In another case in 2006, Lloydspharmacy was sued for millions of pounds when one of its pharmacists accurately dispensed a prescription for dexamethasone 4mg, even though the PMR showed the patient had not previously been prescribed more than 0.5mg. The pharmacist had noted the increase in strength but concluded it was appropriate to make a supply because the prescription was within the therapeutic range referred to in the BNF. A high court judge decided that the pharmacist had been negligent, because once the pharmacist knew of the patient's recent medication history from the PMR, he should have questioned the strength of the dexamethasone before dispensing the prescription. Lloydspharmacy was held liable to compensate the patient. The prescriber was sued as well. When such errors occur, the prescriber is typically ordered to pay 60 per cent of any compensation to the patient, with the pharmacy owner paying the rest.
If, as has been called for, pharmacists are given access to patients' medical records, it will no doubt benefit patients and enable pharmacists to provide an even better standard of care. However, the duty of care pharmacists owe to patients will place a greater obligation on them to check the records and take them into consideration when exercising clinical judgement.
There will be no excuse for not consulting patient records and considering whether to question a patient or prescriber before deciding whether to make a supply of prescribed medication. With greater empowerment of pharmacists will come greater responsibility.
David Reissner is a pharmacy law specialist and head of healthcare at Charles Russell LLP. Contact him on 020 7203 5065, or at david.reissner@charlesrussell.co.uk
| Recent proposals to give pharmacists access to patients' medical records have reminded me of several cases I have been involved in regarding dispensing and prescribing errors. I once represented a pharmacist at a disciplinary hearing who had dispensed a prescription for 100mg sustained release morphine (MST) when the prescriber meant to prescribe 10mg. The patient had not used that particular pharmacy for some months so, wrongly, the pharmacist did not question the prescriber or patient on noting that the PMR did not show previous prescriptions for a strength of MST greater than 10mg. Sadly the patient died. The pharmacist received a reprimand. Many years ago, when a GP prescribed an overdose of Migril for a patient who was severely injured and a pharmacist dispensed the prescription accurately, the high court recognised the professionalism of pharmacists when ruling that they owe patients a duty of care to ensure that prescribed medication is appropriate for a patient, not merely that it is in accordance with a prescription. Mr Justice Stuart-Smith described it as an "active duty" that is independent of the duty of care owned by a prescriber. | |
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 The duty of care pharmacists owe to patients will place a greater obligation on them to check the records and take them into consideration |