Having arrived in the wonderful world of locums, and having joined the PDA, I recieve from the PDA their newsletters which detail all the things that can take a locum by surprise. Now the PDA is a wonderful organisation, but some of the the things they detail make my hair curl.
My main worry is the problem of errors whilst dispensing - everyone make these - the only pharmacist who does not make errors is buried six feet under!! How they are dealt with by the various bodies, makes me wonder whether locums should be better than the dead pharmacists in the cemetary, and not make errors at all.
Errors are a way of life, we don't like to make them but they happen, and whilst we go to all the lengths we can to prevent them, they still pass through the checking. Whilst it is very good Clinical Governance to report all errors, and whilst the CG managers report a "No Blame" culture, one cannot help thinking that a black mark goes against your name, otherwise why would the PDA take such pains to detail them?
Working in a pharmacy that does upwards of 500 items a day, means that just by probabilty alone, one mistake is bound to get through, not every day, but as the numbers of items rises the error rate goes up -despite all the best efforts of the locum on duty.
I have come across instances of locums not being able to work for pharmacies because of an error they made. Would the regular manager be treated differently?
Locumming to me is a wonderful experience, and I have the opportunity to work with (mostly underpaid) first class supporting staff. Locumming is something I should have done a long time ago, but I get this feeling that at the same time, locums are asked to be beyond that council of perfection that makes no errors!!
Do other locums share my views on this?
Regards
Bob Dunkley
Hi Bob, interesting post.
Hi Bob, interesting post.
I've been locuming (outside of my full time position in hospital/academia) for a couple of years now and I have a slightly different experience. I am lucky enough to have found a regular locum spot, near home, with great support staff. I work long days (14hrs), doing upwards of 500 items a day and have made occasional errors, all of them dealt with personally and in accordance with SOP's and none of them life-threatening. Coming from a hospital setting, the culture of accountability and risk management is ingrained and my error rate is very very low.
What I have found unnerving is the number of mistakes that locum colleagues make, that they do not report, that are potentially serious, where they do not have the courtesy or professionalism to deal with the patient directly (leaving it to the store manager) or report using the SOP in place.
To my mind, locumming is a competative industry and I'm sure that shifts will become more scarce as the economy contracts and corporate belts are tightened, increasing the competition for work. A good locum should trade on the basis of a good reputation for competence, accuracy and reliability. While errors do happen and heavy-handedness in the management of them is undesirable and unhelpful, what system is in place to identify those locums who flit from dispensary to dispensary, spend the day on their mobile phone, arrive to work and immediately open a book, conceeding to do the minimum level of work at a speed just fast enough to keep the dispensary ticking over? Who work without enthusiasm or regard for the patients or support staff?
If only more pharmacy managers were prepared to vote with their booking sheets, and more agencies were prepared to refuse to represent poorly performing individuals, this alone would improve the quality of locum services. It is sad that we will tolerate poor (perhaps dangerous) performance on the basis of keeping a pharmacy open.
I have never worried about having my reputation tarnished by a dispensing error as the very few I have been party to have always been reported to head office and rectified with the patient personally - there was no risk to the patient and my professionalism in dealing with the issue was commended. Conversely, I often find myself mopping up after the errors of other locums, apologising profusely to the patient, offering to deliver the correct medication myself etc etc, many times more often than I deal with my own.
I think you'll find that rather than locums being unfairly disciplined for inevitable errors made in less than suitable working conditions, there are a good few of them out there who make very many errors due to inattention and lack of CPD, but who are never brought to account because of flaws in the reporting system or a perception that the dispensary needs a pharmcist so badly on a given day that anyone with a certificate will do.
As an example, the counter staff I work with recently told me of a locum they had worked with who had driven all the way from Scotland (I am based in the South East) for the shift, and was of a very low standard. I can't believe that you would need to drive for 12 hours a day to get work if you were any good at your job. The fact that you do maybe is a reflection on your abilities.
Any Scottish pharmacists out there? Is locum work in that short a supply north of the borders?
So in short, Bob, I don't think a good locum pharmacist has too much to worry about, providing SOPs are followed and the error is reported quickly and professionally. There is (another personal observation) a tendency towards locums to whinge at the high work load, the less than satisfactory conditions etc etc. But thats why a full time locum can earn upwards of £50K - the rewards reflect the difficulty.
Best regards Bob, happy locuming! :-)
Good points
I think Lindsay manages to cover just about every pertinent point excellently. There are too many pharmacists (not just locums) who think that dispensing and/or checking is beneath them - and consequently makes a poor job of it.
Another factor that I believe contributes to errors is the under-resourcing of pharmacies - both in terms of support staff and the layout and size of the premises. IMO you need quite an operation to cope with 500 items a day, many of the pharmacies that I work in would struggle with such numbers.
I don't believe it's fair to expect a single pharmacist to cope with these volumes in a standard 8 hour shift either - perhaps acceptable spread over 14 hours (with adequate rest breaks of course...!).
I think there has to be a sea-change in contractors' attitudes that the only thing that counts is item numbers - especially if we are to deal with prescription interventions, more OTC, PGD supplies, MURs... the list goes on.