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All pharmacists at some time face situations when they need to make a decision or take action based on ethical principles and practices. Often there is no right answer - just a best answer. As we gain in experience, making these decisions becomes easier. Technicians, interns and newly qualified pharmacists, however, need time to develop confidence in handling such situations. They look to staff around them to coach them and to act as role models.
Differences in practice
Sometimes practitioners - especially, but not only, new practitioners - face situations where there appears to be a mismatch between their own understanding of practice standards - legal, professional and ethical - and those of senior staff in their workplace; where their attempts to follow best practice are discounted or discouraged, or they feel pressured to undertake activities they know to be 'bending the rules'. They may become confused as to their obligation to behave as directed by their preceptor or boss on the one hand, and their obligation to comply with professional standards on the other; and may be reluctant to raise their concerns because of potential conflict in the relationship.
Examples of situations where anxieties may arise include: being left without supervision when the pharmacist is not on the premises, being encouraged to sell medication that is not appropriate in the circumstances (such as when immediate medical intervention is indicated, or when misuse is suspected), being discouraged from checking with the doctor where there are concerns about the clarity, appropriateness or safety of a prescription, and being encouraged or expected to conduct the sale of a Pharmacist-Only medicine rather than ensure this is undertaken (or, in the case of an intern, overseen) by a registered pharmacist, including selling emergency contraception when not accredited to do so.
Legislation and standards
Pharmacists' obligations regarding these issues are clearly stated in the Medicines Act (ss 18 and 42A), Code of Ethics (Obligation 3.10 and 3.15) and Pharmacy Council Standards and Protocols. Pharmacy staff are required to maintain practice standards by the Code of Health and Disability Services Consumers' Rights (Right 4(2)), which sets out the consumer's right to services that comply with all legal, professional and ethical standards, and the Medicines Act (s 55C), which states that any pharmacist who is employed or engaged in duties at a pharmacy may not be requested or required to act in a way that is inconsistent with the applicable professional or ethical standards of pharmacy practice. These words are printed on the licence on display in every pharmacy and are there to ensure employees are protected.
Raising concerns
Practitioners who find their ethical approach at variance with others need to raise concerns in a way that preserves mutual respect, maintains the working relationship and focuses on solutions. This is best done when time has been set aside to address the issue, and the practitioner has thought about what words and phrases best convey what needs to be said, without emotion and in a non-blaming way: naming the issue, describing its impact, giving the reason for concern, and making a request for change.
Example
Kylie is a trainee pharmacy technician who was sometimes left in the pharmacy alone while the pharmacist 'popped out' to do an errand. She was very uncomfortable with this situation as she knew this behaviour contravened the legislative requirements for the pharmacy, and for her supervision. Despite her anxiety at raising the issue, Kylie said to the pharmacist: "When you leave the pharmacy I feel uncomfortable with the situation because I know the law says the pharmacist is required to be on the premises at all times. Can we find a way to fix this situation?" The pharmacist was well aware of the legislation but had chosen to ignore it. She had not realised the negative impact this had had on Kylie. As a result, she postponed some of her errands, and delegated others to Kylie.
Maintaining standards - and integrity
Not all issues may be easily resolved. If a direct approach to the appropriate staff member is not helpful, advice and support is available through the Pharmaceutical Society.
Practitioners need to be mindful of their professional integrity. Regardless of their employment situation, they have a responsibility to practice in accordance with standards and to negotiate solutions when these standards are compromised. If called on to do so, they need to be able to explain why they have not raised their concern in a situation that warranted it.
Elizabeth Finn
HDC Education Manager
Pharmacy Today, April 2008