Close Up on Complaints: Ethical Consideration and Clear and Transparent Communication Key When Offering Professional Pharmacy Services
Delivering pharmacy services is a complex, human process. Communication and transparency are essential as pharmacy compensation mechanisms adapt to support the provision of professional services that are not directly linked to dispensing a prescribed medication. “Close-Up on Complaints” presents some of the challenges that can arise when charging a fee for professional services so that practitioners can use them as learning opportunities.
Ideally, pharmacists and pharmacy technicians will be able to identify areas of potential concern within their own practice, and plan and implement measures to help avoid similar incidents from occurring in the future.
Summary of the Incident
This incident occurred when a patient from a retirement residence tried to have his prescriptions transferred. The pharmacist from the new pharmacy called to have the prescriptions transferred on behalf of the patient. He was told by the transferring pharmacy that they would have to check with the nurse at the retirement residence and speak to the patient themselves before they could do anything.
The patient then called the pharmacy himself and asked the pharmacist to transfer his medications. Initially he was told the transfer would be completed immediately, but when he checked with the new pharmacy an hour so later they had still not received the transfer.
Have a Complaint?
Anyone who is not satisfied with the care of services provided by a pharmacy, pharmacist, pharmacy technician, student or intern can file a formal complaint with the College. Complaints must be received in writing and include as much detail as possible. The College investigates all written complaints.
The pharmacist from the new pharmacy then made a second call to the transferring pharmacy and was told that no one had requested a transfer for the patient. Frustrated and confused by this response the patient again intervened with a call to the pharmacy and was now told that he had to pay a $100 fee before the transfer could be completed. The patient refused to agree to the charge, claiming he was unaware that such a fee was required, and insisted that the pharmacy transfer his prescription immediately.
Later in the day the patient placed a third call to the transferring pharmacy to inquire about the status of transfer. The transfer had still not been done and the patient was now informed that he had to submit a signed request, including proof of his identity, in order for his prescriptions to be transferred. The patient complied with the request and was subsequently asked to fax his Social Insurance Number as additional proof of identity.
After many hours, and multiple phone calls, an incomplete profile of the patient’s prescriptions was transferred to the new pharmacy. Eventually, the patient’s physician had to intervene with a telephone call to the transferring pharmacy on the patient’s behalf in order to finally get the transfer completed.
Why Did This Happen?
In reading the summary of this incident it is obvious that the pharmacist and his staff at the transferring pharmacy did not respond to the patient’s request for a transfer in a professional and collaborative manner. Their lack of cooperation resulted in both the patient and new pharmacist having to make multiple phone calls to the pharmacy before the transfer was completed. The pharmacy also requested information from the patient at multiple stages of the process further frustrating and confusing the patient and ultimately delaying the transfer.
Complaint Outcome
The College’s Inquiries, Complaints & Reports Committee (ICRC) oversees investigations of each complaint the College receives. The Committee considers a practitioner’s conduct, competence and capacity by assessing the facts of each case, reviewing submissions from both the complainant and the practitioner, and evaluating the available records and documents related to the case.
In considering this case the Committee noted that pharmacists and pharmacy technicians have specific obligations under the Code of Ethics and Standards of Practice to respect a patient’s choice of pharmacy and transfer prescriptions in a timely manner.
The Committee found that in this case the pharmacist did not have firmly established and communicated professional and ethical processes in place to ensure the safe and timely transfer of prescriptions requested by patients.
The Committee issued advice and recommendations to the pharmacist to enhance adherence to established practice and conduct expectations relating to prescription transfers.
ADVICE/RECOMMENDATION
Advice/recommendations allow an opportunity for practitioners to improve conduct or care.
Advice/Recommendation is issued as a remedial measure for matters which are not serious in nature and are considered to pose low risk of harm to the public.
Learning for Practitioners
Reflecting on this complaint provides practitioners a number of learning opportunities to help improve the delivery of patient-centred care.
This incident could have been avoided (or at least de-escalated) by improved transparency to patients regarding the cost for pharmacy services and clearly establishing and communicating a professional and ethical process for transferring prescriptions.
Ethical Consideration
Pharmacy professionals are responsible for demonstrating professionalism and applying ethical principles in their daily work. The primary focus at all times during patient care must be the well-being and best interests of the patient.
One of the fundamental principles of healthcare ethics outlined in the Code of Ethics is Respect for Persons. This principle refers to our obligation, as healthcare professionals, to honour the intrinsic worth and dignity of every patient. There are many ways that practitioners demonstrate their commitment to this principle including respecting patient’s autonomy to make their own informed decisions about their healthcare.
As clearly outlined in standard 3.9 of the Code pharmacists and pharmacy technicians must – respect the patient’s right to choose a pharmacy and/or pharmacy professional and facilitate the patient’s wish to change or transfer pharmacy care and services as requested.
Timely transfers are a matter of courtesy and respect for a patient’s choice of pharmacy. In this case, the pharmacy took many hours to provide an incomplete transfer of the patient’s prescriptions and requested that the patient provide information at multiple points during the process. Pharmacy professionals should ensure that any personal information they request from a patient is required
to provide the professional service.
Clear and Transparent Communication
With respect to clear and transparent communication the first issue in this case occurred when the patient initially brought a prescription to his original pharmacy and was not informed in a clear and transparent manner about the fees required for prescription transfers. Although pharmacies have the right to charge for professional services, as outlined in the Code (standard 4.23), any fees charged must be transparent.
Additional guidance is provided in the College’s Policy – Fees for Professional Pharmacy Services – which states that all fees must be communicated to patients in advance of the provision of the service or product, readily accessible to patients and fair and reasonable. In addition, the patient’s consent to payment must be received prior to the service being delivered.
The pharmacist or pharmacy technician in this case should have informed the patient about the prescription transfer fee so that the patient could make an informed decision about whether to receive services from that pharmacy before the first time dispensing.
The transferring pharmacy should have also clearly communicated the requirements and process for transferring a prescription during the initial phone call with the patient. The patient also should have been informed of the time required to complete the transfer. This would have avoided the need for multiple phone calls and requests for additional information, and the patient would not have been concerned about the status of the transfer.
Appropriate Policies and Procedures
A final contributing factor to this incident was the absence of appropriate policies and procedures for providing prescription transfers. In all community pharmacies the designated manager is responsible for ensuring that the pharmacy has appropriate policies and procedures in place to support pharmacy professionals in practicing to the Standards.
For example, procedures to ensure that all staff engages in appropriate processes for reviewing a patient’s medication history to determine what prescriptions need to be transferred, recognizing pertinent information that should be communicated to the receiving pharmacy, and providing transfers in a courteous and timely manner. The policies should clearly outline what information is required from the patient to provide a transfer.
In the end however, all practitioners are individually responsible and held accountable to practice to the Standards of Practice and the Code of Ethics to ensure the safe, effective and ethical delivery of pharmacy services..