When you hand your prescription in at the pharmacy counter, there is a process to follow. If my colleagues and I don’t follow process and a mistake is made, it’s our careers on the line. We dance with risk every time we step foot in the pharmacy and fear of mistakes keeps us awake at night.
A common theme which community pharmacists find is the impatience of the general public when waiting for a prescription:
‘Can’t you just stick a label on the box and give it to me?’
‘It’ll only be five minutes I’ll wait’
‘Why does it take so long?’
‘I’ve got a bus waiting, hurry up!’
The process of your prescription can be lengthy! It is usually labelled by a dispenser on the computer, picked off of the shelf and stickered and checked by the dispenser and then passed to the pharmacist.
The pharmacist undertakes three main checks:
- Legal Check
- Clinical Check
- Accuracy Check
Legal checks make sure the prescription is, as it says on the tin, legal. Is it in date, does it comply with the rules, is it signed by a genuine prescriber? You’d be surprised, but people try and get away with forgeries. Most pharmacists have come across forgeries and I’ve had experience in referring to the police in the past. Certain drugs are more at risk of being forged and handwritten prescriptions are also a red flag to watch out for.
Clinical checks make sure the doctor/nurse prescriber/dentist/pharmacist prescriber has prescribed medicines appropriately for the patient. This is perhaps the most misunderstood part of being a pharmacist. Just because your doctor is qualified to write prescriptions and knows what medication you take, does not mean that they are an expert in medication or that they are going to prescribe appropriately! The clinical check involves ensuring the medicines are suitable for the patient, their age, their weight, their gender, any allergies and any health conditions they already have (since some medicines can worsen pre-existing conditions). I’ve lost count of how many times I’ve stopped a patient receiving antibiotics they are allergic to “well the doctor KNOWS I’m allergic to penicillin”! It also involves checking the doses of the medicines (often a big risk is children as the doses are commonly weight dependent) to ensure they aren’t too high or in the odd case, too low to be of benefit. “The GP weighed my daughter, she knows the dose is right” And to add to that, if you already take medication or you’ve been prescribed multiple medicines, we need to be sure they are okay to be prescribed together. The more medicines you take, the greater the risk of interactions and many can be severe or require dose alteration. If there’s a problem, we then have to contact the surgery and battle the receptionists to get access to the prescriber to query it.
Once we are comfortable everything is legally and clinically safe, only then do we pick the boxes of tablets up. And then it’s a case of spot the difference. Has the dispenser picked up the right items? Have they labelled it for the right person? Is it the right quantity, form and strength? Is the label titled with the right item on it and are the directions matching that of the prescription with the correct warnings on the label? Are the medicines in date? Dispensers are great and when they’re good at their jobs, they work very hard. But as with ANYONE, they’re human and they can so easily pick the wrong item or label it wrong and it can be missed.
Then, and ONLY THEN do we bag up the medication to be handed to you.
If you’d like to factor in multiple distractions to this process: other prescriptions to be checked, ‘someone wants a word with the pharmacist’, a delivery of controlled drugs arrives to be checked, a colleague needs help finding a medicine they don’t know the generic name for, there’s a phone call for the pharmacist, there is a first aid incident in the shop, the computer system has crashed, someone needs the controlled drug cupboard keys and other reasons to be broken off, then you add time to the process and risk.
So in a nutshell, that’s why you have to wait.
Patients who want their prescriptions filled safely wait patiently; impatience is a killer.
Once we are comfortable everything is legally and clinically safe, only then do we pick the boxes of tablets up. And then it’s a case of spot the difference. Has the dispenser picked up the right items? Have they labelled it for the right person? Is it the right quantity, form and strength? Is the label titled with the right item on it and are the directions matching that of the prescription with the correct warnings on the label? Are the medicines in date? Dispensers are great and when they’re good at their jobs, they work very hard. But as with ANYONE, they’re human and they can so easily pick the wrong item or label it wrong and it can be missed.
Then, and ONLY THEN do we bag up the medication to be handed to you.
If you’d like to factor in multiple distractions to this process: other prescriptions to be checked, ‘someone wants a word with the pharmacist’, a delivery of controlled drugs arrives to be checked, a colleague needs help finding a medicine they don’t know the generic name for, there’s a phone call for the pharmacist, there is a first aid incident in the shop, the computer system has crashed, someone needs the controlled drug cupboard keys and other reasons to be broken off, then you add time to the process and risk.
So in a nutshell, that’s why you have to wait.
Patients who want their prescriptions filled safely wait patiently; impatience is a killer.
Laura Buckley is a community pharmacist who runs a very successful blog. She is passionate about pharmacy and about parenting. Support her by checking out her blog by clicking here.
Excellent – will be sharing with work colleagues in GP practice.