Should I report this?

[IAmAHorcrux]

I have been covering some work for a colleague when they are on holiday for a week. They text me Yesterday to say A mother of a patient of theirs phoned to ask about having a new prescription issued and he asked if i could do it for him from work. I said i would get a look at things.

I was busy yesterday and didn't get round to sorting the prescription out. I phoned the mum to try and clarify dosages with them and to get a little bit of background since I wasn't able to locate their file in the office. The mum is giving almost double to dose that has been recommended so are getting prescriptions very frequently. I tried to discuss this with them but they said not to worry about it because their GP surgery had phoned to say come and collect the prescription.

I called the GP to find out how a new prescription had been issued since i hadn't called them yet and they said they had got an email from my colleague requesting it.

He is currently in Croatia...and has apparently sent an email from a personal account to the GP to ask for this to be done. This is clearly a massive breach of hospital policy and of a patients right to data protection, aside from the fact I would not have been prescribing this in the first place, there is also an issue of misuse by the patients mother.

I am not senior to this person, and our direct supervisor is also on leave, what do i do? Ignore it all until they come back from leave or whistle-blow?

I would make very clear record about the sequence of events and timeline asap.
Do you have an "untoward incident" type of system to record this on too - then it's official.
Is there anyone else you can ask for advice about this?

I know it doesn't seem life-threatening or anything but this seems like it is a breach of several policies and procedures.

This sounds very dodgy, I’d leave it alone until either your colleague or LM returns. Is there someone in another branch that could advise, just to cover your back. I think you’re absolutely right to question it and if anyone questions that you should be content that you’ve paid due dilligence.

I would also whistleblow; I’m not sure how complicit you could be if anything were to happen to the patient and there was an investigation xx

There must be someone to speak to in the absence of your direct manager. It all sounds very odd and the inch high private eye in me would be investigating.

Should I try and speak to my colleague or just document for the file and leave it until someone more senior is available? The only other person is the head of services and I don't know if reporting to them will lead to really extreme consequences. I am also really concerned that the patient file is not on site.

Also, what is GP thinking with issuing a prescription based of a flipping email from hotmail or similar! surely any old nut could request anything if that was the case.

I think you should go upwards with this and certainly not contact your colleague on holiday.

Where is the patient file, then?

I would get round it with your colleague by saying the person you reported it to was standing next to you at your desk when his email came through.

The GP may have a reason for this prescription and it could be not corrected as hospital instructed a higher dose
It could be that they know the GPS work email and the GP should have sorted it before they went away
Are you a Gp too and is the dose too high or is it higher then average?

What’s the medication?

Do not contact your colleague. It sounds like they have not followed protocol. You should. Don’t get involved, surely your job would be at risk?

Report it to the Head of Services. You don’t need to be accusational (is that a word?!). Just explain that you e come across a situation that you’ve not encountered before and would like to know how to proceed with it. As a previous Head of Service (not in this field) I would’ve preferred to know about a situation before rather than deal with the consequences of a bad decision later on because that means paperwork and more often than not, disciplinary. Again, if anything happens and your name is implicated in anyway, you’re at risk. It may be entirely innocent and just a case is updating policies and procedures. Your gut is telling you otherwise I think and you need to do the right thing x

You must have a whistleblowing policy at work. Have you looked at that?

Is it not dangerous to be taking double the prescription dosage?

I wouldn’t get involved either (or at least not until a senior manager that can deal with this is around). I only say that as it could backfire on you. I’m assuming that your colleague is quite senior in the NHS if he can direct a GP to issue a prescription from his personal email address. Who knows, maybe the extra dosage is legit?

To me, it seems odd that your colleagues and the mother of the patient seem to have a personal contact outside of your workplace - as he has asked you to issue the prescription, and then issued the prescription himself from his personal account both whilst he is on holiday. To me, this suggests that the mother has asked him about this whilst he has been out of the office - first to issue the prescription (where he asked you to) and then secondly for an update perhaps (as you said you didn’t have time but called her instead, so she may have contacted him about this, to which he sent the email to the GP).

About the prescription dosages, is this something her GP would be aware about? Isn’t there a regular medicine review? Surely the GP would have noticed at some point that the dosage is higher, or that she is picking up this medicine more frequently?

I have no idea where I would even look for a policy guide and I don't want to ask a lot of people who work here because I feel a bit unsure about things.

In my opinion the thing that is being prescribed isn't really appropriate for this type of case but if you were prescribing it the dosage would be about half of what this person seems to be using. that's why i made contact with the mum, because i couldn't get my head around the dosages.

I have made a record of everything that has happened and have emailed it to my direct managers work email so there is a contemporaneous record. I am slightly worried about going over peoples head and getting anyone in trouble but this is definitely not the right way of things.

Ok, firstly I'm a bit surprised you are posting this online. There are a few identifying features e.g. Where your colleague is. You must have someone in work you could discuss this with?
How do you know it was a personal email account used? I agree that pt details should not be sent unless on secure email but do you know for sure they were , seems very odd that someone would not use their nhs email for this ?
Lastly if the GP has issued the prescription then they take responsibility for it. They may well have spoken to the parent and / or know them well , they presumably have clinic letters on their notes.
Situations like this can be v difficult, hope you can resolve it.
Sounds like it can probably wait until your colleague returns.

The patient file isn’t available either namechange so it’s not like the OP has anything to reference. OP, protect yourself x

I'd report this to Head of Service. Aren't all e-mails of this nature supposed to be encrypted where they contain patient name and information - so there's a data breach there. The rest of it sounds like bad practice and without the file it is difficult to know if the patient can legitimately be given a higher dose than currently prescribed. It may be that they have been told they can if needed but that the prescription has not been altered - in which case that needs amending.Some of my DD's medication used to be labelled XX dose as required up to a maximum of YY in 24 hours which allowed for additional doses to be given.

I would also be worried that this could be the tip of the iceberg in unethical practices as far as the colleague is concerned and wouldn't want to be the person who had known something was amiss but didn't report. I guess Harold Shipman had colleaues who didn't want to be the one to spill the beans . Equally it could just be a workaholic colleague who is just trying to provide great service. But you'll never know unless you report.

Surely this is for the practice manager to deal with? Wouldn't the pharmacy computer also have flagged wrong dosage amounts? What country are you in?