Fintan Moore offers a practical suggestion for dealing with scrawled and illegible prescriptions
I know that pharmacists are generally a bunch of caring professionals who try to do their best for the patients we are serving. Personally, I try not to get too caught up in the emotive side of looking after people, not because I am unfeeling, but rather because I view emotional wear and tear as a genuine workplace hazard akin to any other kind of mental health stress.
For any healthcare worker, it can be a risk to care too much. My approach is to keep an emotional distance from the patient’s situation, and focus my energy on doing everything that I can practically and reasonably do to resolve any issues they might encounter in relation to accessing medication. My idea of what is reasonable might stretch beyond (or fall short) of what other pharmacists think, but I see my role as being a problem-solver rather than a carer.
There is one specific hard-to-solve problem that does grind my gears, and likewise that of every community pharmacist in the country, namely the staggering inability of so many hospital doctors to write a clear and legally-valid controlled drug prescription. Yes, I know the doctors are busy in a challenging and under-resourced environment with multiple demands on their time and attention, but it takes about five seconds more to write a legal prescription than it takes to lash out a piece of scrap paper.
To spend that extra five seconds does take a degree of care, along with the basic commonsense to realise the knock-on problems that an incorrectly written CD prescription creates down the line for the discharged patient when they present it at a pharmacy. The only legally-valid option the pharmacist has is to refuse to dispense a non-legal prescription with the resultant impact on the blameless patient. The ethical argument can be made that it’s in the best interests of the patient to dispense if the prescriber’s intent is clear, but that is still not a legal action. The really galling thing is that any sloppy doctors can scrawl as many illegal prescriptions as they want with no legal consequences.
For what it’s worth, all the major hospitals seem to have a Patient Advocacy Department, dedicated to resolving issues where failures on the part of the hospital have led to adverse consequences for patients. Like the hospitals themselves, these departments seem to vary in quality, but a while back I was very impressed with the people in Tallaght Hospital.
After I had spent two wasted days trying to clarify a CD prescription with the emergency department, I emailed a complaint to Patient Advocacy. Within an hour I had a phone call from one doctor getting more details, followed shortly after by a call from another doctor (getting the same information again), followed about an hour later by a call from the actual prescriber who had previously been uncontactable.
So, as a suggestion, every time we end up sorting out the fallout from a dud prescription, we should email Patient Advocacy with the details of how patient care was delayed or otherwise compromised, and let them follow up.
Testing Patience (Instead of Patients)
Another recurring problem where the patient and the pharmacist get chewed in the teeth of the State bureaucracy arises when a pregnant woman gets diagnosed with gestational diabetes and needs extra test strips. Some GPs and their teams are really efficient at sorting out the request for approval of additional strips, but some of them not so much.
I currently have one patient who was given a Coombe prescription for extra strips at the end of July, and three weeks later was still waiting on the GP to sort the approval. What seems to happen every time she contacts the GP surgery is that we get a freshly Healthmailed prescription for five boxes of strips, so we Healthmail back to remind them again regarding the lack of approval… and then nothing happens.
In fairness to this particular GP practice, they are usually very good at negotiating the PCRS hoops and at responding to queries, so it may be a holiday blip. It is nevertheless both head-wrecking and time-wasting for us and the patient. I have also learned the hard way over the years that the PCRS don’t care if a patient was provably pregnant when she got extra strips – unless she had approval in place at the time of dispensing, the strips will not be paid for. It’s obviously not fair or reasonable, but ours is not to reason why.
Stick on Satisfaction
One of the cheapest, simplest things you can do to make your pharmacy a happier place is to buy a few sheets of stickers for children. Kids aren’t too choosey, so anything from animals to rainbows to sunshine will work, preferably a choice of all of the above and any others you can find.
So, if a kid has been really good at letting you look at their cut hand, or the rash on their tummy, or getting their flu vaccination squirted up their nostrils, then you have an immediate small reward for them. Even if a child has just been quiet and well-behaved while waiting in the pharmacy, a sticker can be a nice way to acknowledge that.
It can also be a handy way to defuse a looming battle if a toddler has got their hands on something bright and colourful that they don’t want to relinquish – a brief negotiation involving a proffered set of stickers can resolve the situation amicably and save a grateful parent from a meltdown. To kind of quote Neville Chamberlain, ‘Peace in our time – peace with sticky, shiny paper’.
