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Are pharmacists really doing a clinical check?
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By Matt Yates
23 Jul 2012
A prescription for Zopiclone 7.5 mg tablets ONCE daily comes into the pharmacy. All seems well, the dose is appropriate for the 40 year old gentleman. The pharmacist is satisfied. He accurately checked the dispensed item; all was fine.
The pharmacist asks the patient if he is taking any other medicines; ''Yes, I'm taking something to help me sleep .. erm Nitra .... ? Nitrazepam? Yes that's the one.
The pharmacist thinks 'Two sleeping tablets? Really? ' This isn't safe.
The pharmacist could have used the Patient Medication Record to check if the patient was taking other medicines. Why didnt he?
Obviously, there is no substitute for proper patient interaction; there is no greater tool during the clinical check than talking to the patient.
However, just because the Zopiclone dose was safe, this did not mean that taking the Zopiclone was safe.
Pharmacists, at present, seem to only check the PMR to see if a patient is eligible for an MUR, or a candidate for NMS. shouldn't it be standard practice for a pharmacist to clinically check first, and then pass the prescription on for labelling and dispensing.
I could not imagine being a pharmacist and not carrying out a clinical check using the PMR. Printing off an interaction label means nothing to the pharmacist. They need to be able to utilise the PMR and assess the individual patient. Without using the PMR, I feel we are taking a risk when deeming a medicine 'clinically safe'.
When I qualify as a pharmacist, I fully intend to insist that I use the PMR to carry out a full clinical check before labelling and dispensing. I could not imagine practising in any other way, and I would hope fellow future pharmacists would adopt the same attitude.
Yes, time is tight, but we could miss so many interactions: Diltiazem and Ivabradine, Beta blockers with asthma medications, thiazides in diabetes etc. The PMR is there to help us, we should not let this help go unused.
A view on clinical checks in reality
Not sure from this whether you are still at college and how much of your comments result from watching pharmacists in action - I hope that pharmacists DO perform clinical checks when needed to in real life. Your ideal scenario of the pharmacist doing the checks on all scripts BEFORE any dispensing is done would be great but in an actual pharmacy is unrealistic. What I as a community pharmacist rely on is the whole process - my pharmacy team telling me if a patient has a new medicine and/or if the software has highlighted any interactions, leading me to then review the situation whilst checking. If there is an issue, I will then sort it out - my dispensers have highlighted the issue for me, as they have been trained to do. Something you will find out is that the vast majority of scripts dispensed each day are items the patient has had before and have already had a check done - only the new medicines will need to be flagged.
There is another aspect to this - experience and almost a 'sixth sense' that comes with practising pharmacy for many years. You look at a script and you just know there is an issue, even if it is not totally obvious at the time. The other thing to remember is that not all interactions are bad or wrong - some interactions I learnt about at college are actually utilised for the patient's benefit by the doctor or are recognised but considered a necessary risk as the benefits are bigger. I would like to think that interactions are, in fact, rarely missed.
Most company's SOPs will indicate that a clinical check should be done anyway - all I can say is when you are a pharmacist yourself, you are in charge of how you do things and accountable for your actions. If you want to insist on clinically checking everything first, that is your perogative. You might have to think again however when you have several scripts to check, MUR/NMS to do, patients to counsell and more - relying on your dispensing team to help you as much as they can is the most important 'tool' in community pharmacy...
Personally speaking, i use