Ethical Dilemmas and Dispensing Errors
8 minute read
What you will learn
- Describe a step-by-step way to approach an ethical dilemma
- Respond to common dilemmas in a pharmacy
- Explain what to do when a dispensing error is found
- Explain why errors must be reported and not hidden
- Describe ways of preventing errors
- Explain how pressure and conflicts of interest affect ethical decisions
Key points
- A dilemma is a situation where the right action is not obvious, or where two good aims conflict.
- Stop, gather the facts, think about who could be harmed, ask the pharmacist, decide, and record.
- If an error is found, protect the patient first, tell the pharmacist at once, and record what happened.
- Never hide an error. A hidden error cannot be corrected, and it can happen again.
- Most errors are caused by system problems, such as rush, tiredness and look-alike packs, not just carelessness.
- Pressure from customers, employers or sellers must not decide what is dispensed.
- Gifts and incentives that could influence choices must be declared or refused.
What is an ethical dilemma?
An ethical dilemma is a situation in which the right action is not obvious, or where two good aims conflict. For example, a patient wants a medicine, but supplying it might not be safe. Dilemmas are common, and a technician needs a method for dealing with them.
A method for dilemmas
- Stop and do not act in a hurry.
- Find the facts: what is being asked, and what is the risk?
- Think about who could be harmed, and who could benefit.
- Think of the principles: safety, honesty, fairness, privacy, the patient's choice.
- Check the rules: the law, the pharmacy's policy, your role.
- Ask the pharmacist. You are not expected to carry the decision alone.
- Act, politely and clearly.
- Record what happened, if it matters.
Common dilemmas at the counter
| Situation | A sound response |
|---|---|
| A customer asks for a prescription-only medicine without a prescription | Explain politely that it needs a prescription, offer to refer them to a doctor, and involve the pharmacist |
| A customer asks for antibiotics for a cold or fever | Explain that antibiotics may not help and can cause harm. Involve the pharmacist |
| Someone repeatedly buys large amounts of a medicine that can be abused | Tell the pharmacist. Do not make the sale without approval |
| A friend asks you to bend a rule | Treat friend and stranger the same. Rules are for safety |
| A patient cannot afford the full course | Tell the pharmacist. Do not hand out a partial or wrong course unless the pharmacist approves |
| The pharmacy is busy and queues are long | Do not skip checks. Ask for help or ask people to wait |
| A colleague is not following safe practice | Speak to the pharmacist or manager, in line with the pharmacy's policy |
| You find expired stock on the shelf | Remove it, record it, and tell the person in charge |
Pressure and conflicts of interest
Pressure can come from customers, employers, colleagues or the wish to make money. It must never decide what is supplied.
A conflict of interest is a situation where your own gain, or that of someone close to you, could affect your judgment about the patient's good. Examples:
- accepting gifts or payments to recommend a product;
- pushing a product because it gives a bigger profit;
- dispensing for family or friends in a way that breaks the rules.
When there is a conflict of interest, decline the gift, declare the situation, or ask the pharmacist to deal with it.
Dispensing errors
A dispensing error is a mistake in the process: the wrong patient, medicine, strength, form, dose, quantity, label or directions. Most errors are caught before they reach the patient. Some are not.
Common causes
- Rush, interruptions and heavy workload
- Tiredness
- Look-alike or sound-alike medicine names and packs
- Illegible prescriptions
- Poor storage, such as similar items side by side
- Skipping checks
- Poor communication
What to do when you find an error
- Protect the patient. If the medicine has already been handed out, tell the pharmacist at once, so that the patient can be reached and advised.
- Do not hide it or try to fix it quietly.
- Tell the pharmacist exactly what happened.
- Help get the right medicine to the patient as soon as possible.
- Record what happened, including what was dispensed, what should have been, and the actions taken.
- Look for the cause with the team, so it can be prevented. The aim is to learn, not to blame.
Be honest. An error reported early can usually be put right. An error that is hidden can harm the patient, and it usually costs a person their reputation when it comes out.
Preventing errors
| Measure | How it helps |
|---|---|
| Read the label three times | Catches wrong stock |
| Independent check by a second person | Catches mistakes the first person misses |
| Store look-alike medicines apart | Reduces mix-ups |
| Clear, legible labels and records | Reduces misreading |
| A calm, uncluttered workspace | Reduces slips |
| Ask when in doubt | Resolves unclear prescriptions |
| Counselling and teach-back at hand-over | The patient can spot an error |
| Keep to one patient at a time | Avoids mixing up labels |
Whistleblowing
If you see unsafe or unethical practice, such as selling expired products or serious misuse of medicines, report it to the pharmacist, the superintendent or the manager. If that fails, report it to the regulator. Speaking up protects patients, and doing so honestly and with facts is not disloyalty.
Exam focus
- State the steps in handling an ethical dilemma.
- State what to do immediately when a dispensing error is found.
- Give ways of preventing dispensing errors.
- Common mistake: trying to fix an error quietly instead of reporting it.
Quick check
Test yourself before you move on. Pick an answer to see the explanation.
1.You find that a patient was given the wrong strength of a medicine yesterday. What is the first priority?
2.Why should errors be reported and recorded?
3.Which of these helps prevent dispensing errors?
4.A customer who is angry asks for an antibiotic without a prescription and says 'I know what I need'. The best response is to:
5.A representative offers you a personal gift if you recommend his product. This is: