CROSSING THE LINE INTO PHARMACY PRACTICE

Allison Benz, R.Ph., Sr. Enforcement Officer

Each year the Board receives numerous complaints alleging that non-licensed pharmacy personnel have been engaged in illegal or improper activities, such as performing duties that may only be provided by a pharmacist. The following examples are descriptions of actual complaints received by the Board that alleged unauthorized activities by pharmacy technicians or other non-licensed pharmacy personnel:

(1) A pharmacist allegedly instructed a pharmacy technician to telephone a prescriber to clarify a difficult-to-read prescription calling for Aricept 5 mg tablets. Apparently, the pharmacist thought the prescribed drug was Duricef and asked the technician to phone the prescriber's office and verify that the name and strength of the prescribed drug was Duricef 500 mg capsules. Allegedly, Duricef 500 mg capsules were dispensed to the patient as a result of the poor communication between the pharmacy technician and the prescriber's office. The patient allegedly took the wrong drug for seven weeks, thereby delaying the patient's drug therapy.

NOTE: All pharmacists should be aware that they may not delegate judgmental duties to a pharmacy technician, such as clarifying a prescription drug order. If a pharmacist receives an illegible, confusing, or questionable prescription drug order, the pharmacist must contact the prescriber to clarify the accuracy of the prescription order before delivering the prescription to the patient. During the process of clarifying an illegible prescription, a pharmacist should consider not offering the name of the drug that the pharmacist presumes has been prescribed, but rather, asking the prescriber or prescriber's agent for the name AND diagnosis or intended use of the drug prescribed. Had the "intended use" of the drug been discussed with the prescriber in the complaint described in (1) above, the alleged error may have been avoided.

(2) An antibiotic oral suspension was allegedly reconstituted improperly, in that the drug was depleted in 5 days rather than the prescribed 10-day course of therapy. The patient allegedly ingested the overly concentrated suspension and experienced adverse side effects. After contacting the pharmacy, the patient's agent was told that an unsupervised cashier had incorrectly reconstituted the antibiotic suspension. Apparently, the pharmacist on duty was allowing cashiers to perform duties normally assigned to a pharmacy technician during periods of heavy prescription volume.

NOTE: All pharmacists should be aware that duties relating to the preparation and distribution of drugs, such as reconstitution of oral antibiotic suspensions, may only be delegated to qualified and properly trained pharmacy technicians.

(3) A pharmacist allegedly mislabeled a prescription bottle containing Augmentin 400 mg/5 ml suspension with incorrect directions for use. Allegedly, the prescription called for the patient to "take 1 teaspoonful twice daily," but the prescription label directed the patient to "take 4 teaspoonfuls twice daily." A clerk read the instructions on the prescription label to the patient's agent when the prescription was picked up.

NOTE: The Board's patient counseling rules prohibit a clerk or a pharmacy technician from providing information to patients or patients' agents about a prescription drug. If a pharmacist had read the directions to the patient's agent, rather than a clerk, as alleged in the complaint described in (3) above, the alleged error may have been detected before the patient's agent left the pharmacy. When a new prescription is entered into a computerized recordkeeping system, the dispensing pharmacist should ensure that all information has been entered correctly. Failure to ensure that the prescription information is correctly entered into the pharmacy's computer is a serious error, due to the fact that all subsequent records and transactions rely upon the accuracy of the information in the computer.

If non-licensed employees are being used in a pharmacy, pharmacists must ensure that the non-licensed employees are trained and qualified to perform the assigned duty before delegating the duty to the employee. In addition, non-licensed employees must be trained with regard to which duties they may and may not perform.