My ze high

SimonH2 said:

Well a prescription I picked up recently was for 84 tablets. The tablets come in blister sheets of 10 from this particular vendor - IIRC different makes have come in different sized sheets. So I got a white box with 8 full sheets, and 4 cut from another sheet.

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Fair enough. Computerised prescribing attempts to avoid that situation, by trying to to constrain (or, at least, 'encourage'!) one to prescribe in quantities that correspond with available 'packs'. However, that doesn't always work because, despite 'encouragement' (I don't think there is yet any compulsion) different manufacturers may (although usually don't) produce different 'pack sizes'.

Although it involves the breaking of one of the tamper-proof seals (if present), the 'correct' (at least, usual) way of dealing with the situation you describe would essentially maintain 'Original Pack Dispensing', by cutting off the required number of blisters in one of the packs (but still leaving the remainder in the original pack). For example, if the most appropriate 'original pack' of your tablets contained '5 sheets' (i.e. 50 tablets), one would dispense one whole 'original pack', and a second pack from which one sheet had been removed and 6 blisters had been cut off one of the other sheets.

Pharmacists don't like cutting blisters off sheets, since (unless they break rules!) it loses them money. They obviously have to buy in products as whole sheets, but only get reimbursed (by NHS) for the number of tablets actually prescribed and dispensed. However, if one cuts a sheet of blisters into two parts, only one of the parts will still bear both the batch number and expiry date, so the other part has to (should be!) destroyed, since it should not be dispensed without that embossed information. That's lost money for the pharmacist - and, if it's an expensive drug, might be an appreciable loss, potentially in excess of the dispensing fee they get (i.e. they make an overall loss out of the exercise).

SimonH2 said:

As to the error I was describing, it was almost like having two systems even though they were in the same software package. One shows the prescriptions that have come in, the other shows the pharmacy record of what the patient gets. I.e., information from the GP does not update the pharmacy records. So when the prescribed medication changes, the pharmacist has to see that there's a change and transfer that change from one system to the other - there may be a process that handles this. The "missing link" is that the computer should be able to compare the two and highlight when (as in my mum's case) the prescription doesn't include something the pharmacy record says it is going to dispense.

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I'm still not totally clear. Are you simply saying that what was dispensed differed from what had been prescribed, perhaps because the current prescription differed from a previous one?

Kind Regards, John

JohnW2 said:

Are you simply saying that what was dispensed differed from what had been prescribed, perhaps because the current prescription differed from a previous one?

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Correct
An item had been stopped, and therefore wasn't on the next prescription - which appeared in one screen of the software.
Another screen of the software had a list of all medications previously or currently prescribed - with tick-boxes for the ones that should go in the packs. Someone failed to notice that an item was still ticked when it wasn't on the prescription, and so it got included.

As I mentioned, the pharmacists governing body were powerless to even "slag off" the software vendor for pushing out a package that seems purposefully designed to cause such errors. I would have thought the least they could do would be to include a notice in their next communication along the lines of "for all of you using xxxx package, we've been made aware of this scope for mis-dispensing" which would have put the software vendor in the position of either fixing their software or justifying the design.
All they could do was tell the pharmacist to "be more careful in future", which I think was addressing the symptom rather than the cause.

For good measure, mum also went into hospital shortly before this because of seasonal flu. On the ward, they took mum's packs away, and of course dispensed from their own stock. But they insisted on including this medication because it was listed on the pack - this was between it being stopped, and her packs running out. Both my brothers told them about this, but they refused to stop that medication even though it caused mum really bad diarrhoea. But when mum got the trots, they shoved her into isolation because they assumed she had an infection. So not only was she stuck in hospital, she was stuck in solitary as well.
It was a few days later before I could visit her, IIRC I'd had a cold/flu as well. I was ready to chew someone's backside off over this - but luckily for the ward staff, the ward pharmacists overheard the conversation and agreed the medication could be stopped.
Was was most annoying wasn't that they didn't take our word for it - but that they refused to accept that we could be telling the truth. So they never (for example) checked with the GP surgery.
Sadly, that ward "has a reputation", you don't willingly send relatives there.

SimonH2 said:

Correct. An item had been stopped, and therefore wasn't on the next prescription - which appeared in one screen of the software. Another screen of the software had a list of all medications previously or currently prescribed - with tick-boxes for the ones that should go in the packs. Someone failed to notice that an item was still ticked when it wasn't on the prescription, and so it got included.

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If I now understand you correctly, that does sound a bit daft. What is dispensed should be dictated by what is on the current prescription, regardless of what had or had not been previously prescribed, so I don't really understand why that "another screen" was necessarily presented at all, let alone used as something one had to tick/untick to determine the dispensing of the current prescription. Are you sure it was as you describe?

SimonH2 said:

For good measure, mum also went into hospital shortly before this because of seasonal flu. On the ward, they took mum's packs away, and of course dispensed from their own stock. But they insisted on including this medication because it was listed on the pack - this was between it being stopped, and her packs running out.

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That was surely the fault of the hospital prescriber (doctor, 'nurse prescriber' or whoever), wasn't it? No medicine (not even 'over-the-counter' ones) should be administered to a hospital patient unless such a 'prescriber' has 'written up' an 'inpatient prescription' for it. Patients often arrive at hospital clutching a bucketfull of medicines they've been taking, and it is very common for at least some of them not to be continued whilst they are in hospital - but that decision is down to the judgement and discretion of whoever prescribes what they are to receive whilst in hospital. Who, I wonder, prescribed this medicine that your mum shouldn't have been continuing to take?

Kind Regards, John

JohnW2 said:

Are you sure it was as you describe?

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Yup, absolutely

That was surely the fault of the hospital prescriber (doctor, 'nurse prescriber' or whoever), wasn't it?
...
Who, I wonder, prescribed this medicine that your mum shouldn't have been continuing to take?

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AFAICT, they simply took her pre-packs and dispensed what was listed on the sheet. As I say, they could have consulted the GP, especially after having it questioned - but no, they simply took what was on that list and weren't prepared to budge. But then, with the reputation that ward has, I am not in the least surprised.
In hindsight, if I hadn't been "somewhat underperforming" at the time due to my own medical and mental issues, I'd have kicked up a right stink about it - and I wish I had, but from memory I don't think I was in a fit state to do so at the time.

SimonH2 said:

AFAICT, they simply took her pre-packs and dispensed what was listed on the sheet. As I say, they could have consulted the GP, especially after having it questioned - but no, they simply took what was on that list and weren't prepared to budge.

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That was just plain wrong, then. What medicines are (or are not) administered to a hospitalised patient is entirely down to the clinical judgement of whoever does the hospital prescribing - so if something gets prescribed and administered that a patient should not have got, the responsibility for that remains fairly and squarely on the shoulders of the (hospital) prescriber.

However, having said that, to be fair, it is very understandable that what you describe happened 'in the first place', since it arose out a a pretty unusual situation. If I recall correctly, something like 50,000 people are admitted to UK hospitals every day, and a high proportion of them come clutching the medicines they have been receiving from their GP (or a list thereof).

Only a tiny proportion of those medicines will be ones that have been 'recently stopped' and, even in those cases, the patients concerned will often/usually be able and sensible enough to bring it to attention of the hospital staff. Such a problem could only be avoided (in the remainder) 'in the first place' by 'consulting the GP' in every case but, even if each call only took a couple of minutes or so (probably wishful thinking - it could take longer than that to get past the receptionist!), 50,000 phone calls per day would amount to best part of 2,000 man-hours per day of additional work!

What is seemingly wrong and inexcusable in your mum's case is that they did not 'consult the GP' (or whatever) when the problem was brought specifically to their attention - and that would have been just one phone call, not 50,000!

Kind Regards, John .