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Published on 1 November 2007

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Science, responsibility and professionalism

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Medication safety has moved up the agenda and is now getting the attention it deserves. But this puts the spotlight on pharmacists as the recognised experts on medicines

Ray Fitzpatrick, Consultant Editor

This issue of HPE contains an eclectic mix of subjects, covering science, clinical, and professional services, with patient safety a recurring theme. One of the central principles of any healthcare professional’s code of ethics is to “do no harm” to our patients. In the UK we have established a National Patient Safety Agency (NPSA) to help us all learn collectively from incidents. It is interesting that in a recent report from the NPSA,[1] medication-related incidents were the second most reported incident in hospitals after slips, trips and falls. This means medication safety has now moved up the agenda and is getting the attention it should have. However, this puts the spotlight on pharmacists, as we are the recognised experts on medicines.[2]

Recently the UK Department of Health launched a consultation in England on the responsible pharmacist,[3] which in view of the importance of patient safety opens the whole debate about how far a pharmacist can delegate duties. The reason for the consultation is that there is recognition that, if pharmacists are to utilise their clinical skills to the maximum benefit of the patient, they should not be tied to the dispensing bench.

The consultation introduces the concept of a “responsible pharmacist” who takes day-to-day responsibility for the safe and effective running of a pharmacy, but who may not necessarily be in the pharmacy all of the time. Although this is a consultation around registered pharmacies in England, the debate it stimulates has resonance in all countries and all sectors of practice.

How do pharmacists take responsibility for what is going on in their area without physically being present all the time to supervise others’ activities? One answer is by delegating tasks to pharmacy support staff using clear standard operating procedures. However, deciding what tasks can be delegated is not straightforward. In principle it should be mechanical tasks which do not require a clinical or professional judgement. However, I know from experience that pharmacists have different views on what can or cannot be delegated. Even seemingly straightforward tasks can require an element of judgement, since when it comes to medicines often there is no black-and-white answer. This is where pharmacists sometimes struggle. As scientists we have been trained to be accurate, precise, and arrive at logical evidenced-based answers. But being a professional is about making a judgement on an individual situation based on the facts presented, in light of one’s own ethical values and standards. Thus, when making a professional decision the answer may not be as clear-cut as the scientist in us would want. On the other hand, our scientific background should help us critically appraise situations and not just accept what we are told. While this dual mindset may make us uncomfortable at times, I for one would not want it any other way. If there were a set formula which could be applied to every situation for us to arrive at a consistent answer, we would be no more than unthinking mechanics in a large machine.

There will always be debate about the correct action in a given situation or what can and cannot be delegated. This is not necessarily a bad thing, since it demonstrates we are a thinking, caring profession. However, when it comes to delegation we should remember that we can delegate tasks, but not our responsibilities.

1. Patient Safety Observatory. Safety in doses: medication safety incidents in the NHS. London: NPSA; 2007.
2. Healthcare Commission. The best medicine: the management of medicines in acute and specialist trusts. London: Healthcare Commission; 2007.
3. Department of Health. Consultation on the responsible pharmacist regulations. London: DoH; 2007. Available online at: www.dh.gov.uk/publications



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