We all received the PSI newsletter this morning and with it a shocking case of poor professional practice.
The Professional Conduct Committee (PCC) heard a complaint in which a patient had been supplied with the High Tech medicine Enbrel® (etanercept) 50mg solution for injection, without a valid prescription on multiple occasions over a 14 month period. This contributed to a situation where the patient did not attend clinical review with their Consultant Rheumatologist for over 2 years. This was brought to the attention of the PSI by a HSE primary care pharmacist and the patient’s Consultant Rheumatologist. As a result, the PSI initiated an investigation into the pharmacy, to review the documentation relating to the supply of Enbrel® to this patient, and the general systems that were in place in relation to the dispensing of Enbrel® generally.
- The Authorised Officer's investigation led to a review of the relevant prescriptions at the pharmacy, which identified that two pharmacists had supplied the patient with Enbrel® 50mg injection after the expiry date of the last prescription issued by the Consultant Rheumatologist. This resulted in the supply of this medicine on 11 separate occasions over a 14 month period, without a valid prescription or any clinical review.
- The Authorised Officer noted that the last valid prescription authorising the supply of Enbrel® 50mg injection for the patient was not endorsed, as required by the legislation. If this requirement had been followed it would have assisted the pharmacists in identifying that the prescription was not in date and that the patient required a clinical review.
- During the investigation the Authorised Officer requested to review the prescriptions used to authorise eight supplies of Enbrel® to other patients. Seven of the eight prescriptions retrieved and presented for review were not endorsed to show the date and quantity of supply to the patient, as required by the legislation.
It is hard to believe that anyone could dispense Enbrel "on 11 separate occasions over a 14 month period, without a valid prescription or any clinical review." While we don't know the exact circumstances of this case, this is a terrible indictment of the Irish community pharmacy. I hope this was an isolated case, otherwise some of us are providing a dangerously poor quality pharmacy service to our patients.
It would also be very interesting to hear the full from the pharmacists involved.
Source: A Complaint Involving the Dispensing of the High Tech Medicine Enbrel® Injection (PSI)