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Australian Journal of Pharmacy : May 2008
professional P dl risk m A n A gemen T Multiple dangers in the dispensary John Coppock, chairman, Pharmaceutical Defence Limited Dispensing multiple repeats is a Dangerous practice perhaps on the rise a necdotal evidence suggests that the practice of dispensing multiple repeat prescriptions at the same time is becoming more prevalent. Let’s face it; the attraction for a pharmacist to dispense the full amount at one time is primarily financial so, if the anecdotal evidence is correct, perhaps it is being prompted by the economic pressures being faced by many pharmacy businesses. Nevertheless, the practice is illegal unless for specific circumstances where provisions are made in the relevant state or Commonwealth legislation. It’s also bad professional practice and demonstrates that the interests of the patient were not a priority for the dispensing pharmacist. I remember a situation that happened some years ago when a pharmacist from a country town dispensed multiple repeat prescriptions of Valium. The patient took an excessive amount and then drove. His car crashed and someone died. Who’d want to risk their professional career over a poor dispensing decision, let alone living with the guilt of contributing to the harm or death of someone else? Because of PDL’s concern about the potential risks involved in dispensing multiple repeat prescriptions at the same time—to the health of the patient and the legal standing of the pharmacist—we decided to get legal advice from our lawyers Wisewoulds. There are certain circumstances that allow a pharmacist to dispense multiple repeat prescriptions at the same time. Many pharmacists will know if they see ‘Reg 24’ on a prescription that it means the prescriber has instructed multiple repeats of the prescription to be dispensed. That’s because Extra caution needed with generics With all the changes occurring to the PBS and their likely impact on the number of generics prescribed, this is a high risk time when it comes to meeting professional obligations for dispensing generics. Every pharmacy should be aware of the increased counselling requirements with generics: it is critical that the patient fully understands that generics brand X is the same as brand Y to ensure against double-dosing. The number of generics suppliers in Australia means that a patient might consistently be offered different substitutes of the Brand Y medicine and the potential for confusion is enormous, especially with the elderly. Always remember to advise the patient to look at the name of the drug and strength on each medicine package before taking it and check against other medicines they have at home. Make sure you tell the patient, if they do have another medicine with the same name, they should not to take both at the same time. Although this places further time pressures on pharmacists, it also offers opportunities to identify customers whose patient profiles make them eligible to receive one of the newly remunerated professional services available to pharmacy. It makes sense that, if a customer has trouble or is confused about what medications they take, they may benefit from having a home medicines review, a dose administration aid, or a patient medication profile. Regulation 24 of the National Health Regulations enables medical practitioners to prescribe the supply of, on one occasion, a quantity or number of units of the pharmaceutical benefit allowable. To do so, the prescriber must be satisfied that: the maximum quantity or number of units of the pharmaceutical benefit is insufficient for the treatment of the patient; that the patient has a chronic illness or lives in a place remote from a pharmacy; and that patient could not, without great hardship, get the required quantity of a pharmaceutical benefit from repeated supplies on separate occasions. However, if called upon to dispense a prescribed medication in quantities greater than deemed necessary and without a ‘Reg 24’ notification, pharmacists should contact the prescriber to seek approval. Pharmacists are allowed to use their own judgement in the absence of a ‘Reg 24’. This can happen when the dispenser has reason to believe that the patient’s medication has been stolen, destroyed, lost or that supply without delay is necessary to treat the patient. To activate this right, the dispenser must write the words ‘immediate supply necessary’ and sign either the Medicare Australia copy or the prescription. However, this right is overridden if a ‘Reg 24’ is activated by the prescriber. Pharmacists can also use their own judgement when they are satisfied that a patient has an immediate need for a S4 medicine and it is impracticable to get a prescription in time to meet that need. However, this can only happen if the patient has previously been prescribed the medicine and that the patient, their agent or carer is aware of the appropriate dose. The pharmacist must also limit the quantity to no more than three days’ supply or the smallest commercially available pack. The penalties for contravening related state and Commonwealth legislation can be significant and includes fine and/or imprisonment. The pharmacist could also face civil action for not taking reasonable steps to ensure the patient’s safety. This also reminds us that, when pharmacists are asked to legally dispense multiple repeat prescriptions at the same time, their professional obligation to provide counselling and warnings is heightened due to the threat of excessive or inappropriate use. In such times, it is advisable to make doubly sure that the patient knows the dose and its frequency. If in doubt, remember to consider the interests of the patient first or contact your local PDL office. n The AusTrAliAn journAl of PhArmAcy vol.89 mAy 2008 36