In a report released today, Deputy Health and Disability Commissioner Deborah James has found a pharmacist breached the Code of Health and Disability Services Consumers’ Rights (the Code) for inadequate care provided to a man in his 50s.
The breach relates to two dispensing errors on two separate occasions in 2021.
The first, on 13 May, saw the pharmacist presented with a handwritten prescription from the man's doctor. It noted a reduced dose of candesartan and the cessation of spironolactone, both medications that were present in the man's pre-prepared blister pack.
The candesartan dose was reduced but the spironolactone was dispensed as usual. However, while the pharmacist did note the change in dose on the pharmacy's internal medicine dose chart, she did not update the Toniq dispensary software to reflect this change and it was also not documented in the man's pharmacy file, as is required by the pharmacy's standard operating procedures.
The second error, which occurred on 27 May, pertains to a prescription put on hold without the changes in candesartan dose being noted or rectified.
The Dispensing Compliance Packs SOP requires that the pharmacist "review patient medication history to ensure consistency of medications".
