A common scenario: you are unwell and have waited an hour at the doctors for an appointment and now face another 15 or twenty minutes wait at the pharmacy while they get your prescription ready. Why can’t the pharmacist work a bit quicker so that you can get home ASAP? There are a few very good reasons why…
What is the pharmacist actually doing back there??
It’s not uncommon for pharmacists to be asked, “Why can’t you just put the sticker on and give it to me?” by patients who aren’t keen on waiting while their medicines are dispensed. There are actually a multitude of steps that take place both before and after a medicine label is placed on your medicine, to ensure that it can safely be handed out. The pharmacist is responsible for getting it right because the wrong medicine or wrong dose has the potential for dire consequences.
Pharmacies are extremely busy places of work. Dispensary staff (pharmacists and pharmacy technicians) multi-task all day long and there are many interruptions such as phone calls, consultations with people wanting to speak to the pharmacist for health advice, requesting a pharmacist-only or over-the-counter medicine, not to mention the other services a pharmacy may provide like vaccinations, emergency contraceptive pill consultations and anti-coagulant monitoring. It may look like there are a lot of staff behind the counter but that’s because there is a lot of work going on – prescriptions can pile up quickly, especially after a weekend or before a holiday period.
Pharmacy technicians help the pharmacist by entering patient details in the computer, generating labels and selecting and preparing each medicine. However, a pharmacist is the only one in the pharmacy that is qualified to do a clinical check of every medicine on a prescription. This has to be done before the medicines can safely leave the pharmacy, and it takes time.
Issues with prescriptions
• Sometimes a prescription may have arrived at the pharmacy but has missing or incorrect information. The missing information can sometimes be obtained from the patient, but at other times the pharmacist will need to get information from the prescriber. This can take time, especially if it is a hospital prescriber – it can take a few days to hear back from them!
• Quite often pharmacists will pick up mistakes (prescribers are human, and occasionally make errors). The pharmacist may need to speak directly with the prescriber to clarify a prescription.
• Handwritten prescriptions (most are now sent via email) can be hard to read and the pharmacist may need to call the prescriber to check.
• Another reason you may have to wait for a medicine or come back another day is if the pharmacist has to order your medicine. Unfortunately, pharmacies aren’t able to keep every medicine in stock, especially those that are rarely prescribed or are expensive. They will have to order these medicines from the wholesaler once the prescription is presented. These usually arrive the next day.
What does the pharmacist check?
The pharmacist undertakes a clinical check for every medicine on the prescription. This means they look for drug-drug interactions and drug-disease interactions. They look at the patient history to see if the patient has had this medicine before, is it a changed medicine, is it appropriate, do the dose, quantity, and directions make sense? It is very important to review the patient’s medication history, especially if the patient has multiple prescribers as they are not always aware of all the medicines the patient is taking. Prescriptions are checked for legality, patient eligibility, accuracy and whether it is clinically appropriate. Once all these checks are made the pharmacist then has to check the medicines themselves – has the correct medicine at the correct dose been selected, labelled correctly for the right patient and drug, is the correct quantity of medicine in the container and are label instructions accurate? Even bagging the prescription is an involved process, as all of the pharmacist-checked medicines need to make it into the right bag for the right patient!
Out-of-stock medicines and drug shortages
Medicine shortages are a global issue right now because of increased demand, higher quality standards and fewer manufacturing sites. Medicines come from a global supply chain. The raw ingredients are made in one country, processed into medicines in another country, sometimes packaged in another country and then freighted by sea or air. Any break in one of these steps in the supply chain can mean that a medicine goes out-of-stock. The Covid pandemic was a challenge for the global medicine supply chain and is still having an effect. A current example of this in New Zealand is the shortage of estrogen patches for HRT treatment.
Doctors are not always aware of medicines that are out of stock and carry on prescribing them. Pharmacists may have to go back to the doctor to change the prescription to provide the patient with an alternative brand or new medicine altogether. Sometimes a pharmacist can dispense a different strength of the same medicine or dispense a smaller quantity until the shortage is over.
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