PDL takes a look at a challenging codeine customer situation
From 1 February 2018 medicines containing codeine will no longer be available without a prescription due to the Therapeutic Goods Administration (TGA) up-schedule. The imminent change will provide opportunities and challenges for many pharmacists and pharmacy staff.
PDL assists pharmacists dealing with codeine requests and other professional issues. Reports to PDL consistently relate to the supply, or denial of supply, of codeine containing medicines. It is anticipated the scheduling change will reduce the number and consequence of many of these incidents.
However, challenges posed by customers requesting these medicines during the transition phase of the up-scheduling may have an impact on pharmacists’ practice and potentially lead to formal complaint, or further action. It is evident that good communication with customers is vital in minimising the likelihood of an incident occurring or in an incident escalating to formal inquiry.
Case scenario – Codeine Sale Refusal
“Customer came into store to purchase Nurofen Plus. After seeing on MedAssist he had only purchased a few days ago (3 or 4 days) I was not happy to provide a pack as it did not seem appropriate since he should already have enough tablets. Referred him to the doctor so he could get a prescription. He was agitated but left the store.
He returned to the store with a prescription for Panadeine Extra from the doctor written four months prior and told me to fill it. I told him that we did not have any Panadeine Extra and he said he wanted the Nurofen Plus instead. I explained to him that I cannot swap the medications as they are different, but I was happy to call the doctor to talk to him about what to do.
Very agitated now, the customer was saying that since Panadeine Extra and Nurofen Plus are the same I should swap it without it being an issue. I told him that I cannot change the prescription to something else and I called the doctor’s office which was closed. I told him that there was not much more I could do. The customer kept telling me that this is my fault and that there was nothing to say he couldn’t have some. I told him it was the protocol with codeine sales that the pharmacist has the discretion whether to supply.
The customer persisted and said he wanted my name which I was not sure I had to give him and I felt very threatened and was not comfortable to give my full name. He also tried to take a photo of me but I turned my face and told him it was inappropriate. After telling him there was nothing I could do to help him he left the store he said he was going to complain about me to the pharmacy board.” – Pharmacist Member of PDL
In this instance PDL assured the pharmacist they acted appropriately on all counts including reporting to PDL for assistance. No matter how inconsequential an incident may seem at the time, it may be difficult to recall details down the line, especially in the case a complaint is lodged leading to official inquiry.
PDL will assist you 24/7 around the clock during the up-schedule period of change. To prepare, here are some key procedures to implement in your pharmacy:
Adequate preparation by pharmacists and pharmacy staff:
- Be prepared for enquiries and envisage a range of scenarios that might occur.
- Review available educational material. The professional bodies, the TGA, individual banner groups and pain management organisations have devoted significant resources to assist pharmacists and staff to prepare for and deal with the transition to prescription-only medicines
- Prepare and make available resources and printed reading material for customers.
- Expect to spend more time one-to-one with these customers in the initial phase.
- Ensure staffing levels are adequate for anticipated workload.
- Make sure pharmacy assistants understand protocols to refer enquiries to pharmacists.
Ensure all interactions with customers are professional:
- Actively listen to and acknowledge your customer’s past experiences, including positive benefits from these medicines and their concerns about the changes to access of these medicines.
- Respect the customer’s right to privacy and confidentiality – breach of privacy is a common allegation in complaints involving requests for these medicines.
- Utilise empathetic and non-judgemental communication – pain is a very individual experience.
- Be mindful of terminology such as tolerance, dependence or addiction. These words can be misinterpreted by customers causing offence and always require context or an explanation. Reconsider your need to use certain terminology in customer interfacing. Discuss or role play with colleagues the kind of dialogue to use in various scenarios and create a guideline for your pharmacy.
- Engage proactively with local health care professionals in anticipation of referral of customers and as a part of the customer’s healthcare team.
- Document your advice and referral for the customer, for their doctor and for the pharmacy.