Dealing with Patient Prescribing Requested

The Dilemma

You are a pharmacist prescriber who runs a clinic for a local surgery, specialising in respiratory medicine (ie asthma/COPD patients). A patient come to the pharmacy for an annual review of their condition, and you have access to their medical notes so are aware of their co-morbidities and regular repeat medication. At the end of a consultation, you are busy writing out the relevant prescription, the patient asks: "While I'm here, could you just prescribe me some of my water tablets?" The patient has been on furosemide 40mg OD for several months. What do you do?

Discussion

The RPSGB advises that all pharmacist prescribers, whether supplementary or independent, must prescribe within their competencies and only medication appropriate for the patient. You know that the patient is already being prescribed the requested item by a GP, but it is for a condition that you do not normally deal with.

If the patient asks for something that I would normally be comfortable selling to them over the counter, such as emollients, antihistamines, or laxatives then I would not have a problem issuing them with their normal prescription. However, if they were asking for their usual medication for a more serious condition, such as heart failure or epilepsy, I would have to refuse as I do not have expertise in those areas.

Patients can put a lot of pressure on pharmacists and, as you know they usually get the medicine, it would be easy to cave in. Remember, however, it is your signature on the prescription and you would be held to be legally responsible if anything were to go wrong even if it is normally prescribed by a GP. It would be difficult to defend your actions in a court of law if you could not demonstrate your expertise in a particular area.

In Scotland, pharmacists are able to prescribe on a Community Pharmacy Urgent Supply (CPUS) prescription any repeat medication that a patient gets for their usual quantity (ie generally up to two to three months), as long as the patient is registered with a Scottish GP. If the patient is from elsewhere in the UK, pharmacists have to do an Emergency Supply, as in England and Wales, and can only give up to 30 days plus levying a charge for the medication.

Where Does the Law Stand?

The July 2010 edition of the Society's Medicines, Ethics and Practice (which will only have been in place for two months or so when it is superseded, because it will be replaced by a new Code on 27th September 2010 when the GPhC...