The importance of pharmacists being accurate in their work and not making mistakes were mentioned frequently by participants in this study. The dictionary defines the word ‘accurate’ as ‘correct in all details’.124 Accurate is an adjective, and in this case the noun it describes is the medicine supplied to the patient. Accuracy was both an accepted and a desired attribute of pharmacists – it was used in descriptions of how pharmacists are and how they should be:
[Describing a pharmacist in five words.]...Er probably safe, accurate... (Hospital pharmacist P)
[a good pharmacist is]...accurate, try and not make many mistakes...(Community pharmacist T)
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Lay pharmacy users also mentioned the importance of pharmacists dispensing accurately:
Interviewer: ...in terms of... pharmacists...what would you say is the main part of their job?
Respondent: Ensuring the proper drugs are given out, proper measurements, proper amount of tablets... (Community pharmacy 2 user G)
Pharmacists and support staff from both sectors of pharmacy expressed a sense that an important responsibility for pharmacists was ensuring that patients received the ‘right’ medicines:
…make sure they’re giving the correct medicine out to the correct people…(Community support staff E)
Obviously making sure the medication [the patient is] getting is correct...(Hospital support A)
Accuracy checking, that is, making sure that the medicines and their label match what is written on the prescription, is one part of the dispensing process. 26,125,126 Accuracy checking
technicians (ACTs) work in some pharmacies and undertake the accuracy check. The presence of ACTs was variable amongst the pharmacies that the pharmacists who participated in this study worked in – some had ACTs and some did not. Consequently, some pharmacists reported that they carried out the accuracy check:
...one of the dispensers would probably dispense it and then I’d do the final check...(Community pharmacist Q)
Even when ACTs were there, it did not mean that the pharmacist would stop accuracy checking altogether:
... [patients] present to a counter assistant usually...who will deal with the prescription and then it gets passed back and is then dealt with by the technician who will dispense it and sometimes label, then the pharmacist would check. That would be the usual, in the busy ones, it is a bit of a conveyor belt type of situation...at least two people always see the prescription, sometimes three people. We do have accuracy checking
technicians as well. So they will look after some of the repeat medicines that have already had a clinical check, so that can happen...they might do some of the repeat medication that’s waiting to be delivered or sent out and I’ll just look after the acute stuff... (Community pharmacist P)
There was variation amongst community pharmacists in this study over who actually carried out this check, and views on who should do this:
...I don’t think we’re gonna get away from checking prescriptions, ‘cause they are bringing in ACTs to do that, but I don’t think we’re gonna end up moving away from that
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role, I think we’re gonna be doing that for quite a while…we are providing more services and we are talking to patients more, rather than standing behind and checking, from when I started...but from when I speak to my friends...you’re constantly behind there, if there’s a busy pharmacy you’re constantly checking, and that’s where ACTs do help cos they can carry on checking and you can talk to patients, so I suppose it is changing a little. (Community pharmacist T)
Oh I was a big fan. When [the introduction of ACTs] came about, the staff and I said, ‘that’s the way forward’, cos it takes pressure off me, and gives [the support staff] more of a role, more sort of a clinical role. (Community pharmacist S)
... we’ve got accuracy checking technicians who will check prescriptions and there’s no need for pharmacists to do that when they could be out on the wards a lot more preventing problems from happening rather than sorting them out once they’ve happened. (Hospital pharmacist T)
Doctors seemed to see pharmacists as having a methodical and careful approach to their work:
Respondent: …pharmacists too, are very directly accountable, you know, if a pharmacist puts methatrexate in a penicillin bottle, that’s his career on the line isn’t it? Interviewer: So they do have responsibility?
Respondent: Absolutely, and it’s their neck on the line too isn’t it? And I think that’s what makes them meticulous and careful. (GP D)
...they’re all a very similar breed of person really, they’re very methodical...will work through things in a very systematic fashion, is my impression...(Hospital doctor C)
Some respondents spontaneously combined an acknowledgement that it is important that the pharmacist dispenses prescriptions safely and accurately, with a desire for them to do so as quickly as possible:
Speed, want you do it quickly...when I go to the pharmacy I want them to be safe with me, erm, I want them to do the right thing with me prescription and me medicines, and to do it reasonably quickly. (Community pharmacist O)
Interviewer: And with patients coming in, what do you think they look for in a pharmacist?...what would they see as a good pharmacist?
Respondent: ...we’ve always prided ourselves on speedy dispensing, we don’t dispense with accuracy but we accurately dispense and in a timely manner, that they like...(Community pharmacist Q)
So did this lay pharmacy user:
...they’re all pretty slow as well, I’ve never seen anyone so slow at doing things, like dishing out prescriptions, it must be part of their training, make sure they do it slowly. I know they have to be very precise in what they’re actually handing out, but really they do tend to be very slow (laugh) (Hospital pharmacy user F)
Several pharmacists expressed concern about making dispensing mistakes. The first pharmacist quoted here seems to refer to a general fear about this:
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Interviewer: Is there anything that makes your job difficult, or any bad sides to it? Respondent: I think it’s just, erm, when you’re worried about making mistakes. (Community pharmacist T)
This pharmacist seemed reluctant about the idea of delegating accuracy checking to support staff (ACTs) because of worry about their potential to make mistakes:
...[if technicians carry out the checking] the pharmacist is still liable, if they mess it up you’re still gonna be the one that gets in trouble, which doesn’t seem right either. (Community pharmacist T)
This pharmacist expressed a sense of generally increased pressure on pharmacists not to make errors:
...dispensing errors...the power seems to have shifted more to the patient, away from the pharmacist, so there’s more pressure on pharmacists not to make mistakes, or...be seen to have done something wrong...(Community pharmacist S)
And these pharmacists seemed to express a fear of ‘punishment’ for making mistakes that seemed to pervade much of their practice:
...the society’s waiting to jump on you. They can jump at you at any moment...(Community pharmacist Q)
Everyone’s down on pharmacists for making mistakes, even our governing body is out to get us, I think I fear them more. There’s a culture of blame and claim. Patients say, ‘If it’s wrong I can sue you!’ And they’re joking, but you have to have a million pounds insurance in place….pharmacists get scape-goated. (Hospital pharmacist N)
This doctor cited getting things ‘wrong’ in describing his idea of what would make a bad pharmacist:
Well I suppose it would be making bad mistakes...(Hospital doctor D)
While the quote from the doctor above was theoretical, the pharmacist below had several years of experience working with a range of pharmacies across a whole PCT area. She mentioned the importance of having a well organised dispensary with good systems in place in terms of safety, and described the variation that she had observed in this respect:
…[a good pharmacist is] organised...as soon as you walk in through the door, I kinda know, what I’m facing...you walk into the dispensary...I mean I’ve walked into some pharmacies and you’re like, ‘oohhh – disaster!’ You know, cos stuff’s everywhere and there’s stuff all over the place, and you think, ‘this is a disaster waiting to happen, this is where mistakes are made’. (Primary care pharmacist C)
This pharmacy user recalled an incident where the wrong tablets had been dispensed for a prescription she collected. Participants in this study were not asked directly about pharmacy
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‘mistakes’, but they were asked for examples of any ‘bad experiences’ they had had with pharmacists, and about how they would define a ‘bad’ pharmacist. It is notable that this is the only example of a pharmacist giving the wrong drug to a patient in a community pharmacy that was raised during the entire set of interviews conducted for this study:
... they can get the prescription wrong, so you’ve got to be careful. I mean, there has been occasion where [I picked up a prescription] for my mother, and they got it a bit wrong, you’ve got to watch that they’re giving you the tablet that’s on it...(Community pharmacy 2 user C)
Whilst direct personal accounts of experiencing pharmacists’ mistakes were very rare amongst the data generated for this study, participants did provide several examples of pharmacist ‘errors’ that have featured in the media. These quotes describe real-life cases that the participants recalled seeing reported:
I think the only things you see it’s like on TV or anything is if they’ve done an error somewhere...maybe in the local papers...if something’s happened...(Community support staff D)
... in the paper actually, what’s her name? The poor pharmacist who got the criminal record for making a dispensing error...I think it did go into the main press so that’s not a good light really...(Hospital pharmacist P)
These pharmacists recalled seeing fictional examples of pharmacists making dispensing errors:
I think the worst thing about kind of media type pharmacy things...television dramas, films, anything, they always portray the pharmacist to be either a failed medical person...or somebody who’s made a terrible mistake, and that really annoys me...(Hospital pharmacist R)
Although this pharmacist did recall an instance where an initially negative portrayal of a pharmacist was changed after pressure from within the profession:
...there was a famous pharmacist in one of those programmes, [Peak
Practice]...apparently there was a big furore because he was portrayed as a buffoon and made a dispensing error and then everybody in the pharmacy profession
complained and then they changed the story line and he became a hero and saved a patient’s life...(Community pharmacist R)