The Pharmacy Board of Australia’s Guidelines for Proprietor Pharmacists provides guidance to owners in relation to their professional responsibilities which is not detailed in the legislation or a registration standard. This includes guidance on how proprietors must maintain an active interest in how the pharmacy business is conducted, and how proprietor pharmacists cannot delegate their professional obligations.
Two recent cases demonstrate how proprietors who did not take an active interest in their pharmacies were unaware of non-adherence to legislation. This resulted in missing schedule 8 drugs in one pharmacy, and excessive supply of schedule 8 drugs to a patient who subsequently overdosed in another.
A substantial amount of schedule 8 drugs were reported as ‘lost’ when a locum pharmacist identified that a quantity of drugs were missing in a pharmacy. In line with his legal responsibilities he reported the large discrepancy to the Pharmaceutical Regulatory Branch of NSW Health, and also to the police. An investigation ensued with several employed pharmacists at the pharmacy admitting to having known that drugs had been found missing on several occasions over several months. However, no one had reported the missing stock. The proprietors were also unaware of the ongoing missing stock. They did not routinely visit the pharmacy but relied on a pharmacy manager to relay information. Further investigation by the Pharmacy Council uncovered many breaches of the legislation including storage of the schedule 8 safe key on a hook in the pharmacy, access to schedule 8 drug safe by non-pharmacists, not checking the balance of the schedule 8 drugs on issue or receipt, and unauthorised ordering of schedule 8 drugs by non-pharmacists.
Following a drug overdose, the police uncovered a large quantity of schedule 8 drugs in a patient’s home which included large quantities of fentanyl patches and morphine injections. Investigation by the police and the Pharmaceutical Regulatory Unit identified that one pharmacy had supplied the majority of the drugs over several months. The pharmacist manager in the pharmacy admitted to supplying drugs to the patient which occurred on an almost daily basis. The pharmacist confirmed meeting the patient once and was convinced they had chronic pain; the pharmacist had also spoken with the prescriber who conveyed that the patient was managed by a pain specialist. The pharmacist did not check with the specialist or contact the Pharmaceutical Regulatory Unit about the ongoing and excessive prescribing of opioids by the prescriber. The pharmacy was owned by three pharmacists – one of whom was the pharmacist manager. Neither of the other two proprietors had visited the pharmacy or had reviewed any reports on drug supply in at least eight or nine months, and were unaware of the quantities or types of drugs being ordered or supplied.
The Guidelines for Proprietor Pharmacists includes advice on how proprietors must maintain an active interest in how the pharmacy business is conducted, and how proprietor pharmacists cannot delegate their professional obligations. Where necessary, proprietors must intervene to ensure that the practice of pharmacy is conducted in accordance with applicable laws, standards and guidelines. All proprietors have equal responsibility irrespective of their percentage interest in the business and whether they work in the pharmacy on not.
In addition to action taken against employee pharmacists in these pharmacies, conditions were applied to the registration of all the Proprietor Pharmacists to promote the safe operation of the pharmacies.
The Pharmaceutical Regulatory Unit has a website which provides information and guidance to health professionals. For guidance on missing or loss of schedule 8 drugs click here.
To contact Pharmaceutical Services, NSW Ministry of Health click here.