Responding to complaints

LEARNING OUTCOMES

  • By the end of this lecture, you should be able to:
    • Minimize the risk of dispensing errors.
    • Know how to respond in the event of a dispensing error.
    • Review dispensing errors for future prevention.
    • Practice through Workshop 7 including case examples.

WHY DEAL WITH COMPLAINTS?

  • Standards for pharmacy professionals include:
    • Providing person-centred care.
    • Behaving in a professional manner.
    • Speaking up when there are concerns or errors.
  • The General Pharmaceutical Council (GPhC) has published guidelines on the duty of candour.
  • Further resources are available on the GPhC website.

DUTY OF CANDOUR

Essential Components
  • Open and Honest Interaction: Healthcare professionals must inform patients when something goes wrong with treatment that may cause harm or distress.
  • Key Actions:
    • Inform the patient (or their representative) promptly.
    • Apologize appropriately.
    • Offer remedies or support, if possible.
    • Explain both short and long-term effects of the incident.
    • Engage in reviews and investigations as required.

WHY COMPLAINTS ARISE

  • Main causes include:
    • Human error.
    • System failures, such as inadequate Standard Operating Procedures (SOPs).
    • Initial handling of the complaint in the pharmacy.
  • Approximately one-third of all complaints pertain to dispensing errors.

TIPS FOR RESPONDING TO COMPLAINTS

Key Strategies
  • Active Listening:
    • Listen without interrupting and show empathy.
  • Maintain Professionalism:
    • Stay calm and avoid defensiveness.
  • Acknowledge the Issue:
    • Thank the patient for raising their concerns and apologize if necessary.
  • Investigate Thoroughly:
    • Collect information including checking records and interactions.
  • Resolve Promptly:
    • Offer solutions or alternatives and involve pharmacists if needed.
  • Document Everything:
    • Keep records of complaints, actions taken, and outcomes.
  • Follow Up:
    • Contact the patient after resolution to ensure satisfaction and show you value their feedback.

SAYING SORRY

  • Meaningful apologies are vital for healing and include:
    • Clear explanation of what happened and actions taken to rectify the situation.
    • An apology supports learning and fosters patient safety, but does not imply legal liability.
    • Pharmacy professionals should follow workplace policies regarding apologies.

MINIMISING THE RISK

Dispensary Practices
  • Layout Considerations:
    • Maintain an organized and conducive environment for dispensing.
    • Implement stock alerts and ensure staff competency.
    • Use segregated dispensing and checking areas.
  • Dispensing Process Protocols:
    • Label products before selection from the shelf.
    • Always refer to the prescription (Rx), not the label.
    • Perform checks and involve multiple people when possible.
    • Take mental breaks if working alone.

THE TOP TEN ERRORS IN DISPENSING

  1. Omitting/Delaying prescriptions for medications.
  2. Errors with anticoagulants.
  3. Opioid analgesics mistakes.
  4. Insulin dispensing errors.
  5. Issues with nonsteroidal anti-inflammatory drugs (NSAIDs).
  6. Drugs needing regular blood-test monitoring.
  7. Allergies to medications not accounted for.
  8. Drug interactions that were overlooked.
  9. Errors with loading doses.
  10. Oxygen dispensing errors.

TYPES OF ERROR

  • Categories of Errors:
    • Administering, dispensing/supplying, monitoring, prescribing, and transcribing errors.
    • For guidance, consult the RPS Errors and Near Misses guide.

IN THE EVENT OF AN ERROR

  • Immediate Actions:
    • Apologize and conduct a root cause analysis.
    • Establish if the patient has taken incorrect medications.
    • Inspect the incorrect medication with patient consent.
    • Do not downplay the seriousness of the error.
    • Supply the correct medication as needed.
  • Follow-Up:
    • Understand patient expectations for resolution and provide information about official bodies if requested.
    • Report and document the incident according to SOPs and notify the pharmacist on duty.

THE NEAR MISS LOG

  • Purpose: This log is for documenting near miss incidents to analyze and improve pharmacy practices.
  • Essential details to record include:
    • Date and time of the incident.
    • Staffing levels and personnel involved.
    • Medicines involved and types of near misses.
  • Regularly review this log to identify and mitigate risks.

RPS ERROR REPORTING STANDARDS

  1. Open and Honest: Be transparent when errors occur.
  2. Report: Notify appropriate local or national reporting programs about safety incidents.
  3. Learn: Investigate and learn from all incidents, including minor and severe cases.
  4. Share: Communicate findings to enhance safety systems.
  5. Act: Implement changes to practice based on learnings.
  6. Review: Consistently review the effectiveness of improvements.

REVIEWING ERRORS

  • Maintain written records of findings, considering conditions like workload and staffing competency.
  • Ensure that checks are thorough and based on legible prescriptions.

SUGGESTED READING

  • Errors and Near Misses Guide | RPS (rpharms.com)