To have walked out of chemist without prescription because of "consultant pharmicist" wouldn't fill DS's prescription?

[mm22bys]

I went to a branch of well-known pharmacists today to fill a repeat prescription for DS2 - he's been on the drug for two months.

He is quite young to be on this medication, but it was prescribed by a consultant pediatrician at a major London teaching hospital, so I trust they know what they are doing.

The "consultant pharmacist" started giving me a hard time about how I actually give it to him - it is a single tablet once a day, and he wanted to change it to liquid form. I explained that I prefer the tablet because based on past experience with liquid antibiotics and pain medication, I never know how much he actually gets (spills out of mouth etc).

He then wanted to know if I crush the tablet or if I give it to him whole, mixed in cereal. I do both, depending on what sort of mood I'm in .

He then said he would have to ring the manufacturer to find out best way of giving it to him.

I waited for 15 minutes, and he got back to me and told me that they would have to ring down to the pharmacy at the manufacturer to find out.

At that point I asked for the prescription back and told him I would go somewhere else.

I went to local pharmacy and got it straight away, no questions asked.

I have since rung the manufacturer myself, and they just take voicemails, but have looked it up on the internet and found out you can crush it.

Was I unreasonable to have walked out of the pharmacy, without waiting for further information?

This is why I'm thinking of packing it all in!

Some people are just so unreasonable and ungrateful.

nooka "A good pharmacist should discuss your medication with you, check that you are comfortable and have understood the doctor's instructions etc."

What worries me in this case is that the pharmacist clearly didn't know what he was talking about and the customer did. It's all very well to warn against crushing pills that should be swallowed, or taking suppositories up your nose, but only if you know these are bad things to do. Asking "Do you crush them - because, um, you might not be supposed to do that, erm, hang on while I phone someone, um, I can't get through, um, search me" is not the most helpful sort of advice.

Uber. The pharmacist knew that the drug was being prescibed off license. In that situation it is totally up to the pharmacist to work out if it was actually ok for THEM to dispense, because they are the ones that will loose their jobs if something goes wrong. If something is prescribed off license it means they can't just look it up in a book. It requires several phonecalls to people who might have finished work and can't get back to them immediately. They were not deliberately making the customer wait (because they have this sick wish to irritate their customers) while they probably had a shop full of customers ALSO needing their prescriptions which no doubt they ordered late and not one of them have any tablets left and are also getting increasingly pissed off that they have to wait for their prescriptions.

You don't sound happy in your work Jennster

That's the bit I don't understand really though - I completely understand why the pharmacist may ask questions to confirm an 'unusual' precription, but why is it her responsibility to check it's OK? Surely it's the responsibility of the prescribing doctor and up to the pharmacists to dispense correctly as per the prescription.

Hi - I work for a pharmaceutical company and I think it is really good that this pharmacist decided to check in this case, although I can completely understand you finding it frustrating.

It sounds like it was a medicine not normally given to children that young, which should raise the alert for a good pharmacist anyway, as it is unusual and often medicines for adults have more complicated dosing requirements or formulations than for children which some children can't cope with easily. Often tablets are slow/modified release - they are designed to not get into your body until they are in your stomach, or to relase slowly over the course of say 24 hours. This is achieved through special coatings on the tablets, so if you crush the tablet then you lose the slow/modified release properties and risk the tablet being absorbed in the wrong part of your body (e.g. tongue when it should be your stomach) or getting a too high dose upfront and losing the full 24 hours of action. Another reason for checking is that some tablets have particular food requirements - e.g. if you need to take before a meal so that food doesn't interfere with absorption into your blood stream then mixing it with food would make it much less effective and your child might not be getting any benefit from the drug. Still further, some drugs have slightly bizarre interactions - grapefruit juice is a classic one for having a weird effect on some drugs.

So although I can see it is very frustrating when you are a busy mum and just want to get in and out (waiting for prescriptions to be dispensed is one of the most boring wastes of time ever!), given it is an unusual medicine, for a person younger than the normal age for the drug, I think the pharmacist was really really responsible for taking time to check rather than just dispense - and if I were you I would be tempted to use him to dispense all my medicines in future as he clearly is very alert (even if it sounds like his manner wasn't exactly overly friendly!)

What i dont understand is why he didnt pick up his BNF and check it in there ? it owuld tell him if it was slow release and so not suitable for crushing etc . If you really want the third degree go back and ask for a bottle of phenergan syrup !!!!

Because practically NOTHING is licensed for children and so there will be no directions, no guidance, and no dosage for children in the BNF. Just because it isn't modified release doesn't mean you can dissolve it, crush it. It's just not that simple. FFS the pharmacist was doing their job!

And the pharmacist can dispense correctly off a prescription, but if the dose is wrong then the pharmacist is in trouble. They can't assume there hasn't been a transcribing error somwhere down the line from hospital to patient. It's happened before. Patient taking something for a while and then goes to a different chemist who checks the script with the Consultant and there was an error months ago that was repeated over and over.

Just checking back here.

Jennster I never said the dosage had been changed. It was effectively a repeat prescription - it was a thyroid medication, actually very common, even if not for a one-year old, and the dose was the same as what had been prescribed previously. When I checked on line, the dose is actually very small, and so no chance of over-subscribing (25 mcg a day, and I would notice if it had changed - not everyone would though!).

I saw the two consultants yesterday who prescribed exactly the same medication again (didn't need it but thought it will save me wasting NHS resources to see the GP again).

If it had been the first time it had been prescribed, or if the dosage had changed, I would have been grateful the pharmacist was "doing his job properly", but DS had been on the small dose before and nothing had changed.

By the way, when I got home I did phone the chemist who dispensed it, and while ideally I would wait 40 minutes between giving him the tablet and feeding him, I can actually either give it whole or crush it, which is how I was directed by the consultant pediatric consultant (who should know more than pharmacist) in the first place.

For a repeat prescription, where nothing has changed, I am not going to use this pharmacist again.

I wasn't referring to your experience mm2bys. I was defending pharmacist. I'm off to retrain.