It is a sad fact that in a large number of dispensing units there is little communication between the dispensing team and the practice GPs.
This could be because, historically, the route of communication has been via a line manager; because the dispensary is in different part of the building from the consulting rooms; or simply because dispensers are nervous about speaking to the GPs directly.
During the course of a working day there are many instances when issues may need to be clarified. There must be a clear operating procedure in place to ensure that someone takes ownership of the problem and sees it through to its conclusion.
Drug errors can occur at any stage and the most significant contributing factor is communication breakdown between health professionals, or between professionals and patients. The increasing use of IT to check medication at the point of dispensing has cut down the number of wrongly dispensed drug errors.
If a dispenser feels there is a valid reason for querying a prescription - for instance if a beta-blocker is prescribed alongside asthma medication - there should be no question of the prescription being dispensed first and queried afterwards.
Raising a query
If a GP is not free to answer immediately, the patient should be told that there is a query on the prescription (without going into detail to alarm the patient) and request that they call back. If the patient prefers to wait, it may be necessary to contact the GP between patients.
Most clinical systems will give a warning to both GP and dispenser if there is an interaction between prescribed drugs. However, where, for example, patients have recently been prescribed warfarin, they may not know that there is a whole list of substances (both prescribed and freely-available from health food shops) which affect its clinical response.
Dispensers should always ask the patient if they are aware of interactions. It is recommended that the dispensary keeps a laminated list of these products so that the patient can be counselled accordingly. Practice nurses should also be aware of these interactions.
The dispenser should not, however, discuss with the patient whether or not the prescription is suitable for them. The dispenser should only step in if they think there is a mistake with dosage or strength of a prescribed drug, perhaps because the patient has had the drug before.
On-screen notes can be checked for an alteration and if there is no note of one, the GP can be contacted to clarify the dose. If the patient is well known to the dispenser, they could be asked if the GP has changed the dosage, but unless that sort of relationship exists it is better to check with a doctor.
In the Dispensary Services Quality Scheme (DSQS) document of September 2006, there was a requirement for dispensers to be competent in patient counselling. This does not mean taking people into a room for an hour, but rather making patients aware of special requirements for the drugs they are given.
A good example of this is when small bottles of eye drops are dispensed. If the regulations regarding labelling are followed, the instruction label should be attached to the bottle, not the box, but this can foul the dosing mechanism.
As long as the patient is told that the label has been put on the box and that they should keep the bottle in that box between doses, the dispenser has discharged their responsibility under the patient counselling clause.
This can be applied to any number of situations and there should be relevant training if dispensing staff do not feel able to fulfil this part of the DSQS contract.
Dispensers, GPs and patients do not exist in individual bubbles, but have to interact at some point each day. It is imperative that the lines of communication in any surgery are clearly defined; that everyone knows how to access one another; and that no one is afraid to do this. Only then will we see a decline in the frustration and danger caused by medication errors.
- Annette Arthur is a consultant for dispensing practices
|Communication in dispensing|