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Health warning: safety margin has been cut

Independent contractor Sid Dajani argues that the additional pressure caused by funding cuts will put patient safety at risk

A dispensing error has made the news. An unconscious baby was rushed to hospital after being given an anti-psychotic drug, olanazapine, instead of omeprazole. It was a case of the right label, wrong drug.

The impact of such incidents on the patient and their family is uppermost in our minds when things go wrong because we share the pain, feel the anger, experience the hurt and reflect on the sorrow made worse by the fact that we’re to blame. Saying sorry is never enough, and there are no words to embroider around that fact. A dispensing error is an honest and hard- working pharmacist’s worst nightmare.

Thankfully the baby made a full recovery but for the poor pharmacist and their team it’s only just the beginning of a gruelling, guilt-ridden, emotional and mental nightmare of living under a dark cloud of contractual, professional, regulatory and civil issues that could result in a prosecution, for up to a year or more. We are all risk averse, keep up to date with professional developments, have dozens of standard operating procedures, and are heavily regulated to stop things going wrong. But if they do, we have to investigate to avoid making the same mistake again.

My heart goes out to the pharmacist whose life will now be hell. There but for the Grace of God go the rest of us.

Professional perfectionists

We can only minimise mistakes, not immunise against them, and some boffin somewhere estimated that we make four errors in every 250 items we dispense – that’s about 50 million errors a year. I know one is too many, but out of 1.2 billion items dispensed that’s a bloody good statistic by any measure.

Pharmacists have to be professional perfectionists. We’re not pedants or nitpickers, but activists in the pursuit of excellence. Yet the reality is, mistakes and accidents occur when people are under pressure, tired and distracted. Safety, care and caution will only come if the front-line is protected, funded adequately, and is a calm and interesting place to work. Pharmacy risk management and quality assurance is ongoing work, and anything that affects staffing levels, increases workload, adds stress or increases bureaucracy that diverts work away from the frontline, is a safety risk.

Pharmacists and their teams need special protection because funding cuts will threaten public safety as pharmacies look for savings, with staffing levels the first to be affected. Cutting the number of pharmacies is not a solution, it’s a problem. Information technology might be hailed as a panacea but is only a sticking plaster because it’s an organ, not an organ grinder.

Tensions between non-pharmacist managers and pharmacists will worsen, and patients will have to expect long delays because final accuracy checks mustn’t be rushed.But it’s not just about the prescription waiting times; cuts will limit access to all the other services we provide, like cholesterol testing, heart health checks, diabetes screening, and the morning-after pill.

Just last week, a suicidal patient walked in having slashed her wrists 20 minutes earlier. Luckily she hadn't done a good job, but she still bled profusely. Having stemmed the bleeding, prevented shock, and reassured her, I didn’t think it was serious enough to call an ambulance. Instead I called her caseworker to take her to the hospital because she could give more of a background history at A&E and hopefully prevent future attempts.

But as the reduced funding kicks in, I’ll have fewer staff and my level of service will plummet. Anyone who tells you they will work better when more streamlined and all staff are stretched to the limit is either a liar, has no clue, or is delusional.

Looking for ideas

Which reminds me of the government and its civil servants, who opened up the pharmacy market to increase competition, adding another 2,500 pharmacies, but now want to cut it back down again. Anyone who runs a business knows you need to invest to improve – in marketing, staff and services. When cuts are made it simply shows someone has run out of ideas. The government looks like it never had any.

Pharmacy is being ruined by desktop jockeys, out-of-date community pharmacists, pharmacists who have never worked in community pharmacy, non-contractors, pharmacists who only see patients when watching Holby City, and others who got their fancy titles because they have a degree in pharmacy. These people would make great hosts on game shows like these:

  • The Cube – three chances to guess the tablets by their markings
  • Catchphrase – an illegible prescription is presented and pharmacists are asked to ‘say what they see’
  • Million pound drop live – patients start off with 100 tablets and gamble them by answering questions on their medication
  • Family Fortunes – two families on benefits  consider: “We asked 100 people to say which box they tick on the back of their  prescription ...”
  • Would I lie to you? – addicts tell pharmacists why they missed yesterday’s collection
  • Gladiators – the age-old battle between pharmacists and GPs, but with lycra
  • The Krypton Factor – how many dispensing errors you can avoid as pressure mounts and time gets deducted.

 

Mistakes and accidents occur when people are under pressure, tired and distracted




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