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 weâ€™re to blame. Saying sorry is never enough, and there are no words to embroider around that fact.Â A dispensing error is an honest and hard- working pharmacistâ€™s worst nightmare.
Thankfully the baby made a full recovery but for the poor pharmacist and their team itâ€™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. ButÂ 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.
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 â€“ thatâ€™s about 50 million errors a year. I know one is too many, but out of 1.2 billion items dispensed thatâ€™s a bloody good statistic by any measure.
Pharmacists have to be professional perfectionists. Weâ€™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. PharmacyÂ 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 needÂ 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, itâ€™s a problem. Information technology might be hailedÂ as a panacea but is only a sticking plasterÂ because itâ€™s an organ, not an organ grinder.
Tensions between non-pharmacist managers and pharmacists will worsen, and patientsÂ will have to expect long delays because finalÂ accuracy checks mustnâ€™t be rushed.But itâ€™s not just about the prescriptionÂ waiting times; cuts will limit access to all theÂ other services we provide, like cholesterolÂ testing, heart health checks, diabetes screening, and the morning-after pill.
Just last week, a suicidal patient walkedÂ 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, andÂ reassured her, I didnâ€™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, Iâ€™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 governmentÂ 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 â€“ in marketing, staffÂ 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 â€“ three chances to guess the tablets by their markings
- Catchphrase â€“ an illegible prescription is presented and pharmacists are asked to â€˜say what they seeâ€™
- Million pound drop live â€“ patients start off with 100 tablets and gamble them by answering questions on their medication
- Family Fortunes â€“ two families on benefits Â consider: â€œWe asked 100 people to sayÂ which box they tick on the back of their Â prescription ...â€
- Would I lie to you? â€“ addicts tellÂ pharmacists why they missed yesterdayâ€™s collection
- Gladiators â€“ the age-old battle between pharmacists and GPs, but with lycra
- The Krypton Factor â€“ how many dispensing errors you can avoid as pressure mounts andÂ time gets deducted.
Mistakes and accidents occur when people are under pressure, tired and distracted