Lec. 2 Practical Considerations in Pharmacy Practice Flashcards
REVIEW: ETHICAL PRINCIPLES/TERMS
1.) Autonomy
2.) Non- Maleficence
3.) Beneficence
4.) Justice
1.) Autonomy: Independent decision making
- e.g., Informed Consent, refusal of tx
2.) Non-maleficence: At minimum, do no harm
- e.g., Dispensing drug with not enough information, negligence, professional misconduct
3.) Beneficence: To do good, to remove harm, to promote welfare
- e.g., Isolation rooms for immunocompromised patients
4.) Justice: Fair distribution of goods, consistency
REVIEW: PROFESSIONAL OBLIGATIONS
1.) Veracity
2.) Privacy
3.) Fidelity
4.) Confidentiality
1.) Veracity: Truthfulness
2.) Privacy: Leaving one alone
3.) Fidelity: Keeping promises
4.) Confidentiality: Maintaining patient identifiers/information
An ethical balance is when….
An ethical balance is when a company is able to find a moral compromise between company, owner, stockholder and stakeholder
interests
ETHICAL DILEMMAS
- Drive-Thru Hurry Ups
- Covid Testing, What Nows
- Vaccine Turn Aways
- Depression MTM
- Lab Ordering and Interpretations
- Test and Treat
.
What to do? TAKE YOUR TIME, REVIEW
OPTIONS, PROBLEM SOLVE… You have a duty to help, do more for your patient is your morals and values do not allow, do more means going the extra step/mile than your job scope requires.
PATTERNS FOR ETHICAL STANDARDS
4 -step process for effectively addressing and managing each of these challenges
PATTERNS FOR ETHICAL STANDARDS
- 23 community RPh’s were asked to describe and resolve ethical problems at work….Pharmacists were/had:
- Lack of attention due to multi tasking and priorities at work
- Ethical reasoning was pertinent to religious faith and common-sense emerged
- Ethical intention was compromised by frequent concern about legal prosecution
- Pharmacists’ failed to report other healthcare professionals’ bad practices!
NOTE: More pharmacist ethical training IS necessary for the patient and the profession.
SOURCES OF ETHICAL STANDARDS
- APHA Pharmacy Code of Ethics
- Pharmacists are health professionals who assist individuals in making the best use of medications.
- This Code was prepared and is supported by pharmacists.
- These principles are based on moral obligations and virtues, are established to guide pharmacists in relationships with patients, health professionals, and society.
BASED ON ONE PHARMACIST’S OPINION, A
PATIENT SHOULD RECEIVE A TEST THAT
WOULD BETTER DETERMINE A TREATMENT
REGIMEN FOR A CARDIAC CONDITION. THE
PHARMACIST’S PHYSICIAN COWORKER
DISAGREES, CITING THE POTENTIAL FOR A
HIGH-COST, LOW-BENEFIT OUTCOME FOR
THE PATIENT. HOW DO YOU PROCEED?
One way to manage limited resources is to have non-emotional conversations with those who oversee the budget while emphasizing that the ultimate goal is to provide high-quality patient care/outcomes
.
SYSTEMATIC FASHION
1. What ethical principle(s) are involved & why?
2. With whom did you consult when making the decision (i.e. nurse, colleague, friends, family)?
3. What other factors have you considered? (i.e. legal issues, financial concerns)
4. What is your final decision?
5. What was the outcome (if applicable) or what does the law state surrounding this?
6. If you did this and someone was recording it, how would you look? Details?
COMMUNITY CASE
- You are asked to sell alprazolam medication more than two days early by a patient who is known to you and has no history of abuse, a direct violation of your Controlled Substance Policies, but not the New Mexico Board of
Pharmacy Law.
- Do you use your professional judgment and take care of the patient?
- Does your answer change if the patient is a prominent local physician?
- Does you answer change if the patient is a neighbor? a good friend? A boss?
- Does your level of helpfulness change with any specific characteristic? situation? Is so, what is it?
1) A patient presents to your pharmacy wanting a tobacco cessation aid prescribed to them to assist them in the quitting process. They strongly suggesting they would like you to prescribe clonidine, an off label medication commonly used for tobacco cessation and have had good experiences with this medication in the past for a previous quit
attempt. What is your best response based on the Pharmacist Tobacco Cessation Prescriptive Authority Protocol?
a) I can prescribe that agent
b) I cannot prescribe that agent
c) I need more information to determine if I can prescribe that agent
d) none of the above
Answer D, I cannot prescribe that agent, but I can provide other FDA approved for Tobacco Cessation agents such as…would you like to meet me this afternoon to discuss further?
2) A patient presents to your pharmacy and is requesting nicotine patches and nicotine gum. She is very anxious for more products, as they were covered on her insurance and were dispensed at no charge to the patient, however, she still reports smoking 1 ppd, the same amount as she was smoking the last time you saw her. You suspect she is returning the product as an over the counter return at another pharmacy location for monetary gain, but are unsure, what are acceptable options
as the prescribing pharmacist?
- a) accuse the patient of this and refuse to assist her further
- b) confront the patient of this and discuss other possible options to assist her further
- c) do not confront the patient and continue to prescribe the requested products
- d) tell your supervisor and continue to prescribe the requested products, but communicate with management to ensure it does not occur again
- e) none of the above, continue to prescribe the requested products, but package it
in a non-returnable way
Answer B or D or E or all three, would be acceptable options, the protocol gives no guidance on such a case, ethics is your basis for the decision making process alone (no legal backing to assist). The TC protocol is meant to help pts with a quit attempt. If you prescribe outside of that scope, it is not
within our prescriptive authority guidelines.
3) You prescribe a patient varenicline after discussing the possible side effects. The patient and you together agree that this is the best option for their quitting attempt, one week later, the patient reports back that they developed bruising on various parts of their body as a result of the varenicline use. What is your best response?
a) tell the patient to immediately DC the varenicline and reach out to the PCP to discuss further
b) tell the patient to continue the varenicline but reach out to the PCP to discuss further
c) tell the patient that this could not be from the varenicline and disregard the patient phone call
d) tell the patient that this could not be from the varenicline, but DC the product anyway
Answer A, the TC protocol outlines we must review pt history, potential contraindications, side effects etc. Because there was none identified and side effects were reviewed, you have met the requirements for safe prescribing within the scope. From the TC home study, the best answer is the one that causes the least amount of harm to the patient.
4) A patient is headed off to college to live in a dorm room, which is a distinct indication for
receiving the meningococcal vaccine, the patient presents from her pediatrician with a hard copy script for Bexsero, is this patient eligible and would she benefit from this Meningocccal B vaccine at this time? What are acceptable options as the prescribing pharmacist?
a) the patient is eligible, and she would benefit from this vaccine at this time
b) the patient is not eligible, and she would not benefit from this vaccine at this time
c) the patient is eligible, and she would also benefit from the MCV vaccine at this time
d) the patient is not eligible for either the MCV nor the Men B vaccines at this time
Answer A and C, the protocol states to look at ACIP recommendations, if you review them,
the MCV is the common meningococcal vaccine and recommended for college freshman. The Men B is recommended by the ACIP as a shared clinical decision making
recommendation to be made by the prescriber and patient to determine eligibility.
Outbreaks have been occurring with both strains of meningococcal over the past few years. Regardless of the hard copy script, the MCV should be given and the Men B should be given (based on clinical decision making for high risk setting of a dorm room).
7) A patient presents at the pharmacy claiming that your colleague gave her the Moderna vaccine rather than the Pfizer vaccine and the patient did not want Moderna and specifically requested Pfizer. What are your next best steps (acceptable options)?
a) ignore the patient and state briefly they are all the same
b) listen to the patient’s concern, research if this is an issue, reassure the patient if not
c) call your co-worker immediately and let them know the situation and document the
occurrence
d) agree with the patient that this was an error and redo the vaccine, complete an error
report
E) explain to the patient that this was an error and primary/secondary doses should not
be mixed and matched, but booster doses can be
Answer B, C, E, the protocol does not give recommendations or preferences of brand names of vaccines. As the prescriber, the Board of Pharmacy & NMPHA is expecting you to manage all adverse events and/or med errors appropriately with and for the patient.
8) A 11 year old boy and mom are at your pharmacy for his tdap shot for school.
They boy is very scared and continues to put his arm under his shirt to avoid getting the vaccine. Mom is prompted to restrain the boy, but is not doing as asked and is expecting you to “do your job.” In an attempt to vaccinate, you have spent 30 minutes with the boy and mom without success, and a line of patients has begun to form. What are your acceptable options?
a) restrain the boy with permission and vaccinate
b) refuse and turn them away without referral
c) refuse and refer them to a more suitable location
d) have one of the certified technicians deal with the situation
Answer is A and C, although nothing in the protocol legally directs pharmacists in
such situations, restraint of a patient is not outlined or mentioned in the protocol,
and therefore, at your discretion, it would be in the patient’s best interest and safety
of all to refer to a more suitable location equipped to handle such difficult patients.
