the community pharmacist has taken up much of the slack in the system. Quietly and cheaply seeing many millions of patients on a daily basis. Sign-posting, treating and generally greasing the healthcare system right at the coal face. Access is critical and is most certainly the unique selling point of community pharmacy these days. Out of hours care both medicinal and otherwise is another tremendous opportunity for community pharmacy which they are certainly capitalising on in Scotland.


Patients get scared and many are fearful about their health. This fear is driven by the unknown. As social cohesion in wider society breaks down people need reassurance more than ever and community pharmacists have become one answer to this need. Explaining to a patient that a symptom is to expected or that a side effect of a drug is actually really common are two very simple examples of the vital work community pharmacists do on a daily basis.


In an ideal world, a pharmacist should be physically present but I fear we cannot hold back the tide of progress forever. In the meantime, the statement below is acceptable to me.


The PDA position on adequate rest is as follows;


“A pharmacist is traditionally one of the few healthcare professionals accessible to patients without an appointment. A pharmacist must be available wherever patients expect immediate access to face-to-face expert advice on any medicines-related matters. The pharmacy owner or employer will meet this expectation by ensuring a pharmacist is available to patients and present in the pharmacy throughout its hours of operation. Pharmacists are the experts in medicines and must be present to ensure that medicines provided to patients are safe and appropriate.”


I agree with this statement.


Adequate rest


Break? What’s a break? Lunch? Don’t think so.


I always feel under constant pressure working in a community pharmacy. The direct day to day result of this was that I felt guilty about taking a break basically because I was completely bought into the ethos of the various companies I worked for over the years and didn’t want to let the employer or my family down.


I would rarely have lunch and I can remember vividly that feeling of ravenous hunger that used to hit at around 3 pm in the afternoon after frequently missed lunchtimes. This feeling I think can be traced directly back to that feeling of having to chase the targets. Rest is so important, I see that now but again in my early years as a pharmacist I did everything I could to hit the numbers and one such thing was missing lunch and rarely taking breaks.


The PDA position on adequate rest is as follows;


“Pharmacists must be able to take at least their statutory and contractual breaks and rest periods, and additional breaks as required to meet their professional obligations. Pharmacists will be enabled to take these without interruption and will not be placed under any direct or indirect pressure to forfeit. To keep patients safe, pharmacists must be alert at work.”


I agree with this statement.


Respecting professional judgement


The nub of this issue is the fact that if you step outside a standard operating procedure the employer could easily wash their hands of you. Indeed there have been notable examples in the pharmacy press over the years where the employer has pushed the blame on to the responsible pharmacist because they did not follow the standard operating procedures blindly. In community pharmacy, you are often isolated and often working at the weekend when other services may be shut so professional judgement comes into play relatively frequently. So if as the responsible pharmacist you decide to step outside the standard operating procedure it is open season. Especially I would argue if ‘your face doesn’t fit’.


The PDA position on professional judgement is as follows;


“Pharmacists will be enabled and encouraged to exercise professional decision-making in the workplace, so that patient safety and professional standards can be placed above any commercial or other operational considerations. Organisational and other targets must not inhibit professional autonomy. As health professionals, pharmacists put patients.”


I agree with this statement.


Raising concerns


If you want to commit career suicide then start raising concerns.


“Pharmacists will be able to raise concerns without reprisal or fear. This will be facilitated by a supportive, open and receptive organisational culture. Issues identified will be promptly addressed and robust and enduring solutions implemented without delay. Concerns at work which could impact on patient safety need to be raised and resolved without delay.”


I agree with this statement.


Physically safe


This one speaks for itself.


“Pharmacists will not have to work in the pharmacy alone and will have access to the necessary support at all times to perform their roles. Risks will be assessed and preventive measures put in place so that patients and staff are safe – and can feel safe. A zero-tolerance approach will be taken to violence or abuse of pharmacists and other pharmacy staff.”


I agree with this statement.


The PDA safer pharmacies charter


I think the charter is a really positive idea. I find it very difficult to argue against supporting any of the points raised within the charter. I feel I need to support and endorse this positive work. It’s tough out there and as the cuts keep coming each of the points in the charter will come into ever more stark focus and will result in increased pressure on community pharmacists at the ‘coal-face’.


The Grouchy pharmacist is old and grouchy but does have a big heart and most certainly cares deeply about our great profession of pharmacy.


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