The Council is concerned that some pharmacists are putting the public at risk through an unwillingness to challenge a prescriber when they see a prescription that is inappropriate, unclear or not understood. The Council has dealt with a number of such complaints and when questioned, the excuse “I am just responsible for dispensing the medication. It’s the doctor who is responsible for the prescribing” is often heard.
Pharmacists have a professional responsibility to step up and question a prescriber when appropriate and proceed in the best interests of their patients.
The importance of being able to challenge a prescriber was highlighted in the recent inquest into the death of a 77 year old Melbourne man due to methotrexate toxicity. Coroner Rosemary Carlin found the death to be ‘needless and entirely preventable’. She also stated that the pharmacist afforded ‘too much respect, or at least lost sight of her role as an independent safeguard against inappropriate prescribing.’
The ISBAR framework represents a standardised approach to communication and can be used in any situation. Pharmacists may consider using a similar approach to prepare themselves for a conversation with another healthcare professional.
The ISBAR acronym stands for:
Introduction - Who you are, your role, where you are and why you are communicating
Situation - What is happening at the moment
Background - What are the issues that led up to this situation
Assessment - What do you believe the problem is
Recommendation - What should be done to correct this situation.
If a pharmacist still has concerns after contacting a prescriber, they are under no obligation to dispense a prescription. These situations should be managed carefully in the best interests of the patient.
Pharmacists are also reminded of the Pharmacists’ Support Service (PSS), which is a helpline pharmacists may access for support. PSS volunteers are pharmacists themselves and can be contacted every day between 8am and 11pm EST on 1300 244 910. To read more about PSS click here.
To read the full finding from the Inquest click here.