PM3PY1 Ethics in Prescribing Workshop Student Workbook Model answer (1) PDF

PM3PY1 Workshop – Advance Ethical Decision-making: Ethics in Prescribing Learning outcomes By the end of the workshop, you should be able to: 1. Discuss the importance of ethics in prescribing. 2. Identify things to consider when prescribing. 3. Explore common eth...

PM3PY1 Workshop – Advance Ethical Decision-making: Ethics in Prescribing Learning outcomes By the end of the workshop, you should be able to: 1. Discuss the importance of ethics in prescribing. 2. Identify things to consider when prescribing. 3. Explore common ethical issues faced by pharmacists in prescribing. TASK 1: A SELF-PRESCRIBING PRESCRIBER Case Scenario You are a pharmacist prescriber. Over the last few months you have been experiencing persistent headaches, which you have not sought treatment for. You are also a heavy smoker, which you suspect may be contributing to your symptoms, but you haven’t done anything about this. Today, your headache is particularly bad and presents with symptoms similar to a migraine. You don’t want to make an appointment with your doctor at the local practice. So, you decide to prescribe yourself sumatriptan tablets and get the prescription dispensed at your local pharmacy.. 1. How could your decision to self-diagnose and self-prescribe affect both your safety and your accountability as a medical practitioner? Answer: Impaired objectivity: Professional guidelines advise against self-prescribing due to the lack of objectivity in assessing one’s own health. Your heavy smoking could be a factor contributing to your headaches, which might lead to an inaccurate self-diagnosis without external input. Risk of misdiagnosis: Without an unbiased clinical assessment, there’s a greater chance of overlooking important factors like drug interactions or other underlying conditions. Lack of documentation and monitoring: Self-prescribing makes it difficult to maintain proper documentation and monitoring, which are essential for continuity of care. If side effects occur, there would be no formal record of your treatment for other healthcare professionals to reference, posing risks to your care. 1 PM3PY1  PM3PY1 Workshop – Advance Ethical Decision-making: Ethics in Prescribing Violating ethical guidelines: Self-prescribing violates established ethical guidelines, which stress the need for healthcare professionals to avoid treating themselves or close family members. Compromised professional accountability: Healthcare professionals are responsible for justifying every prescription they sign. Lack of oversight and documentation when self- prescribing can lead to ethical breaches. Professional guidelines emphasise that prescriptions should be made with clear, justifiable reasoning, which is difficult to ensure without external input. Safety risks: Without external medical input, safety is compromised due to the possibility of inaccurate diagnosis and improper treatment. Potential reputational damage: Failing to follow ethical guidelines could lead to professional misconduct or reputational harm, as trust in your clinical judgment could be undermined within the healthcare community. Breaches of ethical standards, like self-prescribing, can result in disciplinary actions from regulatory bodies, damaging your professional standing. A one off instance may not be seen as bad, but repeatedly self-prescribing would be an issue. How should you balance concerns about maintaining your professional reputation with the need to prioritise your own health and seek appropriate medical care? Answer: Seeking medical help: Prioritising your health by consulting another doctor is a responsible and ethical action, despite concerns about reputational damage. Ethical guidelines emphasise that personal fears, such as fear of judgement, should not deter you from seeking appropriate care. Importance of professional medical input: Consulting another healthcare provider ensures an objective and thorough clinical assessment, aligned with ethical standards and supported by proper documentation and monitoring. Transparency protects professional standing: By avoiding the pitfalls of self-prescribing, you maintain transparency in your treatment, which helps to protect your professional reputation and credibility. Adhering to ethical guidelines, even when dealing with personal health concerns (such as smoking), demonstrates integrity and reinforces your commitment to patient safety. 2 PM3PY1  PM3PY1 Workshop – Advance Ethical Decision-making: Ethics in Prescribing Task 2: THE DUAL ROLE DILEMMA Case Scenario You are a pharmacist prescriber trained in mental health working in a Community Mental Health Team (CMHT) in Reading. You also work part-time at a local pharmacy. Today, you are seeing one of your regular patients, who has schizophrenia. They bring in a prescription for aripiprazole 10 mg tablets, taken once daily, and tell you that they have been struggling with adhering to their treatment, and feel their condition is worsening. The patient tells you that they have discussed switching to the long-acting injectable form of aripiprazole with their psychiatrist, however no change in their medication was made. The patient now asks you to write a prescription for the aripiprazole 400 mg long-acting injection, dispense it and then administer the injection to them. How should you balance the patient's request for convenience with the need to separate prescribing and dispensing functions for safety? Answer: Patient safety priority: prioritising safety by adhering to professional standards that encourage separation of prescribing and dispensing functions is crucial. Involve another healthcare professional: Where possible, involve another healthcare professional such as a pharmacist to dispense the medication or a nurse to administer the injection. This provides an additional check for clinical appropriateness and ensures that tasks are distributed in line with guidelines. Alternative options: Discuss alternative options with the patient, such as having the medication dispensed by another pharmacist the following day or receiving the injection from a nurse to ensure an additional safety layer. Maintain professional boundaries: Explain the need to follow regulatory guidance, highlighting that involving another professional (e.g., a nurse) for administration maintains the integrity of care and enhances patient safety. Reinforce the importance of following proper protocols to safeguard patient safety, even if it means a less convenient option for the patient. 3 PM3PY1  PM3PY1 Workshop – Advance Ethical Decision-making: Ethics in Prescribing What steps can you take to ensure patient safety if you prescribe and administer the long- acting injection? Answer: Follow a clear procedure: Implement a risk assessment and follow a formal procedure to minimise any risks associated with prescribing and administering the medication. Conduct a mental break: Take a mental break between prescribing and administering to ensure objective thinking and reduce potential errors. Maintain a full audit trail: Document every decision thoroughly, including the rationale for prescribing and administering the medication, to ensure transparency and accountability. Consultation with colleagues: When possible, consult with colleagues or a second healthcare professional to verify the appropriateness of the prescription and administration plan. Task 3: THE REPEAT PRESCRIPTION DILEMMA Case Scenario You are a prescriber pharmacist at a surgery. A patient who recently registered with your surgery after four months without a GP calls to request a repeat prescription for their Fobumix Easyhaler 160/4.5 mcg, which they have been using to manage their asthma for the past two years. The patient is prescribed 1 puff twice daily, and their prescription has been renewed without any changes during that time. The patient has informed you that they have less than 10 puffs remaining in their inhaler and urgently need a new prescription. The patient mentions that they moved several months ago and has only now registered with your surgery after realising they were without a GP and needed to register with a new surgery to continue obtaining their repeat prescriptions. You do not yet have access to their full medical records, and it has been two years since their last comprehensive asthma review. Although you have the authority as a prescribing pharmacist to issue a repeat prescription, you are concerned about the long gap in care and the lack of recent evaluation of their asthma management. The patient is pressing for an immediate prescription to avoid running out of their inhaler. 4 PM3PY1  PM3PY1 Workshop – Advance Ethical Decision-making: Ethics in Prescribing What steps can you take to ensure patient safety when issuing a repeat prescription for a patient who has not had a comprehensive asthma review in two years? Answer: Issue a short-term prescription: Provide a limited prescription to cover the patient’s immediate needs, ensuring they have enough medication until a full review can be arranged. Arrange an urgent asthma review: Schedule a comprehensive asthma review as soon as possible to assess the patient’s current condition, treatment efficacy, and any required changes to their management plan. Request access to medical records: Obtain the patient’s previous GP and specialist records to ensure continuity of care and identify any relevant medical history or exacerbations. Review prescribing guidelines: Ensure the repeat prescription is within your prescribing competence and follows best practices, as highlighted by GPhC guidance on prescribing safely. Communicate with the patient: Educate the patient on the importance of regular reviews and explain that their inhaler prescription will be reassessed based on their current condition and asthma control. Please note that while all cases are based on real-world scenarios, they may have been simplified for ease of understanding. -End- 5 PM3PY1