Oral EXAM Practice - Ethics Scenario

Oral Exam: Section 5 – Ethics Scenario

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ORAL EXAM SECTION 5: ETHICS SCENARIO Case 1: It is September and it is time to do the DD count. You work in a large pharmacy with three DD safes and your preceptor leaves you with the prestigious task of doing the biannual inventory. You check the stock in the safes against the balance in the drug register. Everything looks fine except there are two tablets of Oxycontin 20mg missing. Your preceptor tells you to move those two tablets to the ‘Expired stock’ section of the DD book, start a new DD book and then leave out the expired stock from the previous book. What do you do? Assert that such an action is illegal and unprofessional. Investigate the cause of the discrepancy. Thoroughly check the safe for the missing tablets. Double-check all calculations in the drug register since the last stock count, for addition and subtraction errors. Check through invoices to ensure all incoming stock had been recorded. Check dispensing reports to ensure all supplied stock had been recorded. If the discrepancy remains unexplained, then the Pharmacy Board must be notified.

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Oral Exam: Section 5 – Ethics Scenario

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Case 2: A customer wishes to return five boxes of Mixtard Penfill because he was meant to get the Mixtard Flexpen instead. The other pharmacist checks on the computer, takes them back, puts them in the fridge and gives him the correct boxes to replace them. Later in the day, you notice the same pharmacist dispensing the Mixtard Penfill which he had placed in the fridge and then giving that to another customer. What do you do? Approach the other pharmacist immediately and assert that new stock should be used for the patient. Any medications returned to the pharmacy should not be used for another patient. This is especially important for fridge lines. There is no guarantee that these medications have been stored in the correct conditions once they have left the pharmacy. Returned S4 medications should be disposed of in the yellow bin. Discuss with the other pharmacist about how the customer returning the insulin should have been dealt with. The customer had claimed that they received Mixtard Flexpen instead of Mixtard Penfill. Dispensing records should have been checked for the type of insulin they normally use. The original prescription or duplicate should also have been checked to confirm what the doctor had prescribed. If the doctor had written Mixtard Flexpen and the Penfill was dispensed instead, then records should be corrected. If the doctor had written Mixtard Penfill, then the doctor should have been contacted to clarify which formulation they had intended to prescribe. If a dispensing error had occurred, the incident should be recorded and PDL should be notified.

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Oral Exam: Section 5 – Ethics Scenario

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Case 3: You are newly registered and you have just started working at a new pharmacy. One day, you notice a pharmacy assistant talking to an elderly lady. The lady gives her an unopened, in-date pack of Endone which her recently deceased husband didn’t get a chance to take. The assistant inspects the pack, refunds cash to the lady before putting the Endone into a hidden cardboard box. The manager then tells you that this is the ‘stash of extra DD stock’ which he keeps in case the DD balance is short. How do you respond? All returned stock must be entered into the ‘Expired/returned stock’ section of the drug register. All returned S8 medications should be clearly labelled and placed in an isolated part of the safe, where it awaits appropriate destruction by either a board inspector or police officer. Returned medications must not be refunded or used again for other patients. The drug register should be balanced at all times and should discrepancies occur, actions should be taken to reverse the error. Additional stock should not be obtained from other sources to disguise any inconsistencies in the drug register. All of these actions are illegal, unethical and unprofessional. The involvement of both the pharmacy assistant and the manager in this sort of misconduct undermines the integrity of the profession. Explain to the manager about the serious legal and ethical issues associated with this matter. Strongly assert that you will not participate in this sort of professional misconduct with them. Emphasise the importance of abiding to legal obligations. Offer to take care of the returned pack of Endone. Record the details in the drug register. Label the pack as returned stock and place it in an isolated part of the safe. Express your concerns to the Pharmacy Board regarding the remaining medications in the hidden cardboard box.

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Oral Exam: Section 5 – Ethics Scenario

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Case 4: The Illegal Dumping Squad comes into the pharmacy and shows you photos of rubbish bags found at a park. One of the officers then shows you labelled methadone take-away bottles inside for a particular patient from your pharmacy. He then asks for the patient’s contact details. How do you respond? Confirm whether the methadone take-away bottles were supplied by the pharmacy. Do not provide any further details about the patient until a written warrant has been issued from the police station. A pharmacist must respect the confidentiality of the patient and must not disclose any information without the consent of the patient or without a court order requiring the release of such information.

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Oral Exam: Section 5 – Ethics Scenario

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Case 5: It is Saturday night and your aunty comes to the pharmacy. She has just finished a box of Duromine 40mg and she tells you about how happy she is about the weight she has lost. She asks you for a new box and tells you she’ll get a prescription from the doctor tomorrow. How do you respond? Compliment her on how great she looks. Assert that Duromine is an S4D medication which can not be supplied without a doctor’s prescription or the doctor’s consent. Inform her that it is best for her to visit her doctor again to monitor her progress and to see whether the doctor would prefer her to continue taking it since it has been working so well. If it is too inconvenient for her to see the doctor, offer to contact the doctor on her behalf. Should the doctor authorise a supply, ensure a copy of the prescription is faxed to the pharmacy and the original is sent within seven days.

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Oral Exam: Section 5 – Ethics Scenario

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Case 6: A regular customer comes in and tells you that her mother lives overseas and that she takes omeprazole 20mg. She would like to buy six packs of Acimax 20mg for her privately, without a prescription, because it is cheaper here. She would also like to buy six bottles of fish oil to send to her for her arthritis. How do you respond? Assert to the customer that you can not supply them with omeprazole 20mg. Omeprazole is a prescription only medicine that can only be obtained with a doctor’s prescription. The doctor should not write a NSW prescription for the customer’s mother in the first place, especially if she is residing overseas. Fish Oil is a non-prescription medication so it is legal for the customer to buy fish oil to send overseas. However, there are ethical concerns related to the bulk supply of such a large quantity at one time. Suggest for the customer to buy two bottles first. Counsel the customer on directions of use for fish oil and the importance of checking for interactions with other medications their mother may be taking. Provide additional non-pharmacological advice on management of arthritis.

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Oral Exam: Section 5 – Ethics Scenario

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Case 7: A lady presents a script for Lipitor 80mg. She asks you whether she can ‘swap’ that for nappies and toiletries. She reassures you the manager does that for her all the time. How do you respond? Inform the patient that such an action is illegal and unethical. Assert that you can not help them out in such a way. Approach the manager to confirm whether medications have previously been ‘swapped’ for the lady. If the accusation is not true, then inform other pharmacists about the patient’s potential intentions. If the assertion is true, then immediately inform the Pharmacy Board and Medicare Australia of such actions. Exchange of prescription medications for any other items is clearly illegal, unethical and unprofessional.

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Oral Exam: Section 5 – Ethics Scenario

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Case 8: A patient presents a dental prescription for Stilnox 10mg 1 n quantity of 42. He tells you the dentist has prescribed it for severe dental pain because he has had a lot of trouble sleeping recently due to a recent tooth extraction. According to the computer, he has a history of taking various other medications for insomnia from different prescribers. How do you respond? Contact the dentist to inform him of the patient’s history of insomnia. Indicate the potential for abuse. Recommend for the dentist to prescribe an alternative medication (such as Panadeine) for relief of dental pain. Otherwise, suggest for the dentist to reduce the quantity of Stilnox tablets prescribed from 42 to14. Sleeping difficulties associated with dental pain should not normally last for more than two weeks so such a large quantity of Stilnox may not be necessary. If insomnia persists, advise the patient to seek medical attention from a doctor. Note that there are many ways to answer this question and there is more than one right answer. A dentist can legally prescribe Stilnox provided it is used in association with dental treatment. The main idea behind this question is to use your professional judgement to reason and resolve the problem on hand.

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Oral Exam: Section 5 – Ethics Scenario

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Case 9: A gentleman comes into the pharmacy with a prescription for Reductil. He tells you that he actually wants to buy Xenical but asks you to print him a receipt for the Reductil so that he can claim something back from his private health fund. He says his private health fund only covers for Reductil and not Xenical. What do you do? Inform the patient that such an action is illegal and unethical. Assert that you can not help him out in such a way. Emphasise to the patient that taking the most suitable medication for their condition is far more important than whether the medication is claimable from their private health fund. Check whether Reductil or Xenical is more appropriate in meeting the patient’s needs, and advise the patient of your recommendation. Offer to print an official receipt for the medication the patient wishes to purchase. Provide additional advice on the importance of dietary control and frequent exercise. These actions ensure that a pharmacist performs their duty of care to the best of their ability without compromising their ethical principals and legal obligations.

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Oral Exam: Section 5 – Ethics Scenario

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Case 10: A young lady in school uniform comes into the pharmacy and asks for the morning after pill. The pharmacy assistant tells you this is the third time she has asked for the same medication this week. How do you respond? Take her to an isolated part of the pharmacy and openly acknowledge your concerns. Check to ensure she has not been abused or assaulted in any way. Also confirm her age. The age of consent for sexual intercourse in NSW is 16 years. Counsel the patient on the use of the morning after pill by explaining the directions and precautions. Assert that it is not recommended for frequent use. If she is 16 years or over, advise for her to discuss with the doctor about ongoing contraceptive options. If she is under 16, tell her that her actions are illegal and that it is important for her to refrain from such acts until she is of a suitable age. Note that there is more than one way to answer this question. If the patient is less than 16, some pharmacists may choose to refer them to a medical practitioner. However, bear in mind that the longer she waits until she takes the pill, the less effective it is likely to be, the greater the potential for pregnancy. It is important to weigh out the consequences of your options and to make a decision based on that.

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Oral Exam: Section 5 – Ethics Scenario

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Case 11: You are putting together the PBS claim to send to Medicare Australia. There are some scripts missing. Your preceptor tells you to reprint the missing repeats from the pharmacy. For the missing original prescriptions, he tells you to defer them and then dispense the deferred script. How do you respond? Assert to the preceptor that the missing scripts should be removed from the claim. His suggestion is unprofessional, unethical and has implications of PBS fraud. Furthermore, he should not undermine the integrity of other pharmacists by encouraging them to take the same sort of practice.

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Oral Exam: Section 5 – Ethics Scenario

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Case 12: A methadone patient presents a clearly forged script for a benzodiazepine. You know she has been going through some difficult times recently. After some clarification, she admits it is forged, breaks into tears and tells you she’ll never do it again. What do you do? The prescription that has been presented is clearly forged. This is an offence, regardless of the circumstances for the offender. The police must be notified immediately.

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Oral Exam: Section 5 – Ethics Scenario

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Case 13: The manager’s wife comes in and requests for Amoxil 125mg/5mL for her son. He has just finished a bottle and she tells you she has lost the repeat. It is Sunday night. The doctor is not contactable. The computer shows she should have one repeat left. She tells you that he has a really bad cough and says she’ll go to the doctor to get a new prescription for it tomorrow. What do you do? Assess the issues presented: The repeat has been lost, the doctor is not contactable, the medication is unlikely to be abused and it is important for the child to complete the full course of the antibiotic without missing a dose. Outline your actions: Provide the antibiotic to her as an owing prescription. Ensure she obtains a new prescription from the doctor the next day. Otherwise, contact the doctor the next day, explain the situation to him, ensure he faxes a prescription to the pharmacy and sends the original within seven days. This ensures the pharmacist is fulfilling their duty of care. The repeat on the computer should not be reprinted under any circumstances as this is illegal.

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Oral Exam: Section 5 – Ethics Scenario

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Case 14: It is winter and you have just started at a new pharmacy. The pharmacy assistant brings a bundle of 30 Fluvax prescriptions for different patients from a particular local doctor. The dispensary technician busily starts dispensing them at intervals between other scripts. You ask them what is going on. They tell you that the manager has made a special arrangement with the doctor where the pharmacy delivers a bulk amount of Fluvax to the doctor, the doctor gives the patient the Fluvax injection, the patient pays the doctor and then the doctor prints out a script for the patient and adds up the total cash he’s collected which will be picked up by the pharmacy assistant. She tells you it is an ingenious plan the boss had thought of to save time and paperwork for all parties involved. How do you respond? Strongly assert that you will not be involved with this sort of dealing as it is illegal, unethical and unprofessional. Fluvax should not be bulk delivered to the doctor unless it is included in a doctor’s bag. This makes supply of the injections to the doctor illegal. The doctor should not supply and administer a medication obtained in illegal ways. The doctor should not be paid by patients for such deeds. The prescription should not be printed out and given to the pharmacy after the medication has been administered. The prescriptions should not be dispensed after the medication has been administered and signed on the patients’ behalf. The prescription is a legal document confirming the supply of the medication and should be signed by the patient to acknowledge the supply. Financial gains from illegal acts should not be shared amongst health care professionals involved. This is a clear case of PBS fraud. Approach the manager about the situation and express your legal and ethical concerns. If he is unwilling to change his practices, then Medicare Australia and the Pharmacy Board must be informed.

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Oral Exam: Section 5 – Ethics Scenario

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Case 15: You are working as a locum. The pharmacy assistant shows you around the dispensary and tells you about the ‘21 day’ files. She tells you they are prescriptions which are dispensed every 21 days for patients. The scripts get dispensed, the pharmacist signs the prescription on the customer’s behalf and the stickers are left on file until the customer needs the medication. She tells you this saves waiting time for impatient customers. What is your view on the situation? Three main concerns are raised by this situation: •

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Implications of PBS fraud: The patient’s signature on the prescription is a legal agreement confirming the supply of the medication. It should be signed by the patient on the day it was supplied to acknowledge the supply. Having the prescription signed by the pharmacist every 21 days defeats the purpose of this legal agreement. Associations with PBS fraud may also be implied. For example, if a patient is to cease a medication but the prescription for that medication had been dispensed already and the prescription had already been sent in the claim to Medicare Australia, then the pharmacy would have been paid for a medication that wasn’t supplied and this will be a clear case of PBS fraud. Dispensing procedures: Having the sticker placed aside after the medication is dispensed means the pharmacist who labels and checks the medication last is only checking the medication against the details of the label and not the original prescription. Many potential errors in the process of transferring the prescription details onto the dispensing program, unintentional changes in strength or directions may be neglected. Dispensing errors may increase as a result. Management of impatient customers: Patients should be educated about the importance of the pharmacist’s role in ensuring that the medications they take are appropriate for their medical conditions. Customers should appreciate the effort and time taken by the pharmacist to perform such duties.

Outline your actions •

Express your concerns about ethical and legal aspects to the manager. Suggest for the ‘21 day’ files to be removed. If the manager continues with such practices, contact Medicare Australia.

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Oral Exam: Section 5 – Ethics Scenario

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Case 16: A man comes in for three packets of emergency contraception. It is for his partner who he says is currently working and is unable to get it herself. -

Emergency contraception is a Pharmacist Only medicine that requires professional advice and counselling by a pharmacist, after they are adequately satisfied the medicine is suitable for the customer.

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Explain to the man that his partner will have to come in for the product as there is a standard protocol that needs to be carried out which involves asking the customer several personal questions (especially why 3 packets are requested), before the pill can be supplied. Remind him the earlier she can come in, the more effective the tablets will be. If she is not in the area, she may get it at another pharmacy within 72 hours of unprotected intercourse.

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Oral Exam: Section 5 – Ethics Scenario

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Case 17: A man comes into the pharmacy, breathless, asking for Ventolin. You ask him for an asthma card and find out that he’s used 3 puffers in the last 8 weeks. He is not on any other medications but said he has used Seretide before long time ago. He has no time to go to the doctor due to work. Supply him with the Ventolin. Refer him to see the doctor for a lung assessment and review his asthma management plan. There is missing therapy of a preventer and ask for repeats so he only needs to see the doctor a few times per year for a check-up. Explain a preventer is necessary in reducing lung inflammation and reducing the use of Ventolin.

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Oral Exam: Section 5 – Ethics Scenario

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Case 18: An assistant at your pharmacy shows you an empty box of Oxycontin 20mg tablets. It is for her mum and she has run out. You check on the record she is using it on a regular basis. Her doctor is not working today and the assistant assures you to return the script tomorrow if you give her an ‘owing’.

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Explain legal concerns regarding supply of Oxycontin without a prescription Oxycontin is an S8 medication which can not be supplied without a prescription, regardless of the situation. No owings are allowed. Outline your course of action The pharmacy assistant needs to be reminded that obtaining any medication, especially an S8, without a valid prescription is an illegal act. Explain to her the options available, such as contacting obtaining a prescription from another doctor or using an alternative analgesic.

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Oral Exam: Section 5 – Ethics Scenario

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Case 19: A young man walks into the pharmacy and requests the morning after pill for his girlfriend. You explain to him that the patient has to come into the pharmacy to answer a few questions in person to purchase it. He thanks you for your time and walks out. One of your pharmacy assistants pulls you aside and asks you what her friend was getting. How do you reply? Emergency contraception is a Pharmacist Only medicine that requires professional advice and counselling by a pharmacist, after they are adequately satisfied the medicine is suitable for the customer. This is difficult when the patient is not available. Due to privacy and confidentiality laws, you need to explain to the assistant that you cannot divulge any information related to the query – to avoid a breach of confidentiality. All these actions highlight the importance of maintaining professionalism in pharmacy. It may also be useful to have a private counselling area if there isn’t one already.

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Oral Exam: Section 5 – Ethics Scenario

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Case 20: A regular customer of your pharmacy comes in with a Regulation 24 prescription for Coversyl 5mg with 5 repeats. He is going away for 2 months only. You were about to dispense 2 months worth but your boss tells you to dispense 6 boxes and only give 2 boxes to him. What is wrong with this? This is clear example of PBS fraud. Explain to the owner that what he is doing is illegal and unethical. It is illegal because the owner is being paid for issuing NHS medications which he has not supplied to patients. The owner is also compromising on his professional autonomy. Let the patient know they have an option of taking all 6 boxes. All remaining repeats will be cancelled if they take two boxes.

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Oral Exam: Section 5 – Ethics Scenario

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Case 21: You are working as a pharmacist at the pharmacy inside the medical centre. One of the doctors comes into the chemist, requests Xanax 2mg and wants you to charge it to his account. There is no script. The assistant tells you that he does that all the time when the boss is here. What do you do? Explain to the doctor that taking any medicine from the pharmacy needs to have a valid prescription for legal purposes. Furthermore, it is an S4D medicine, and can be possibly subjected to abuse. If the pharmacist is concerned about the level of prescribing attributed to a particular prescriber for self-use, they should notify the Pharmaceutical Services Branch (PSB) outlining the concern.

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Oral Exam: Section 5 – Ethics Scenario

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Case 22: You are working as a locum pharmacist at a community pharmacy. The staff members have just received a bag of old medications which belonged to a customer who had recently past away. You notice the staff placing unopened, in-date medications (S4s and S8s) back onto the shelf. Some of the opened ones are used for preparing existing Webster packs for other patients. What are your duties as a pharmacist? •

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Confront the staff members immediately and tell them that what they are doing is extremely unethical. The medications could have been exposed to any sort of storage conditions outside of the pharmacy, making re-use of returned medications unsafe and unethical. All S4 medications should be placed into the yellow rum bin for destruction. The S8 medications should be entered into the ‘Returned Stock’ section of the Drug Register, before being appropriately labelled and placed into an isolated section of the safe. S8 medications can only be destroyed by a board inspector or police officer.

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Oral Exam: Section 5 – Ethics Scenario

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Case 23: A low profile Australian TV celebrity walks into your pharmacy to purchase some over-thecounter products. She leaves in hurry after paying and one of your assistants who recognised her starts talking with the other staff members. Out of excitement, she also decides to call her friends and you overhear her say: “XXX just came in! Guess what she just bought – a haemorrhoid cream!” This is where you interrupt her. Although it is an over-the-counter product, a customer’s purchases should not be exposed to other people – this is a breach of privacy and confidentiality. Explain this to all staff members that it is important to be maintain a professional image of the pharmacy and that behaviour like this should not be tolerated.

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Oral Exam: Section 5 – Ethics Scenario

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Case 24: A regular customer of your pharmacy wants to return 4 boxes of un-used Novomix Flexpen as the doctor will be changing him over to a different insulin. He has a new prescription and wants you to exchange the old ones for the new ones instead. The doctor said he can do that. What do you do? Explain to the pharmacy that according to industry standards, pharmacies are not allowed to process any exchange or refunds on medications unless it was a mistake and it was not intended for the patient at the time of supply. Returned S4 medications should be disposed of in the yellow bin and cannot be reused for another patient due to storage reasons. Offer to provide contact phone numbers and printed information regarding the exchange and refund process of medications from pharmacy organisations such as The Pharmacy Guild of Australia and the Pharmaceutical Society of Australia to the patient and doctor if necessary. Make a note in the computer records about the change.

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Oral Exam: Section 5 – Ethics Scenario

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Case 25: You see the doctor personally handing a bunch of prescriptions to your boss. He starts dispensing them but keeps the labels aside. He gets the patient to sign all the PBS scripts then hands over one box of Reductil 15mg to that patient, free of charge. He adjusts the stock on hand and throws the labels left aside in the bin. What do you do? Approach the boss to confirm whether PBS medications are being exchanged for a private item. Exchange of prescription medications for any other items is fraudulent, illegal, unethical and unprofessional. This arrangement needs to be informed to the Pharmacy Board and Medicare Australia

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Oral Exam: Section 5 – Ethics Scenario

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Case 26: The son of a regular customer comes in with a prescription for Avapro 300mg. When you process the prescription, it is rejected by PBS Online due to patient being overseas. The son decides to go back to the doctor to get the prescription rewritten under his name so he can get the concessional benefit. What is wrong with this? It is illegal to take or send PBS subsidised medicine out of Australia for reasons other than for personal use. It is also illegal for doctors to prescribe medicines that are not intended for use by the named person. PBS medicine also may not be sent overseas for the use of anybody other than the sender. If the patient is overseas and require medications, there are 2 options available: -

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Contact their doctor in Australia to obtain a non-PBS prescription for the medicine. It will have to be packaged and delivered with a letter from the pharmacy noting non-PBS or a Medicine Export Declaration form. Consult a doctor overseas and obtain medicine in that country. Reciprocal health care agreements exist in certain countries with the Australian Government. Check with the embassy.

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Case 27: You get a hospital prescription for Stemetil 5mg 1 tds. Upon questioning, you find out it’s for the man’s wife who is 5 months pregnant. It is for her morning sickness and she has not tried anything else. You contact the hospital doctor who wants you to give Stemetil even after you explain the precautions and options. Do you proceed? Stemetil is Category C - have caused or may be suspected of causing, harmful effects on the human foetus or neonate without causing malformations. These effects may be reversible. It is a pharmacist’s duty of care to inform the patient of the risks of taking the medicine. The prescriber should be informed about the risks and other safer alternatives such as Maxolon or Garlic tablets. Check references and professional judgement/experience of other pharmacist colleagues. If you are not satisfied with the response of the prescriber, hence the safety/efficacy of the medicine to be used in the patient is in doubt - do not dispense the prescription.

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Case 28: You have just been handed a hospital prescription for a three day supply of an expensive antibiotic. It appears unusual as the normal course is normally 7-10 days so you question the patient who says he’s had a few days course in hospital. Breaking packs is not permitted under the policies of the pharmacy. Do you dispense? Breaking packs are legal but may be costly for the pharmacy as broken packs in this situation will be difficult to use for future dispensing. It is important to abide to policies of the pharmacy; however, it may be seen as unethical if supply is refused for a patient who requires the medication immediately. Explain to the patient the financial concerns and policies of the pharmacy. If the patient is happy to purchase the whole box instead, then offer to contact the prescriber to amend the quantity or refer to the family GP. If the patient cannot afford to purchase the whole box, then contact the hospital and suggest them to have the prescription filled at the outpatients’ hospital pharmacy, as broken packs are commonly used there and wastage is minimal.

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Case 29: A newly employed pharmacist refuses to dispense the contraceptive pill for a young lady due to his personal religious beliefs. It was not the first time the patient has purchased the pill from that pharmacy. While declining to supply on the basis of personal, moral and religious beliefs are not illegal, pharmacists still has the responsibility of ensuring the continuity of care. The pharmacist must be certain and be able to refer another pharmacy where the medicine can be obtained, particularly in rural/remote areas where services may be limited. In situations where a pharmacist’s moral belief is likely to impact on the services available to patients, the pharmacy should consider: Reaching an agreement between the employer and employee pharmacist about the limitations in their provision of medicines and services. This should be made clear in their employment contract. Providing a sign or brochure to clarify and clearly inform patients of these limitations and appropriate alternative sources. The legal ramifications where personal beliefs limit the supply of certain products and services may include discrimination claims on the patient based on medical, disability, cultural, religious issues. The pharmacist could be held liable for any consequences that may arise; hence legal advice should be sought first if the pharmacist knows their beliefs can affect their professional practice.

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Case 30: A lady calls your pharmacy one day asking for some information about her niece. She explains that her niece has been recently diagnosed with schizophrenia. She finds a bottle of unknown tablets with the label removed inside your pharmacy’s paper bag and would like to know what it is. •

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A pharmacist must respect the confidentiality of information acquired in the course of professional practice relating to clients and their families. Such information shall not be disclosed to anyone without the consent of the client. Inform her you may not reveal any details regarding the mediation and medical history of her niece due to privacy reasons without due consent. Moreover, many medications have multiple indications. Advise her to speak to her niece or come in together if she wants know. If possible, make an appointment with the doctor to have a discussion to assess the suitability of selfmanaging medications.

Copyright © The Medicine Box 2010 All rights reserved. Apart from any use permitted under the Copyright Act 1968 of Australia, material in this publication must not be reproduced or stored in any way without prior written permission of the publishers. Disclaimer: While every effort has been made to ensure this publication is as accurate as possible, the Medicine Box team does not accept any responsibility for any loss which the user may suffer as a result of errors or inaccuracy of information contained in this publication. It is also noteworthy that The Medicine Box is unaffiliated with the Pharmacy Board of Australia, the former Pharmacy Board of NSW, the Australian Pharmacy Council or the Pharmaceutical Society of Australia. All information in this publication is provided by past pharmacy graduates and has not been verified by the above organisations.

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