Ethical Dilemma in Pharmacy Practice

SulmanAshraf17908536

Ethics in Pharmacy Practice: Pharmacistsareanimportantpartofhealthcaremultidisciplinaryteamensuringthatmedicinesareusedinthesafestandmosteffectiveway.Itissignificantthatpharmacistsalwaysmaintaintheirprofessionalintegrityandattempttoprovidethebestservicetotheirpatients.(5)

For professional decision making, we need to follow suggested frameworkwhichinvolvesdifferentstepsbeforemakingafinalconclusion.Thisframeworkrevolvesaroundfour-stepsapproach:(4)

1. Gatherrelevantfacts2. Prioritiesandascribevalues3. Generatearangeofoptions4. Chooseanoption

WhatissuesshouldIconsider?(4)

Lawrelatingtoresponsiblepharmacist. Key responsibilities and standards of professional performance in thecodeofEthics.

Principlesofnegligence. Interestofstaffandgeneralpublic AwarenessofSOP’sregardingdosetteboxes Controlleddrug’scupboardkeycontrol

Weneedtolookintothese4stepsforourfinaldecisions.

Step1:Gatherrelevantfacts:

Thisstephasbeenbrokendownintofurtherstepsandweneedtocheckifthesestepsappliesinourcase.

1. Whatcriminallawsapply: TheMisuseofDrugs(SafeCustody)Regulations1973asamendeddetailsthestorage and safe custody requirements for Controlled Drugs. TheMisuse ofDrugsRegulations2001(andsubsequentamendments)definestheclassesofpersonwhoareauthorisedtosupplyandpossessControlledDrugswhileactingintheirprofessionalcapacities.(6)Methadoneisschedule2controlleddrugandpossession; supply andprocurement is authorised forpharmacists andotherclasses of persons named in the 2001 Regulation. Furthermore, under themisuseofdrugs(safecustody)regulations1973,(6)methadoneisrecommendedtobekeptinsafecustodyunderthedirectsupervisionofapharmacistduetopotentialmisuse.ItisillegalforpharmacystafftoopentheCDcupboardwithouttheauthorisationofthepharmacist.AccordingtoHumanMedicinesregulation2012,itisagoodpracticetoassembleanddispensemedicinesinthepresenceof the pharmacist and if there is any patient’s harm due to the incorrectdispensingofmedicine,thenpharmacistisheldresponsibleandhemayhavetofacefitnesstopracticecommittee.(7)

2. Whatadministrativelawsapply:

Thetermsofpharmacyservicesregardingopeninghoursandenhancedservicesare set out in schedule 4 ofNHS (Pharmaceutical and Local PharmaceuticalServices)Regulations2013.NHScommunitypharmacycontractservicesapplyinthiscaseastheymusthavecontractedhoursundertheNHSregulations2013andunabletoopenthepharmacywithoutcontractedhours.Furthermore,theymust have signed up for essential services which are commissioned by NHSEngland. Under section 72A of The Medicine (Pharmacies) (ResponsiblePharmacist)Regulations2008,responsiblepharmacistshouldcomplywithlegalduty of the pharmacy procedure. (2) Administrative law does not apply in this case.

3. Whatcivillawsapply: Pharmacisthasadutyofcaretowardsthepatientsanditshouldbemaintainedatalltimes.Inthiscase,ifpharmacistdecidedtoremotelyloginasaresponsiblepharmacistwithouthispresenceandpharmacystaff can dispense methadone and dosette boxes thenhe is not awareof right strength, right quantity andstabilityofthedrug.Pharmacistshouldbeexpectedtorecogniseanypotentialharmtothepatientandincaseofanydispensingerror,pharmacistisdeemedtobenegligent.Toprovenegligence,threecriteriashouldbemet-dutyofcare,pharmacistfailtomeethisdutyandpatientharm.

4. Whatprofessionalstandardsandguidanceapply: GPhC has produced 9 standard which every pharmacy professional has tocomplywith.Outofthese9standardsonlystandard8appliesinthisscenario.Standard8statesthat“Pharmacyprofessionalsmustspeakupwhentheyhaveconcernsorwhenthingsgowrong” (1)Atalltimes,pharmacistshouldbeadheredtostandard8andspeakupifthereisanythinggoeswrong.Asmentionedbytheareamanager,previouslocumwasremotelyloginasaresponsiblepharmacistandall dispensing of methadone and dosettehasbeendonewithouthispresence.Thisisnotagoodpracticeandcancausepatient’sharmsoitshouldbechallengedandcanbereportedtorelevantauthoritye.gGPhC. Inthisscenario,wehavetheoptiontospeaktotheareamanageraboutthepoorpracticeandbehaviourandshouldmakethingscorrectinordertoimprovethequalityofcareandpharmacypractice.

GPhCguidanceforResponsiblepharmacist:GPhC has produced a guidance for responsible pharmacistwhich states that“securingthesafeandeffectiverunningoftheregisteredpharmacy.” (3)Thereare certain activities which can be done in the absence of the responsiblepharmacist and they are laid out in Appendix A of the GPhC guidance forresponsiblepharmacist.Inordertosecurethesafeandeffectiverunningofthepharmacybusiness,responsiblepharmacistmustbesignedin,displayhisnoticeboardandpersonallysatisfiedabouteffectiverunningofthepharmacy.Dosetteboxdispensingcanbedoneintheabsenceofthepharmacistbutifthereisanyrisk of dispensing error then this activity should be avoided. DispensingmethadoneandaccessingCDcupboardwithoutpharmacist’spresence isnotmentionedintheappendixAsoconductingthisactivity would be considered as illegal. (3)

5. WhereelsecanIlookorwhocanIaskforhelp:In this scenario, I can read about legislative laws, GPhC standards andresponsiblepharmacistguidanceinordertobefullysatisfiedbeforemakinganydecision.IcanalsocontactRPSforanyprofessionaladvice.Step2:PrioritiesandAscribevalues:

a. Patientandcarers:PatientisalwaysmyfirstpriorityandanydecisionImadeshouldnotharmpatient.Inthisscenario,ifpharmacystaffdoes not dispense dosetteboxesandmethadonethenitcanaffectpatiente.gmethadonepatientcanbeagitatedfornotgettingmethadoneontime.Furthermore,ifthereisanyurgentdosetteboxforthesamedaythenpatientwouldnotbe abletogetitontimeandwouldmissdose.Moreover,patient’scarercollectingdosette box on behalf of patientmight have towait longerwhich canaffecttheirschedule.

b. Otherhealthcareprofessionandyourprofession:

My ultimate concern is to provide person-centred care and I shouldensurethatintegrityofpharmacyprofessionshouldbemaintainedatalltimes.Becauseofmydecisions, if patientdon’t getmedicineson timetheycanlosetheirtrustonthepharmacy.Theycanalsocomplaintotheirdoctorandpharmacyprofessioncanbeinquestion.

c. Yourstaff,youremployer:

Because of my decision, there is possibility that employer can have financial impacton thebusinessandcan lose trustonmyprofessionalabilities.IfIfailtofollowmyareamanager’sinstruction,Iwouldbeheldaccountable for my actions and I have duty to maintain people’sconfidenceonmyemployerandprofession.Mycolleaguemightnotbeabletoworkearliersomightbehesitanttowork with me.

d. Yourself:

Asmentionedearlier,Ihavedutytomaintainpeople’sconfidenceonmyprofession whilstreducingpatient’sharm.Becauseofmyactions,Imightbeabletogetregularworkordon’tgetworkinthefutureatall.IneedtomakesurethatIamnotbreakinganylawandIwouldnotbepunishedforbeingnegligent.

Step3:Generatearangeofoptions:There are different options which we can generate in order to make finaldecision.Option1:RefusaltologininremotelyasaResponsiblePharmacist IfIrefusetologininremotelyasaresponsiblepharmacistthenIneedtoseetheimpactonthepatient.Becauseofmyaction,methadonewouldnotbedispensed on time and patient would be agitated. Pharmacy would havefinanciallossbecauseofdelayedservices.IwouldnotbeabletogetanylocumworkinthispharmacyinfuturebutIwouldcovermyselffornotbreakinglawandbeingnegligentinprovidingpatientcare.Option2:Recommendingareamanagertostartshiftearlier Anothergoodoptionistogiveoptiontoareamanagerforstartingshiftearlieri-estartworkat8aminsteadof9am.Inthiscase,methadonewouldbedispensedand checked on time and urgent dosetteboxesforthatdaywouldbeeasily dispensed and checked. I would not be breaching any NHS contractservicesor laws.Managementonlyneed topay foranhourextrapaywhichwouldbenothingconsideringanyfinancial.Inthiscase,benefitwouldoutweighriskwithoutcompromisingpatientharm.

Option3:Refusaltoworkasapharmacist BecauseoftheunawarenessoflocalSOP’sandstaffskills,Icanrefusetoworkasapharmacist.Inthiscase,Iwouldnotcompromisemydutyofcareandareamanagerstillhave time to find an alternative.Option4:Agreetoworkasperareamanager’sinstructions If Ichoosetoworkasperareamanager’s instructions,thenIwouldbeheldaccountableformyaction.Methadone is a controlleddrugandaccessofCD cupboardkeys inpharmacist’s absence is criminaloffence. If there is anydispensing error, then I would be held accountable and can face fitness topracticecommittee.Onlyadvantageisthatpatientwouldgetmedicationsontimeandareamanagerwouldgivelocumworkinfuture.Option5:Advancedispensingofmethadone: PharmacycandispensemethadoneadayadvancebutifCDcupboardisnotbigenoughtokeepallbottlesthenstoragewouldbeanissue. Step4:Chooseanoption: After careful consideration of the scenario and reviewing all laws andguidance,Ihavecometoconclusiontochooseoption2whichisproposingareamanagertostartworkanhourearlier.ThisisoneofthesafestoptionswhichisnotbreachinganylawandNHScontract.Patientwouldhavesameconfidenceonthepharmacyandallmedicationsincluding methadone would be suppliedontime.Word count with scenario & references: 1760 Word count without scenario & references: 1650 References:

1. General Pharmaceutical Council. Standards for pharmacy professionals.https://www.pharmacyregulation.org/sites/default/files/standards_for_pharmacy_professionals_may_2017_0.pdf (accessed 04 March 2018).

2. General Pharmaceutical Council. Responsible Pharmacist. https://www.pharmacyregulation.org/responsible-pharmacist (accessed 04 March 2018).

3. General Pharmaceutical Council. Guidance for Responsible Pharmacists. https://www.dispensingdoctor.org/wp-content/uploads/2015/02/GPhC-Responsible-pharmacist-guidance.pdf (accessed 03 March 2018).

4. Wingfield J, Badcott D. Pharmacy Ethics and Decision Making, 1st ed. London: Pharmaceutical Press; 2007.

5. Smith Y. Ethics in Pharmacy. https://www.news-medical.net/health/Ethics-in-Pharmacy.aspx (accessed 05 March 2018).

6. NICE. Controlled drugs and drug dependence. https://bnf.nice.org.uk/guidance/controlled-drugs-and-drug-dependence.html (accessed 05 March 2018).

7. MHRA. The Human Medicines Regulations 2012. http://www.mhra.gov.uk/home/groups/comms-ic/documents/websiteresources/con179735.pdf (accessed 06 March 2018).