Write down an ethical case report in word document by reviewing the following.
Errors in the pharmacy are inevitable and something that can’t be avoided, and this is why there must be adequate processes in place to ensure that they are recognised. When it is a recurring issue there is an ethical dilemma for a pharmacist such as myself, as I must choose whether it is appropriate to act or dismiss these errors. If I choose to act then I must do so in a way which results in the best outcome for everyone involved.
The whole pharmacy team is responsible for providing the right medicine to the right person at the right time and as pharmacists we are accountable for ensuring that this happens. We must be the final check that catches any and all mistakes. Most of the errors being missed are not the result of any particular dispensing staff but are the result of one particular pharmacist, a colleague, and possibly a friend. There don’t appear to have been any severe adverse effects yet but there are roughly 2 errors per week, which if it continues it is inevitable that something serious will occur. This is possibly as a result of negligence from the pharmacist in question or due to not enough pharmacists the handle the 2800 scripts dispensed each week. The quality assurance processes are clearly working as they have been able to identify the mistakes made, this is however too slow, as the patient may have already been harmed.
This is an issue, which concerns three other parties, the pharmacy owner, the patients and the pharmacist who is missing the errors. It is therefore important to do the right thing by each party ethically. Beneficence and nonmaleficence principles are most applicable to the patients; in this instance patients are the victims of maleficence as they are receiving the wrong medication so the act directly conflicts with a pharmacists obligation to do no harm and the principles of beneficence and nonmaleficence. The fidelity principle applies most to my colleague and boss, they should be made aware of the entire issue so they are able to actively address the issue and work to improve the outcome. By reporting what you know and trying to stop the errors I would be fulfilling my obligation as a pharmacist under the fidelity principle. Autonomy is not particularly relevant in this instance unless a patient asks not to have their medication dispensed by the pharmacist who made the mistake, in which case their right to choose their treatment and who provides it should be respected. Through the non-disclosure of the errors to the pharmacy owner, I could be seen as being dishonest and violating the principle of veracity. This is also relevant to any patients as their condition may be adversely affected. Their doctor and any other health professionals should be informed as they may need to take in to consideration any medication alterations which have occurred. Whether they are deliberate changes or accidental changes, if medication is being misused unintentionally there is a distinct possibility for direct harm to the patient which has the possibility to lead to death causing a breach of the avoid killing principle. Finally you must consider justice, the mistakes are serious and the person responsible should be made accountable but to what degree is the question, this is perhaps not an ethical dilemma for me but instead the pharmacy owner.
In my opinion there are three possible ways to approach this situation. I could accept that 2 out of 2800 scripts may not be accurately dispensed and ignore the issue, causing a conflict of essentially all the ethical principles. I could also just tell the pharmacist causing the problem and in doing so, abandoning the principle of fidelity and justice. This could be justified as possibly a first warning but your boss does deserve to know and the patients need to know so their treatment can be readjusted to avoid any harm as a result of the wrongly supplied medicine. The third option is to be open with the three other parties, the owner and other pharmacist need to know in order to make adjustments that may fix the problem in the future and the patient also needs to know to avoid the maleficence of being given the wrong medication.
To minimise any further mistakes a team approach is needed and so I think addressing everyone involved is the best way to move forward. This is the best way to abide by the ethical principles and get the best outcome for everyone involved. Patients can have their treatment readjusted, limiting any violation of the beneficence, nonmaleficence, fidelity and avoid killing principles. The pharmacist responsible also has a chance to reassess how they check scripts before they go out and work with the owner to improve their skills. This option may seem like a possible over reaction to the situation to some but as a trusted health professional, I don’t think we can be too careful with patient’s health.
Quality assurance is one of the main principals that must be followed while practicing pharmacy, and is expressed in a variety of ways. As a pharmacist, a component of the practice is to evaluate the dispensing errors that occur as a segment of the regular quality assurance process. In this scenario it was noted that approximately two dispensing errors were made weekly by the dispensing staff.
However, it appeared that one of the pharmacists was responsible for the majority of the dispensing errors that reached the patients, resulting in an ethical issue. As a pharmacist, I would be concerned about the integrity of my fellow colleague, yet based on the board’s guidelines I must prioritize the patient.
According to the Pharmacy board of Australia Code Of Conduct section 1.2 and the Pharmaceutical Society of Australia code of ethics principle 1, a pharmacist is obliged to make the wellbeing of the consumer their primary priority. Therefore as a pharmacist the beneficence of the patients that have received incorrect treatment is a concern. In order to avoid the patients from additional harm, further information regarding their health needs to be collected. Prior to any action, I would notify the manager about this issue and discuss supplementary procedures such as contacting the patients and notifying them of the problem. Intending to respect the patient’s veracity and fidelity, the pharmacy would inform them about the errors, acknowledge the mistakes, and comfort the patients by affirming that the prior will not be a problem in the future. In addition, a small discussion with the patients should take place in order to identify their health state and wellbeing, whether they have been suffering from any new symptoms or complications since they began taking the medicines and the duration of time in which they have been consuming the incorrect treatment. Accordingly, their doctor should be notified and the patients would either be advised to refer to their doctor as soon as possible or be admitted to the hospital in order to obey the ethical principle of avoid killing the patient. Consequently a regular follow up with each patient would be necessary in order to improve the non-maleficence of the patients.
Moreover, to ensure that these issues will not be taking place in the future and that the patients’ wellbeing will be maintained, the pharmacist responsible for these errors needs to be aware of their severity and express acknowledgement. In this scenario, an incidence report would likely be issued, however, according to the AHPR Guidelines for mandatory notifications, prior to the issuing of any report, there must be a reasonable belief, respecting the pharmacist’s right of justice.
In order to determine the appropriate course of action, further information regarding the pharmacist’s health would be required. This is essential as regardless of the reason behind this lack of efficient work, the pharmacist is posing a threat to the patients and may pose further harm. Consequently, the manager should be informed of the issues and perhaps place the pharmacist under observation in order to identify whether these errors were a result of a medical condition that causes cognitive impairment, alcohol or substance abuse, social or family issues, and/or work related stress. In addition, the frequency of this incidence should be put into consideration, as well as the pharmacist’s competence and working skills. If this error was a one-time slip and was not caused by a medical condition or abuse, then a simple warring would suffice. However, if the pharmacist’s ineffective behaviour persists causing a risk to the public, according to the AHPRA Guidelines for mandatory notifications principal 2 and Pharmacy Board Code Of Conduct section 8.3, a practitioner is obliged to file an incidence report to the board to which they will respond with information regarding further procedures.
In conclusion, reviewing dispensing errors is an essential component of quality assurance as it can detect incorrect dispensing of medications, which can be life threatening to patients. In this scenario the patients should be notified about this issue and treated based on their health state. Moreover, the pharmacist’s cognitive health should be assessed and investigated in order to justly respond to the pharmacist’s behaviour. If the pharmacist is suffering from a cognitive related medical condition, or is abusing alcohol or other drug substances, then the pharmacy should automatically contact the board. However, if this incidence was not caused by a lethal factor, the pharmacist will simply be given a warning otherwise an incidence report will be filed if the pharmacist persists on his improper behaviour. This would be the most appropriate course of action as this incidence puts the patients’ life at risk and violates the code of ethics and conduct for pharmacists.