‘Crazy, but that’s the law.’


Should more common sense be applied to drug labelling? asks Angelo Pricolo

Have the medico legal requirements followed by pharmacists for the labeling of medicines taken a wrong turn?

The other day I was in the dispensary with a new graduate who I watched diligently stick dispense labels on 12 boxes of a combination analgesic for an authority script. After this she proceeded to affix a cautionary label 1 onto every box.

The patient watched, as he knew the drill and the time involved with this ritual. He jovially explained the labels were not necessary as the medication was not new. But he knew this made no difference to the diligent pharmacist.

As the second label went on in this mini ‘Henry Ford’ production line I challenged the pharmacist to consider what she was doing. I said “That label 1 is covering up a similar warning printed on the box by the manufacturer.”

Her reply was “Yeah, crazy, but that’s the law” I had no comeback because of course she was 100% correct.

The second script for the same patient was 10 tubes of a cortisone cream that needed to be removed from their individual boxes and also labeled with a flagging system that required some time and precision.

The patient, a long time client confided in me that each new tube he started he ripped off the flapping label first as it got in the way.

So while the customer patiently waited, along with others occupying their time pacing around the store, I wondered if common sense might have a role to play.

When I was a young intern at one of Melbourne’s busy public hospitals I similarly watched the queue at outpatients grow.  Almost daily it reached a three-hour plus wait as pharmacists, interns, students and techs carefully placed multiple labels on tiny vessels with the precise skills usually reserved for watchmakers. 

The sad thing is that these labels were rarely read, and at best maybe one of the 15 boxes was afforded a glance. So many hours of waiting time, so many hours of work and so much frustration at a system that has no flexibility.

Pharmacists often complain about manufacturers’ boxes that look very similar and often, different strengths or drug forms look exactly the same. Could more responsibility be shouldered by drug companies to make labeling more directed to the patient?

Let’s face it, a codeine-containing analgesic or opioid painkiller will always require a warning around driving or operating heavy machinery. Provided it is prudently placed on the packaging, could this not eliminate the need for a label 1? Metronidazole always needs an alcohol warning… and the list goes on…

Saving time and money ultimately is good for business and good for our patients. I’m sure there is not a working pharmacist out there who would not be able to suggest many changes to labeling that would make sense.

But until we see common sense replace rigid rules, law-abiding pharmacists will continue to waste time, money and resources on at best superfluous tasks that are concerned more with the legal than the medical implications.

Angelo Pricolo is an addiction medicine pharmacist and former National Councillor of the Pharmacy Guild of Australia.

 

 

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3 Comments

  1. Youhana Younan
    28/08/2019

    You can’t compromise time for the quality and instead of watching the pharmacist labeling all 12 boxes , you should have helped to label some .And you should start re educate your patients not to remove labels from the medications as you should be promoting quality use of medicines .May be a dispense tech can help labeling if your store is busy .

    • Jarrod McMaugh
      28/08/2019

      What a person does with their medication once it is theirs is up to them. “Reducating” a person about the importance of the label is likely to undermine the relationship the pharmacist has with this person….

      It doesn’t matter what the regulations say or what is “right” if the way you deal with a situation shuts down any future communication.

  2. Geoff
    11/09/2019

    On high usage items eg P Forte or statins we had cautionary labels applied by afternoon staff (supervised) before stock went on the shelf, so technicians, pharmacists and interns could spend time more appropriately.
    Multiple labels on repeat supplies of authorities does seem unnecessary but labels serve other purposes as well as informing the patient- they may be of use on hospital admission, to a carer, to establish ownership with Police or in worst case to a coroner. I am glad the intern stuck up for herself for doing the right process and disagree that labelling correctly is a superfluous task.
    If a patient complained that labels get in the way then I would put a note in their file for next supply to place the label differently. Suppliers were meant to ensure there was sufficient blank space to allow labelling but this is still poor and often a label will necessarily cover important information on the original box. Lots of things could be improved but not by challenging an intern to bend the rules

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