THIS blog describes some of the findings and key themes raised as part of the discussion around the dilemma. To recap on the detail of the ethical dilemma click HERE.
I thought long and hard about whether to reveal the actual resolution to the dilemma we posed previously, and have decided not to. The reason is, that it is not for a single pharmacist to decide on the behalf of others what the correct course of action is in a difficult case like this.
I think it is much better to continue to share and discuss widely further examples of ‘real-life’ ethical dilemmas just like this one. The benefit of understanding the thought process of various pharmacists, and how they approach a situation, such as this, is the key to making a good decision when faced with such a situation in practice.
We ran the following poll as part of the ethical dilemma. I found the results really interesting. Of the participants that chose to commit to supply or not supply the majority chose to supply. Significantly 36.61% of voters showed some reticence and would have sought further information before deciding to supply.
If you were the pharmacist in this case would you make the supply?
The consensus from our poll was that supply was the preferred option. However, the split in the group of 187 voters indicates how tricky a situation like this can be.
We had some interesting comments below the blog that I would like to draw your attention to. The detail here is useful, and I found it intriguing to understand how these pharmacists approached the problem. We will run a dilemma frequently, and I would encourage you to comment so that we can learn from your approach as a pharmacist or a pharmacy technician to difficult situations like this one. Feel free to submit an ethical dilemma of your own to Johnathan, or Ross.
I would attempt to phone regular pharmacy to ascertain if usual item. I assume it’s not on the approved private CD stationary (although I don’t believe this is a legal requirement). If usual pharmacy unavailable & on wrong form I may supply until Monday morning until I could get more info (this is also subject to other contributing factors & suspicions).
Comment by Phantom Pharmacist
Misuse of Drugs Regulations 2001
Provisions as to supply on prescription
16.—(1) A person shall not supply a controlled drug other than a drug specified in Schedule 4 or 5 on a prescription—
(a)unless the prescription complies with the provisions of regulation 15;
(b)unless the address specified in the prescription as the address of the person issuing it is an address within the United Kingdom;
(c)unless he either is acquainted with the signature of the person by whom it purports to be issued and has no reason to suppose that it is not genuine, or has taken reasonably sufficient steps to satisfy himself that it is genuine
16(1)(c) is the tricky one.
In England, prescribers can now ONLY order Schedule 2 or 3 CDs privately on pink private prescription form FP10PCD. In Wales, the required form is WP10PCD or WP10PCDSS and in Scotland, Form PPCD (1).
Prescriber identification number
All private prescribers have been allocated a six digit prescriber identification number (issued by the relevant NHS agency) which must be included on private form FP10PCD (or the Welsh or Scottish equivalent). Private prescriptions for Schedule 2 or 3 CDs should not be dispensed in community pharmacies if they do not contain this identifier. Private prescribers should be referred to their primary care organisation (e.g. local NHS England team) if they require a private prescriber identification number.
If there was ANY doubt as to the authenticity I would wait and confirm on the Monday. That wouldn’t be unreasonable, and would be legal.
I’d double check MEP if you can make a supply on private rx as can’t remember off the top of my head.
Once confirmed what could/couldn’t be done I would speak privately with the patient and discuss what/when supply would be made.
If can’t make a supply due to legality, get all relevant details of the doctor and ring them Monday to get them to send a prescription ASAP to make everything legal. I would also contact superintendent and explain the situation and what I was doing. Notes would be made in POM register and also on PMR. I would also make the supply – the pt clearly has a need for the medicine.