Our professional boundaries

One of my Webster pack patients has been ill. Her daughter tells us that she is constantly nauseous, and on occasion will vomit back up a dose of medications once she takes them.

This can be a problem as she misses out on her daily dose, so the daughter is asking us to give them extra tablets. This way when she vomits, the daughter will have spare tablets to give her accordingly.

Our pharmacy decided to supply her with a whole weeks worth of medications packed into a Webster pack. Later on, we received a call from the doctor's surgery. The nurse had found out on what we did for the patient, and was upset with our actions.

She said that we have no way of knowing how much the drug was absorbed when the patient vomits them up, thus it is dangerous to give the patient extra medicine to take. For all we know, they could be double dosing. She said we over stepped our boundary as a pharmacist and made a therapeutic decision without contacting the doctor. 

Reflecting on this case, this has been a learning experience for me. Firstly it taught me to be aware of the professional boundaries as a pharmacist. I have become more cautious when giving advice /making decisions ever since. 

Secondly, I do not agree with what the nurse said. As a pharmacist if it is impossible for us to know how much a drug was absorbed, how on earth would the doctor be able to know? As for Webster packing services, we keep patients medications to put them into packs. This is not a staged supply of medicines. We are not locking away the patients medicines, but more or less keeping them in the pharmacy for our convenience. The patient has every right to ask for their own medicine. If the tablets were at home with the daughter, she would have given them to the mother without letting us know. 

Indeed it is hard to judge how much the drug has been absorbed, but we had no reason not to give her extra tablets. 

As I said before, what I've learnt from this case is not that we did the wrong thing, but to be more considerate of the doctor's role. If I come across a similar situation, I would give the doctor a call ask for their opinion. I bet they would have made the same decision too.

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Recently, this patient has passed away. I hope she is in a better place and is no longer suffering. Thank you very much for the learning experience.