Role Preparation for Nurse Advisors

Handling Medicines Calls

Self Directed Learning: Ethical Dilemmas

A female patient says her local pharmacist has refused to sell her the ’morning after pill’.
What advice would you give?
Points to consider:
·  Age of patient – Pharmacists cannot sell Levonelle® One Step (a P medicine) to a patient less than 16 years of age. However, the pharmacist may supply Levonelle® 1500 (a POM medicine) to under 16s if this is specified within the Patient Group Direction (PGD).
·  Training of pharmacist – If the pharmacist has not received emergency hormonal contraception (EHC) training under the terms of the PGD, then they are unable to supply the morning after pill.
·  Appropriateness of treatment – EHC may not be appropriate for this patient. Before making a sale or supply the pharmacist must take into account factors such as time since the unprotected sex occurred, stage of menstrual cycle, previous use of EHC, possibility that patient may already be pregnant, potential interactions with other medicines the patient takes, contraindications eg severe vomiting or diarrhoea, Crohn’s disease, liver problems.
·  Religious or moral beliefs of the pharmacist – Pharmacists who choose not to supply EHC on the grounds of religious or moral beliefs should treat the matter sensitively and advise women on an appropriate local source of supply available within the time for EHC to be effective (i.e. within 72 hours of unprotected sex).
A caller asks about the about side effects of her medicine. She has been given fluoxetine capsules after her recent visit to the GP for an infection.
How could you advise the caller?
Points to consider
·  Collect background information. Gather as much information as possible on the patient’s current and previous medicines history and medical history.
·  Did the patient mention any other problems to the doctor apart from the infection?
·  Did the doctor prescribe anything else as well as the fluoxetine?
·  Get the patient to check the label. Does it say her name?
·  Confirm the name and strength of the capsules. Does the label match the printing on the capsule strip?
·  If it appears that the fluoxetine was prescribed or dispensed for the infection, and so a dispensing error may have occurred, then it is important not to undermine the patient’s relationship with either her doctor or pharmacist.
·  Advise the patient not to take any of the medicine until she has contacted her pharmacist.

Role Preparation for Nurse Advisors: Handling Medicines Calls September 2007 v1.0