LAST week we published a dilemma about a situation where a nurse returned some diamorphine to the pharmacy. In case you missed it I have repeated the dilemma below.
A district nurse, who is a regular at the pharmacy, hands back some medicines from a patient that has died. Amongst the medicines is a packet of diamorphine ampoules.
Later that day she drops off a prescription for diamorphine for a palliative care patient which she needs urgently.
Unfortunately you do not have any diamorphine in stock.
What do you do? Click your answer below to be taken to the next stage of this dilemma.
The dilemma above generated comments and debate. Here is a flavour of what was said.
“I would tell her to get the prescription for the next day if there is not such a hurry. If she needs it now, I would contact other pharmacies. Yesterday I had a similar one: someone came in the morning asking for Concerta, I checked on the cabinet and I had some spare tablets, but when I checked the expiry date, the Concerta was out of date on December 2016. She told me that she did not mind that, but I told her that I couldn’t do that. I could get the Concerta in the evening delivery.”
“Big no to reusing returned medicines.”
“Alternatives are usually available. Although I spent far too long ringing around pharmacies last night for Ketorolac for injection. It’s on the stock list for the palliative care pharmacies, but none of them had it in stock.
“Inventiveness prevailed & naproxen was crushed & given orally in melted ice cream by syringe.”
“Absolutely not appropriate to use returned medicines. Sorry but no patient is worth me losing mine and my family’s livelihood.”
“You can always get stock from hospital in emergency.”
“There needs to be a better solution for this. District nurses should have palliative care medicines, then dilemma would not exist.”
We did not include a poll in this dilemma, however the consensus of those that commented or debated the issue was that to supply using returned diamorphine was not the best option. It appears that the majority of pharmacists would not be willing to act in this way. Join us next week for another pharmacy related dilemma situation.
- Note: the purpose of this dilemma is to present a case that may occur in practice; for you to consider what you would do if faced with it; and to encourage you to reflect on your decision. The possible answers are examples, and are not an exhaustive list of all the possible solutions.