Pharmacists must not let standards slip

A disturbing statistic has emerged from an audit of the National Return of Unused Medicines (NatRUM) which indicates pharmacists may be letting their standards slip in some very important areas involving patient safety.
The audit shows that in 3.6% of the medicines collected under the National Return of Unused Medicines (NatRUM) scheme there was a labelling error. Put into simple terms this means there was a mismatch between the label and the contents in the package, bottle or container.
This simply should not be happening and any such errors should be picked up before the medicines leave the dispensary, either during the dispensing process or during the patient counselling.
Apart from the obvious patient safety issues inherent in such a mismatch, it indicates the process used by some pharmacists is not of the required standard.
The NatRUM audit states: ‘There have been a number of reported cases of selection errors due to pharmacists not using scanners which is considered poor professional practice by the Pharmacy Board of Australia and constitutes unprofessional conduct. The introduction of scanners was reported to have reduced selection errors from around 50% of reported errors prior to dispensing to less than 1% currently. The rate of labelling errors observed in this audit may indicate that not all pharmacists are using scanners as legally required.’
So concerned were the authors of the report that they recommended that this high error rate be communicated to key stakeholders in the profession, along with the need to adhere to mandatory dispensing practices. In addition to the obvious consequences of such an error, the legal ramifications are enormous.
Another important point raised by the audit was that nearly half of the medicines returned had not expired, with the authors stating that this was possibly an underestimation given that in-date medicines may have been put into bins and subsequently expired.
The reasons given by consumers for returning such medicines were concerns over their safety and efficacy, death of the person taking the medicines, a change in therapy and the consumer’s belief regarding the need to continue taking the medicines.
While death and change of therapy are outside a pharmacist’s scope, the safety and efficacy, and the need to continue taking their medicines appropriately, should be emphasised during counselling of the patient at the time of dispensing.
One of the strongest arguments pharmacy has to protect the integrity and viability of the community pharmacy network is the fact that pharmacists provide appropriate counselling to patients and customers and subsequent safety in the use of medicines. However, that argument loses much of its impetus and validity when we see statistics such as these. Pharmacists in all sectors of the health system have a responsibility to safety and quality use of medicines.
The audit called for greater research into the reasons consumers are returning their medicines and I believe such research would be very useful.
As a profession pharmacists also need to make customers aware of the NatRUM project. At present many medicines are disposed of in an unsafe or environmentally unfriendly manner such as down toilets or sinks.
The audit reported that every year in Australia, some 500 tonnes of medicines find their way into landfill and waterways. This has the potential for the development of cumulative long-term exposure of communities to trace amounts of drugs which is of particular concern to pregnant women or vulnerable cohorts in our society. The audit highlighted that the unsafe disposal of antimicrobials such as antibiotics, antivirals and antifungals, may also contribute to the development of antimicrobial resistance.
The dangers of such exposure are very real, with a number of international studies reporting altered behaviour, as well as sex changes, in fish resulting from drugs flushed or excreted into waterways.
Pharmacists do a very good job of alerting customers to the existence of the NatRUM project, as well as the location of bins. However they need to capture the attention of those who still dispose of their medicines unsafely and again educate them at the time of dispensing.
Our ever-growing ageing population, made up of many people with comorbidities and the likely resultant polypharmacy, means there will be an increasing need to ensure safe and environmentally friendly disposal of unwanted medicines.
All of the above issues can be addressed to a substantial degree by pharmacists adhering to good dispensing practice, and also speaking to and educating their customers in the pharmacy environment.
Grant Kardachi
Grant Kardachi was elected president of the Pharmaceutical Society of Australia after service as vice president and a board member for three years. He is a community pharmacist who recently sold his business interests but is still accredited to undertake medication reviews and sits on the Australian Association of Consultant Pharmacy.