s Dispensing Errors - What Real Protection for Employed Pharmacists? | I2P: Information to Pharmacists - Archive
Publication Date 01/07/2014         Volume. 6 No. 6   
Information to Pharmacists


From the desk of the editor

Welcome to the July 2014 homepage edition of i2P (Information to Pharmacists) E-Magazine.
At the commencement of 2014 i2P focused on the need for the entire profession of pharmacy and its associated industry supports to undergo a renewal and regeneration.
We are now half-way through this year and it is quite apparent that pharmacy leaders do not yet have a cohesive and clear sense of direction.
Maybe the new initiative by Woolworths to deliver clinical service through young pharmacists and nurses may sharpen their focus.
If not, community pharmacy can look forward to losing a substantial and profitable market share of the clinical services market.
Who would you blame when that happens?
But I have to admit there is some effort, even though the results are but meagre.
In this edition of i2P we focus on the need for research about community pharmacy, the lack of activity from practicing pharmacists and when some research is delivered, a disconnect appears in its interpretation and implementation.

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News Flash

Newsflash Updates for July 2014

Newsflash Updates

Regular weekly updates that supplement the regular monthly homepage edition of i2P. 
Access and click on the title links that are illustrated

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Feature Contribution

Woolworths Pharmacy - Getting One Stage Closer

Neil Johnston

It started with “tablet” computers deployed on shelves inside the retailer Coles, specifically to provide information to consumers relating to pain management and the sale of strong analgesics.
This development was reported in i2P under the title Coles Pharmacy Expansion and the Arid PGA Landscape”
In that article we reported that qualified information was a missing link that had come out of Coles market research as the reason to why it had not succeeded in dominating the pain market.
Of course, Woolworths was working on the same problem at the same time and had come up with a better solution - real people with good information.

Comments: 5

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Intensive Exposition without crossing over with a supermarket

Fiona Sartoretto Verna AIAPP

Editor's Note: The understanding of a pharmacy's presentation through the research that goes into the design of fixtures and fittings that highlight displays, is a never-ending component of pharmacy marketing.
Over the past decade, Australian pharmacy shop presentations have fallen behind in standards of excellence.
It does not take rocket science - you just have to open your eyes.
Recently, our two major supermarkets, Woolworths and Coles, have entered into the field of drug and condition information provision - right into the heartland of Australian Pharmacy.

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The sure way to drive business away

Gerald Quigley

I attended the Pregnancy, Baby and Children’s Expo in Brisbane recently.
What an eye and ear opening event that was!
Young Mums, mature Mums, partners of all ages, grandparents and friends……...many asking about health issues and seeking reassurances that they were doing the right thing.

Comments: 1

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‘Marketing Based Medicine’ – how bad is it?

Baz Bardoe

It should be the scandal of the century.
It potentially affects the health of almost everyone.
Healthcare providers and consumers alike should be up in arms. But apart from coverage in a few credible news sources the problem of ‘Marketing Based Medicine,’ as psychiatrist Dr Peter Parry terms it, hasn’t as yet generated the kind of universal outrage one might expect.

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Community Pharmacy Research - Are You Involved?

Mark Coleman

Government funding is always scarce and restricted.
If you are ever going to be a recipient of government funds you will need to fortify any application with evidence.
From a government perspective, this minimises risk.
I must admit that while I see evidence of research projects being managed by the PGA, I rarely see community pharmacists individually and actively engaged in the type of research that would further their own aims and objectives (and survival).

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Organisational Amnesia and the Lack of a Curator Inhibits Cultural Progress

Neil Johnston

Most of us leave a tremendous impact on pharmacies we work for (as proprietors, managers, contractors or employees)—in ways we’re not even aware of.
But organisational memories are often all too short, and without a central way to record that impact and capture the knowledge and individual contributions, they become lost to time.
It is ironic that technology has provided us with phenomenal tools for communication and connection, but much of it has also sped up our work lives and made knowledge and memory at work much more ephemeral.

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Academics on the payroll: the advertising you don't see

Staff Writer

This article was first published in The Conversation and was written by Wendy Lipworth, University of Sydney and Ian Kerridge, University of Sydney
In the endless drive to get people’s attention, advertising is going ‘native’, creeping in to places formerly reserved for editorial content. In this Native Advertising series we find out what it looks like, if readers can tell the difference, and more importantly, whether they care.
i2P has republished the article as it supports our own independent and ongoing investigations on how drug companies are involved in marketing-based medicine rather than evidence-based medicine.

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I’ve been thinking about admitting wrong.

Mark Neuenschwander

Editor's Note: This is an early article by Mark Neuenschwander we have republished after the soul-searching surrounding a recent Australian dispensing error involving methotrexate.
Hmm. There’s more than one way you could take that, huh? Like Someday when I get around to it (I’m not sure) I may admit that I was wrong about something. Actually, I’ve been thinking about the concept of admitting wrong. So don’t get your hopes up. No juicy confessions this month except that I wish it were easier for me to admit when I have been wrong or made a mistake.
Brian Goldman, an ER physician from Toronto, is host of the award-winning White Coat, Black Art on CBC Radio and slated to deliver the keynote at The unSUMMIT for Bedside Barcoding in Anaheim this May. His TED lecture, entitled, “Doctors make mistakes. Can we talk about it?” had already been viewed by 386,072 others before I watched it last week.

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Dispensing errors – a ripple effect of damage

Kay Dunkley - BPharm, Grad Dip Hosp Pharm, Grad Dip Health Admin, MPS, MSHPA

Most readers will be aware of recent publicity relating to dispensing errors and in particular to deaths caused by methotrexate being incorrectly packed in dose administration aids.
The Pharmacy Board of Australia (PBA), in its Communique of 13 June 2014, described a methotrexate packing error leading to the death of a patient and noted “extra vigilance is required to be exercised by pharmacists with these drugs”.
This same case was reported by A Current Affair (ACA) in its program on Friday 20 June

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Take a vacation from your vocation

Harvey Mackay

Have you ever had one of those days when all you could think was, “Gosh, do I need a vacation.”
Of course you have – because all work and no play aren’t good for anyone.
A vacation doesn’t have to be two weeks on a tropical island, or even a long weekend at the beach. 
A vacation just means taking a break from your everyday activities. 
A change of pace. 
It doesn’t matter where.
Everyone needs a vacation to rejuvenate mentally and physically. 
But did you also know that you can help boost our economy by taking some days off? 
Call it your personal stimulus package.

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Explainer: what is peer review?

Staff Writer

This article was first published in the Conversation. It caught our eye because "peer review" it is one of the standards for evidence-based medicines that has also been corrupted by global pharma.
The article is republished by i2P as part of its ongoing investigation into scientific fraud and was writtenby Andre Spicer, City University London and Thomas Roulet, University of Oxford
We’ve all heard the phrase “peer review” as giving credence to research and scholarly papers, but what does it actually mean?
How does it work?
Peer review is one of the gold standards of science. It’s a process where scientists (“peers”) evaluate the quality of other scientists' work. By doing this, they aim to ensure the work is rigorous, coherent, uses past research and adds to what we already knew.
Most scientific journals, conferences and grant applications have some sort of peer review system. In most cases it is “double blind” peer review. This means evaluators do not know the author(s), and the author(s) do not know the identity of the evaluators.
The intention behind this system is to ensure evaluation is not biased.
The more prestigious the journal, conference, or grant, the more demanding will be the review process, and the more likely the rejection. This prestige is why these papers tend to be more read and more cited.

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Dentists from the dark side?

Loretta Marron OAM BSc

While dining out with an elderly friend, I noticed that he kept his false tooth plate in his shirt pocket. He had recently had seven amalgam-filled teeth removed, because he believed that their toxins were making him sick; but his new plate was uncomfortable. He had been treated by an 'holistic dentist'. Claiming to offer a "safe and healthier alternative" to conventional dentistry, are they committed to our overall health and wellbeing or are they promoting unjustified fear, unnecessarily extracting teeth and wasting our money?

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Planning for Profit in 2015 – Your key to Business Success

Chris Foster

We are now entering a new financial year and it’s a great time to reflect on last year and highlight those things that went well and those that may have impacted negatively in the pursuit of your goals.
It's also a great to spend some time re-evaluating your personal and business short, medium and long term goals in the light of events over the last year.
The achievement of your goals will in many cases be dependent on setting and aspiring to specific financial targets. It's important that recognise that many of your personal goals will require you to generate sufficient business profits to fund those aspirations

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ReWalk™ Personal Exoskeleton System Cleared by FDA for Home Use

Staff Writer

Exoskeleton leader ReWalk Robotics announced today that the U.S. Food and Drug Administration has cleared the company’s ReWalk Personal System for use at home and in the community.
ReWalk is a wearable robotic exoskeleton that provides powered hip and knee motion to enable individuals with Spinal Cord Injury (SCI) to stand upright and walk.
ReWalk, the only exoskeleton with FDA clearance via clinical studies and extensive performance testing for personal use, is now available throughout the United States.

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Attracting and Retaining Great People

Barry Urquhart

Welcome to the new financial year in Australia.
For many in business the past year has been described as a challenging period.
Adjectives are a key feature of the English language.  In the business lexicon their use can be, and often is evocative and stimulate creative images.  But they can also contribute to inexact, emotional perceptions.
Throughout the financial pages of newspapers and business magazines adjectives abound.
References to “hot” money draw attention and comment.  The recent wave of funds from Chinese investors, keen to remove their wealth from the jurisdiction and control of government regulations is creating a potential property bubble in Australia.

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Updating Your Values - Extending Your Culture

Neil Johnston

Pharmacy culture is dormant.
Being comprised of values, unless each value is continually addressed, updated or deleted, entire organisations can stagnate (or entire professions such as the pharmacy profession).
Good values offer a strong sense of security, knowing that if you operate within the boundaries of your values, you will succeed in your endeavours.

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Evidence-based medicine is broken. Why we need data and technology to fix it

Staff Writer

The following article is reprinted from The Conversation and forms up part of our library collection on evidence-based medicines.
At i2P we also believe that the current model of evidence is so fractured it will never be able to be repaired.
All that can happen is that health professionals should independently test and verify through their own investigations what evidence exists to prescribe a medicine of any potency.
Health professionals that have patients (such as pharmacists) are ideally placed to observe and record the efficacy for medicines.
All else should confine their criticisms to their evidence of the actual evidence published.
If there are holes in it then share that evidence with the rest of the world.
Otherwise, do not be in such a hurry to criticise professions that have good experience and judgement to make a good choice on behalf of their patients, simply because good evidence has not caught up with reality.

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Laropiprant is the Bad One; Niacin is/was/will always be the Good One

Staff Writer

Orthomolecular Medicine News Service, July 25, 2014
Laropiprant is the Bad One; Niacin is/was/will always be the Good One
by W. Todd Penberthy, PhD

(OMNS July 25, 2014) Niacin has been used for over 60 years in tens of thousands of patients with tremendously favorable therapeutic benefit (Carlson 2005).
In the first-person NY Times best seller, "8 Weeks to a Cure for Cholesterol," the author describes his journey from being a walking heart attack time bomb to a becoming a healthy individual.
He hails high-dose niacin as the one treatment that did more to correct his poor lipid profile than any other (Kowalski 2001).

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Culture Drive & Pharmacy Renewal

Neil Johnston

Deep within all of us we have a core set of values and beliefs that create the standards of behaviour that we align with when we set a particular direction in life.
Directions may change many times over a lifetime, but with life experiences and maturity values may increase in number or gain greater depth.
All of this is embraced under one word – “culture”.
When a business is born it will only develop if it has a sound culture, and the values that comprise that culture are initially inherent in the business founder.
A sound business culture equates to a successful business and that success is often expressed in the term “goodwill” which can be eventually translated to a dollar value.

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ReWalk™ Personal Exoskeleton System Cleared by FDA for Home Use

Staff Writer

Exoskeleton leader ReWalk Robotics announced today that the U.S. Food and Drug Administration has cleared the company’s ReWalk Personal System for use at home and in the community.
ReWalk is a wearable robotic exoskeleton that provides powered hip and knee motion to enable individuals with Spinal Cord Injury (SCI) to stand upright and walk.
ReWalk, the only exoskeleton with FDA clearance via clinical studies and extensive performance testing for personal use, is now available throughout the United States.

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Pharmacy 2014 - Pharmacy Management Conference

Neil Johnston

The brave new world of health and wellness is not the enemy of Pharmacy, it is its champion.
Australian futurist, Morris Miselowski, one of the world's leading business visionaries, will present the Opening Keynote address on Pharmacy's Future in the new Health and Wellness Landscape at 2.00pm on Wednesday July 30.
Morris believes the key to better health care could already be in your pocket, with doctors soon set to prescribe iPhone apps, instead of pills.
Technology will revolutionise the health industry - a paradigm shift from healthcare to personal wellness.
Health and wellness applications on smartphones are already big news, and are dramatically changing the way we manage our personal health and everyday wellness.

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Generation and Application of Community Pharmacy Research

Neil Johnston

Editor’s Note: We have had a number of articles in this issue relating to pharmacy research.
The PGA has conducted a number of research initiatives over the years, including one recently reported in Pharmacy News that resulted from an analysis of the QCPP Patient Questionnaire.
Pharmacy Guild president, George Tambassis, appears to have authored the article following, and there also appears to be a disconnect between the survey report and its target audience illustrated by one of the respondent comments published.
I have asked Mark Coleman to follow through, elaborate and comment:

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Dispensing Errors - What Real Protection for Employed Pharmacists?

Peter Sayers

articles by this author...

Peter Sayers is vitally concerned about pharmacy professional practice - its innovation, its research and development, and its delivery to create an ongoing revenue stream. Delivery of healthcare is increasingly involved with Information Technology systems. All perspectives in IT must be considered for the impact on pharmacy practice and its viability.

PJ Online, the UK pharmacy publication has published a recent news item relating to dispensing errors. It is actually part of an ongoing commentary that started when UK pharmacist Elizabeth Lee was prosecuted for an error that resulted in the death of a patient.
She did not dispense the prescription (but was pharmacist in charge) nor could a court determine who had actually dispensed the prescription.
Elizabeth Lee was working long hours due to the fact that two pharmacists were not on duty and management had not replaced them.
She was working 10 hour shifts under near impossible safety conditions in a corporate chain environment.

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The Medical & Healthcare products Regulatory Agency is finally undertaking a review of current medicines legislation with the view to remove the process of criminal prosecution in cases of dispensing errors.
They will only be pursued in cases where a health professional has acted with intent or negligence.
This follows on from an unjust prosecution against a UK pharmacist (see Elizabeth Lee go to http://www.i2p.com.au/article/ordeal-uk-pharmacist-ends ) and later, a report from the US involving a serious dispensing error there (see Eric Crop- go to http://www.i2p.com.au/article/time-review-dispensing-error-processes).

In both instances the legal system treated these pharmacists rather shabbily and again, in both instances, major workplace disruptions and delegations beyond their control were found to be major contributors to the errors.
Yet only the dispensing pharmacists were targeted – not the business owners.

The MHRA is seeking views on its proposals as part of an ongoing review of current medicines legislation. It wants to change the law to ensure that prosecution is proportionate and does not compromise patient safety or public health.

Using an informal consultation process, the agency proposes changes to three sections of the Medicines Act 1968 relating to dispensing errors which, if breached, can currently attract a two-year imprisonment or a fine.
The MHRA proposes to amend section 64 of the Medicines Act 1968, which stipulates that medicinal products must be “of the nature or quality demanded by the purchaser”, as well as sections 85 and 86 which say that information on labels, containers and medicine information leaflets must not falsely describe the product or mislead as to its nature, quality, uses or effects.

 The possibility being considered is whether these provisions should be amended so that, where the defendant is a regulated healthcare professional, an offence is only committed if they are found to have acted with intent or negligence.

A single comment posted to PJ Online stated:
“Any dispensing error whereby the wrong product/label/directions etc are supplied would be a negligent act.  All dispensing errors would amount to negligent acts.  The mechanisms to prosecute for negligence are clearly intended to remain in place.  What changes in the law, therefore, do they propose to make if the intention is to prevent prosecution for dispensing errors?”

What are your thoughts on the matter?
Record them in the panel at the foot of this article.

In an earlier Pharmedia article, comments made by Mark Coleman have yet to be taken up and incorporated into an Australian debate on this issue.
The issue of criminality for dispensing errors still remains in Australia, and the issue of employee pharmacist protection and representation may also be problematic, particularly if the complainant holds both the employee and the employer jointly and severally liable.
That could quickly develop into a "blame-game" with the employer holding the employee totally responsible.

If the PSA has the backbone, it should immediately tackle this problem.
However, it may be seen as confrontational by the PGA if the PSA develops a separate professional indemnity coverage to suit employed pharmacists and contractors.
But that should not be seen as a deterrent.

Given that the PSA is now a national body here is a clear example of where that organisation should step in and provide a a range of defence options specifically designed for the needs of employed or contractor pharmacists.
It also should be lobbying to safeguard the interests of all employed pharmacists in the legislative area and to ensure that workplace conditions be part of any future investigation and subsequent prosecution in a joined capacity. Dispensing errors should be decriminalised if they are genuine errors.

Automated dispensing processes may reduce the total number of actual errors, but they also creates “distance” between the dispensed medicine and the pharmacist because he/she is not present at all critical points throughout dispensing. Thus when an error occurs, it is not as likely to be picked up easily and the potential for prosecution may actually increase.

The fact that pharmacists in Australia have not had the distressing legal problems of their UK and US counterparts is more down to good luck rather than good management.

We are an accident about to happen.

Editor's Note:
PDL is the primary organisation involved with pharmacist professional indemnity insurance.
PDL works closely in alliance with Guild Insurance Ltd to provide its service and has furnished the following information to i2P.

"PDL is a company by Guarantee owned by its pharmacist members.
PDL arranges professional indemnity cover for pharmacists irrespective of their area of practice or position. All PDL members receive the same protection and personal service when an incident is reported. There is no discrimination between members.
Of the approximately 26,000 PDL members approximately 20,000 are non-proprietors.

PDL is unique in its service to members offering pastoral care through peer group support to any member reporting an incident. Coupled with this is first class insurance by PDL's underwriters, Guild Insurance.

PDL invests much time and funding in the area of risk management.
PDL works very closely with Guild Insurance to minimise the potential for error. Many factors contribute to a dispensing error, including suitable workplace conditions. PDL recently put up seeding funding of $300,000 to a consortium of universities in Victoria, NSW and SA for research in errors and near misses in a pharmacy.

On the subject of scanners in the dispensary, prior to their introduction approximately 50% of reported incidents to PDL were due to the wrong selection of medication or wrong strength of correct medication. It is pleasing that scanners are mandated Australia wide since National Registration was introduced on the 1st July 2010.

A registered pharmacist is responsible for the direction oif pharmacist staff, not a non-pharmacist.
If a retail manager is a non-pharmacist he/she is not responsible for any task or action that is performed under the Pharmacy Act or any Pharmacy Authority."

Return to home

Submitted by Gerald Quigley on Tue, 07/12/2010 - 12:44.

"There,but for the grace of God go I"....are the pressures of dispensing, under sometimes unprofessional workplace conditions, leading to an increased risk of this happening here, with the inevitable consequences?

Submitted by Kay Dunkley on Tue, 07/12/2010 - 11:30.

Employed or contractor pharmacists in Australia should have their own indemnity insurance to protect them 24 hours a day 7 days a week. PDL offers this at a very reasonable rate and provides excellent support to pharmacists both colectively and indvidually. There is no need for additional services in this area.

Submitted by Peter Sayers on Tue, 07/12/2010 - 15:27.

Hi Kay,
The requirement for registration these days is that all pharmacists carry professional indemnity.
The point I was trying to make was that the PGA are a trade union of employers and are charged with representing their members- a job they do very well.
So where does this leave the employee pharmacist in the event of a major catastrophe where the primary problem may have been workplace conditions?
The PGA is not charged to assist employee pharmacists and if push came to shove, may just happen to give support to their owner-member at employee expense.
Can't happen?
The reality may be different when the chips are down.
I believe pharmacist employees/contractors should insure with an "arms-length" insurer.
Some serious stuff went down in the UK and the US and pharmacy owners were very much part of the problem, but none of the solution.

Peter Sayers

Submitted by Kay Dunkley on Wed, 08/12/2010 - 08:00.

Hi Peter,
I am an employed pharmacist working in a public hospital environment. I have always had my own indemnity cover. However if workplace conditions caused my error (and this is just as likely in a public hospital environement as in a community environment) I would expect PDL and the appointed legal advisor to represent me.
I fully agree that workplace conditions need to be addressed, especially in the current environment of an over supply of pharmacists. The Pharmacy Board of Australia has provided guidelines and PSA provides professional standards. In Victoria I would expect the new Pharmacy Workplace Authority to ensure that these were applied. The other professional bodies (SHPA, PSA, Pharmacists' Division of APESMA etc) also have a responsibility in this area. However we do not need additional indemnity insurers to do this.


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