Hi all,
Here goes for my first ever post (Hope I get it in the right section!)
Our Service User Involvement Team are planning a training event for local Pharmacist's around the issues of what happens when things go wrong with a script. We will be looking at a case study based on 4 view points (Pharmacist, GP, Service User and Service Users Child) however would like to find a common error that happens with the writing of prescriptions. We have a few from our area but would like to see if these are a national thing.
Therefore it would be really useful if people could leave their stories / examples of what has happened to them in the past, why and how it got resolved?
And finally any GP’s who would like to contribute their stories would also help us.
Hope that makes sense – soz if it doesn’t feel free to ask any questions.

from the GP/GPwSI corner: common things that happen.......
1. script miswritten, not in accordance with controlled-drug regulations
2. dates mix-up so overlapping scripts or days missing
3. (in GP-land) usual doctor not available and patient sees doc who doesn't know them and/or is unfamiliar with prescribing in addictions
there are other scenarios but those are probably among the most common.....

.........and also patient failing to pick script up and how services respond to that.

The one that got lost in the wash is a bit of a classic, we have heard it so many times, we tend to be highly suspicious only to end up with egg on face as client's mum prodces washed fragments, which, pieced together, confirm it was the orginal script! I think it would make a great case study.
Another more pharmacy orientated one is: client vomits methadone on the premises
Or wrongly written script one: prescriber has put everything correctly but calculated the total dose wrongly, and it's too late to contact the to confirm, and its a Friday so if they miss it, they will miss the whole weekend and need a restart on Monday

I hope your group will be aware that the answer to susi's last point is that the pharmacist can ammend the script if total is not written correctly and if there are "minor typographical errors" (see BNF page 7)

pharmacist sometimes start a blue script when the patient brings it in , even if that is 2 days later thatn the date at the bottom of the script, which was intended by the Doc to be the start date. then the script carries on for 2 extra days and the patient misses next appt and chaos breaks out.

As Susi suggests in the washing machine story, pharmacist need to be generally in the way of assuming the patient is telling the truth, and trying to help them, unless proved to be an untruth. (innocent til proved guilty)

Very Very important to train all front line staff very carefully, not to inadvertantly break confidentiality.. eg not to shout out "your methadone's ready now" across the shop, or even "was it a blue script or a green script?" I have patients who have been mortified in pharmacies by poorly trained staff. And I believe supervised consumption should never ever be given outside a confidential area, even if the patient "seems" to be happy to take it that way. Again, i had one patient who asked me to ring his pharmacist to ask if he could take him into the back room for his meths as he was too shy to insist on it, but hated drinking it in the shop.

"And I believe supervised consumption should never ever be given outside a confidential area, even if the patient "seems" to be happy to take it that way."

I don't like "never". The patient has a choice of pharmacy - and if they are not happy with the service provided they can use another.
I generally just go along with the patients wishes. FWIW the majority of clients seem to prefer to receive their medicines at the counter rather than to go into the consulting room - though for new clients I try to start in the consulting room as it is useful for getting to know them and to go through the house rules.(missed days etc)

As for incorrect scripts - If I know what's intended - I dispense and get them sorted out later. Overlapping scripts (where one starts before the other has finished) I just fill in "not supplied" on the overlapping days on one and inform the prescriber of the overlap.

My problems over the last couple of months.

1. the script that doesn't come through the post - usually because the client has an appointment and is supposed to pick it up - but sometimes it's just not been sent.
And yes I've been know to give a weekends supply of subutex while hoping that the script was going to arrive (which it did).

Not sure what I'd have done with methadone with running totals that have to be kept. I'll cross that bridge when I come to it. Depends on the client I suppose.

2. Dose changes on a Friday with no warning.
e.g. Weekly subutex collection going from 8mg daily dispense 7 on Friday to subutex 6mg daily dispense 21 on Friday.
End up having to mess about with three regular clients to ensure that they all have enough for the weekend. All as it happens were very understanding.

3. Changing the pick up day without telling the client.
As it happens it also means that the client will now be seeing a different pharmacist - so much for continuity of care.

As for start dates - if you accept that the problem exists consider changing your prescribing to include a start date.
(Not a blame culture - but risk minimisation - mistakes will still happen - we can just try to reduce them)

I'm expecting minor irritations with scripts that are meant to commence on Good Friday.

Jeff

I'll add some EMIS - doesn't add up the totals or alter doses for bank holidays and it increases the chances of errors.
When posting prescriptions 1st class post isn't what it was sometimes it's worse than 2nd class used to be.

Sorry about the "never".. Yes, you are quite right of course. We just had a lot of trouble at the start of supervised consumption, as local pharmacies tend to be very small and with no space for consultation rooms.

You quite rightly say patients must have choice of course, but where the script is written as SC, and the pharmacist only offers the cup across the counter, the patient sometimes needs help to get their right to privacy and confidentiality upheld, and the pharmacist needs help to find funding for suitable confidential areas. Things have generally improved in this area.

The front line pharmacy staff just need continually reminding and training about confidentiality, exactly the same way as our own receptionists (and ourselves).

I use 2 systems - EMIS and Bomic. Bomic is much easier - click and it does everything for you e.g. if on twice weekly pick up it says how much to be dispensed on each day. On EMIS I just put "dispense Weds and Sat" or whatever without the totals to be dispensed on those days. One pharmacy phoned up last week and wanted the amounts to be dispensed on each day specified, which we have not normally done on EMIS. Should that be specified - most pharmacists don't ask for it?

Hi All,
Just to say a big thanks to all whom have contributed to this thread. It has been a great help in developing what I am sure is going to be both a fun and interactive training session.
Regards

Hi Andy
I went to something on the same lines in one of the areas I work in. I thought it was great, the Service Users had prepared brilliantly, and it was a fantastic opportunity to speak to people, whatever the 'side of the fence' they were on, in an open and honest way. I must say, as a Pharmacist, I DID challenge alot of my colleagues perceptions in the group I was in( I think I was a bit of a pain really!), but it was great to see shifts in awareness from all of the people present... I wish I could be there
Let us know how you all get on

Can I add two we see from time to time?

We much prefer prescribers to date the prescription with the date it was issued, and write the start date in the body of the instructions. The reason is that if they consistently put the start date in the "date" box, and then issue a replacement prescription, there may be confusion as to which is the old and which is the new.

A related problem is trying to decide if the new script adds to the old one or replaces it. For example, if Mr X is prescribed 5mg olanzapine and we then receive a prescription for 2.5mg, is that going down to 2.5mg or up to 7.5mg?

On the matter of supervised consumption, I'm with Jeff. Most of our clients much prefer service at the counter in an opaque cup when it could be anything they're drinking. What they want us to do is supervise them quickly and with the minimum of fuss and attention. I have only ever had one who asked to use the consultation room (which we had built with a stable door to facilitate SC).

Hi All,

Just to update you we did the training last Thursday evening and it was a huge success. The case study we used took onboard some of the issues you guys have mentioned in this thread.

So a big big thank you for your help, advice and pointers. Was very much appreciated.

Andy Corfield MRIPH
Wolverhampton Service User Involvement Officer