By: Jim Fitzgerald, RPh
James Fitzgerald is a SUNY Buffalo School of Pharmacy graduate from the class of 1980. He is currently the supervising pharmacist at Pathmark Pharmacy of Baldwin in Long Island, New York. Mr. Fitzgerald is also a community pharmacy preceptor with St. John’s University and a longtime member of the Rho Chi Society.
There are many decisions that pharmacists must make each and every day at the pharmacy. Should I refill this narcotic prescription early? Did the physician evaluate the risk of a drug interaction when he or she wrote this prescription? The EpiPen Jr. prescription on file has no refills, but the patient’s mom says her child is having an anaphylactic reaction RIGHT NOW – do I refill it anyway? Of course, the first reaction in each situation is to contact the prescriber to get his or her authorization and input – but this approach frequently fails because the prescriber is not easily-accessible. Now what?
Many years ago, when I began working as a pharmacist, one of my patients was a medical malpractice attorney. When I first realized his occupation, I was somewhat apprehensive about filling his prescriptions – I feared that he would find some minor issue to litigate about. Over time, I developed a rapport with him, and as it turned out, he gave me a bit of advice that I use on a daily basis in my pharmacy practice. He advised: ask yourself, “Am I acting in the best interest of the patient? Would a reasonable person agree that the pharmacist treated the patient with his/her best interest in mind?” If the answer to those questions is yes, then document the facts and proceed. For example, in the case of the anaphylactic patient, I personally would dispense the EpiPen Jr. and also call for an ambulance. Additionally, I would also follow up with the patient’s pediatrician during normal business hours the next day.
The corollary to my patient’s advice was “never act solely on the profit motive, especially if it puts the patient’s wellbeing at risk.” The early narcotic refill (mentioned above) fits this scenario – filling the prescription would surely improve the pharmacy’s daily numbers, but could hurt the patient. As for the drug interaction risk mentioned above, that is often a tough call. The risk of delaying treatment has to be weighed against the risk of the interaction causing harm. Communication with the patient may help to clarify if the prescriber considered possible interactions. It is a tough judgment call, and just one of the many reasons why pharmacists are healthcare professionals and not merely medication dispensers.