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Fintan Moore looks at the debate on breaks to reduce pharmacist fatigue and finds that there are more layers to this onion

A topic of interest in recent times has been the requirement for pharmacists, and other pharmacy staff, to get proper rest breaks, including lunch breaks, as per the relevant workplace legislation. There have always been varying opinions on this issue among pharmacists. Some employers and employees have preferred not to take unpaid lunch breaks, and some have preferred the opposite, so compliance has varied accordingly. At present, there does seem to be a momentum shift towards taking breaks, and the latest PSI newsletter addresses the matter to emphasise that point. The logic is sound that breaks help to address fatigue, so let’s start asking the obvious question, which is: ‘What else should happen to reduce pharmacist fatigue?’

To give you an idea of what tree I’m barking up, the following sentence from the PSI newsletter will point the way.
“The provision of appropriate breaks, in particular during this ongoing pandemic, where the implementation of infection, prevention and control measures and significant changes to services and work practices have placed considerable further demands on each individual, is one which requires action from those in governance and leadership positions.”

The PSI has correctly identified that the additional work practices created by the pandemic place demands on pharmacists, so it clearly makes sense that the PSI should encourage the reduction or removal of any pre-existing unnecessary work practices to ease the overall demand on pharmacists. The PSI is in both a ‘governance and leadership position’, so is well suited to review the total workload in the average community dispensary and recommend changes. The starting point should be the suspension of FMD scanning during the pandemic, with medicines authentication taking place at wholesale level, which is where it always should have been.

The PSI could also emphasise to the PCRS that excessive bureaucracy is getting in the way of patient care and is a fundamental safety issue. A workload review by the PSI would be innovative, but to again quote the newsletter, “the response to Covid-19 has shown that pharmacies can innovate and adapt with agility in the face of a global pandemic. Addressing work breaks requires this same kind of creative response, driven by the underlying concern for patient safety, which we know motivates everyone working in community pharmacy.”

Fazed and Un-phased

In my view, there is a fairly simple moral and ethical principle underlying the relationship between community pharmacists and the HSE, which is that we pharmacists look after the HSE’s patients properly and in return, the PCRS pay us correctly for doing so. I’m not going to tie myself up in linguistic knots defining ‘properly’, because anybody with a reasonable bit of common sense knows exactly what I mean. At times in recent years, the PCRS has had to clarify what it regards as ‘proper’, and in fairness to them, there have been occasions when a previous lack of clarity had been costing the taxpayer a lot of money. However, the basic principle of correct pay for proper work should not get thrown out with the bathwater.

The logic is sound that breaks help to address fatigue, so let’s start asking the obvious question, which is: ‘What else should happen to reduce pharmacist fatigue?

The current system for the administration and payment of phased dispensing is flawed and unfair. Pharmacists have no way of knowing in advance when a patient’s eligibility for phased dispensing is going to expire, so we are expected to check before we dispense. The blatantly obvious problem this presents is that if the patient’s eligibility has expired, the pharmacist is left in the position of having to decide whether or not to continue to phase the medication, and if so, hope that the GP will promptly re-apply for approval; or stop phasing and hope that the patient will not come to harm. In reality, the only moral option for most pharmacists is to keep phasing to protect the patient, and ring the doctor ASAP to sort approval.

However, where the system is utterly unfair is when a patient’s approval isn’t checked at the time the prescription is put through, which can happen easily, ESPECIALLY IN THE MIDDLE OF A FRIGGING PANDEMIC WHEN PHARMACISTS ARE BUSY PLUGGING THE GAPS LEFT BY OTHER PARTS OF THE HEALTH SERVICE! Apologies for shouting, but it’s nice to let off steam occasionally. So even though the correct patient has been given the correct medication at the correctly phased intervals, as directed by the patient’s GP, the PCRS will refuse to retrospectively pay for the phased dispensing. This is so clearly wrong that it doesn’t need any further comment.

Pack Animals

Am I alone in thinking that the quality of packaging for a lot of dispensary items has taken a serious dip in the last couple of years? Many products have had their outer pack changed, presumably to incorporate FMD requirements. Ironically, this supposed ‘safety’ measure has led to many packs being less safe than they were previously, because identifying features for the medication have been removed from the ends of the boxes, so the risk of a picking error is higher. Another issue is that some companies use nearly identical packs for different products, or for different strengths of the same product, which again creates a potential for error. I don’t know who exactly assesses and approves packaging, but the bar for what is acceptable is set pretty low.

<strong>Fintan Moore</strong>
Fintan Moore

Fintan Moore graduated as a pharmacist in 1990 from TCD and currently runs a pharmacy in Clondalkin.