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When it comes to medicine errors, Hunt treats pharmacy like Cinderella

“Community pharmacists already intervene to prevent many prescribing errors”

It was nonsensical for the health secretary to ignore the sector when drafting his medicines error strategy, argues Cathy Cooke

Community pharmacy seems to have had more than its fair share of knock backs lately, given the essential advisory, medicines supply and clinical triage roles that pharmacists and their teams provide to patients and the public.

Last year’s funding cuts resulted in 79% of contractors in England seeing their income fall, and more recently we saw community pharmacists apparently excluded from involvement in the group advising Jeremy Hunt on a strategy to reduce medication errors. In addition, the report of the advisory group omitted any opportunities to utilise community pharmacists in tackling errors.

So what is the government missing out on when it fails to consult with community pharmacists on policy matters, such as the reduction in medication errors?

Twenty-five years practising as a community pharmacist gave me first-hand experience of the important role that the sector provides in medicines safety. More than one billion prescription items are dispensed in community pharmacies every year and the research report that informed Mr Hunt's strategy estimated that there are 66 million potentially clinically significant errors per year, 71% occurring in primary care. Prescribing in primary care is estimated to account for 33.9% of all potentially clinically significant errors.

Community pharmacists already intervene to prevent many prescribing errors. The availability of additional information, such as access to the summary care record, will have increased that opportunity. Mr Hunt’s measure to allow hospitals to access GP prescribing data will allow retrospective analysis of likely contributory causes to harm – though causation may be difficult to determine – but fails to address early prevention of errors.

Community pharmacists could enhance their safety role by formal engagement in identification of risky prescribing in vulnerable groups; for example, regular use of non-steroidal anti-inflammatory drugs without protective proton pump inhibitor cover and in patients at risk of acute kidney injury. Enabling a more formal referral of concerns to GPs by community pharmacists would enable data to be captured and harm to be prevented. Where GP surgeries have a practice pharmacist, community pharmacists would be able to work with them to raise concerns. This would be a good investment of resource in my opinion.

The research report found that prescribing and monitoring errors are most likely to have the potential to lead to moderate and severe harm respectively. Community pharmacists could be involved in checking that patients have had the required test within the necessary timeframe for a defined list of high risk medicines. Again, a good investment of resource.

Deploying community pharmacists to reduce medication errors is a no brainer, as they are perfectly positioned to intervene at the point of supply, when an error has slipped through and before it reaches the patient. As readily accessible medicines healthcare professionals, why wouldn’t you utilise their expertise?

Cathy Cooke is a former community pharmacist

7 Comments

Jonny Johal, Pharmacy Area manager/ Operations Manager

My first job after qualifying was in a hospital in Wales, 1979. One of their senior pharmacists there kept a draw full of dispensing errors collected from patients when they were admitted, and everyone there said to me if they were more involved in the general management of medications in other areas of the hospital e.g. the wards, they believe there would have been far fewer errors. Well, despite of what they thought and said to me, I saw, too, quite a number of dispensing errors which ended up on the wards (including CD errors)! What do you say, are pharmacists part of the problem or the solution? Is the premise espoused by Cathy Cooke a myth or are there solid evidence to support her assumptions (that pharmacists can stop other people making mistakes in spite of their own failures)? As to us spotting errors before they reached the patient, it is not those which we are discussing, it is those which we don't spot which worries me.

George, if you can't even see this, what does that say about your 'world view'? Benjamin, we can debate what you raised, but that opens up another subject. Daniel, if you can't stay on subject, that means you have no underlying counter-argument.

Leon The Apothecary, Student

I do agree we would he approaching a different matter of debate. We would want to remove the risk of errors, the most logical aspect would be to remove as much human interaction as possible, the primary source of errors, from the equation and automate.

But like you said, that's another matter of debate of heart vs machine.

Adam Hall, Community pharmacist

Best patient conversation:

Patient: You've given me the wrong thing!

Me: No, I've given you what the GP prescribed. In which case, the doctor made the mistake

Patient: Impossible! My doctor doesn't make mistakes

Me: (ROGL)

Jonny Johal, Pharmacy Area manager/ Operations Manager

The premise that pharmacists can help reduce errors is at the moment just a myth. We need more studies to establish that link. I see pharmacists as a major source or errors. 

Again, you strike me as somebody with an incredibly narrow world view. What’s worse is I’m beginning to think you believe the nonsense you espouse. 

Leon The Apothecary, Student

A myth that is backed up by a phantasmagoria of near-miss logs from every single pharmacy. Would you not agree that every time an error is spotted by a pharmacist (or checker) before it is released not an indication of that? 

Daniel McNulty, Superintendent Pharmacist

Do you mean 'of errors'.

If you'd run your comment by me first I would have reduced your risk of error.

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