Ask a Pharmacist

It seems customers have lost the plot when it comes to owings. I am not sure if this is the same general term used overseas, but in Australia, when we give a few tablets to get someone by if deemed urgent enough if they don’t have a script (but we have evidence of their medication history), we give them an ‘owing’ (usually between one and three days supply).

Owings are a good backup system if a patient is in dire need of medication, so it could be deemed an emergency, but not enough to actually make the customer present to the ED because they haven’t got anymore glyceryl trinitrate patches and will be up all night with angina pains. This is something in the pharmacy we can fix. We know the patient has been using a certain strength for the past year on our records, and they state there has been no change in their therapy or condition, it would be reasonable to provide them with a patch until they can get their script from the doctor.

However, things have gotten slightly out of control, and many people feel that this is, for lack of a better word, their ‘right’, rather than at the discretion of the pharmacist as a professional decision. By this I don’t mean we decide whether in an emergency or not to help, but the issue is what most people’s definition is of an emergency does not really fit the bill, medically speaking. Additionally, presenting at a pharmacy that does not have their history, not having any evidence of their medication (old script, empty bottle), and not being able to contact their usual GP or pharmacy to check (normally the way it goes at night) prevents the pharmacist from giving out the medication. We cannot, with zero evidence, give out medication. These are the cases they may need to present to whatever clinic they can. For those readers who are thinking “That’s terrible is an emergency, you’re risking lives!”, well, if it’s a real emergency that means they need to be in an ambulance to the ER if they cannot get themselves to the doctor, and they may be in more trouble if the wrong medication is given.

If you are not a pharmacist or just new to the gig, you need to understand that your actions all have consequences. While in 90% of cases the customer accurately remembers which medication they are on, if you have no documented evidence, there is risk involved taking the patient’s word for it. If they mixed up their medication and there is a consequence of that, this is where the trouble arises. Not only did you play a part in enabling their mistake that caused harm, your profession standing is in question, maybe your license too. There are a series of questions you can ask the patient to determine if their word is enough to go on, it is better to be exhaustively sure. The old days of asking what shape/color to confirm they are talking about the one they think they are talking about is well gone, with a handful of generics per drug available now.

So the first problem is determining what the patient’s medication was, and what action you should take, do you give them the medication if you think they are clear on what they need, or do you refer them to a doctor, a possibly problematic process for the customer particularly when well into the night. The second problem, is dealing with patients when it is not an emergency situation.

If it’s not an (immediate) life threatening  situation, we are generally told owings are not the way to go. However, patients are beginning to expect them more and more. This has stemmed from pharmacists’ being overly helpful to their regular customers when they have forgotten to get a new script or suddenly realize theirs has expired (see my ‘Whipped’ post). The scenario goes “Sure, Mrs Forgetful, I know you’ve been on perindopril for years, just get that script back to me next time, dear, here you go!” I’m not saying that’s a bad thing, the problem is there is an expectation with some persons, say Mrs Forgetful for example, that any pharmacy she walks into she will receive the same “favor”. Not to sound callous but I don’t really care about the customer getting annoyed, it’s simply a side effect of doing your duty, what I care about is pharmacists getting bullied by customers and doing things they know they probably shouldn’t, but do it to get the customer out or simply due to the pressure or abuse leveled at them.

Stand tall, be firm, be direct. State that you are not allowed to give out a drug in this manner unless it is a medical emergency, and while it is an inconvenience to them, it does not validate it as a medical emergency. This isn’t a scaremongering post against owings, it certainly is a good measure to prevent certain cases of people going to the ER or clinic when there is an easy alternative, but it is not worth risking your registration because of a non-urgent case causing you to be bullied to hand over medication. Inform the patient you are not doing this simply because you do not feel like it, but you have to follow legislation and you have limits to what your are permitted to do. They may understand, they may not, but at least you are being honest and keeping to your professional obligations intact.

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This entry was posted on Saturday, January 30th, 2010 at 3:17 pm and is filed under News Posts. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.