HIDRÓLISIS ÁCIDA

The data presented above showed that the pharmacists’ knowledge of medicines and ability to check prescriptions for potential problems was widely appreciated. To be a good ‘checker’,

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pharmacists need to pay close attention to detail. The following quotes from a hospital pharmacist and a doctor (who worked at different hospitals and in different specialties), both emphasise the importance of this, with the pharmacist stating that members of her profession must be ‘precise’, which means ‘very attentive to detail’.124

... an underlying trait is you’ve got to be precise if you like...whether you’re a community pharmacist or a hospital pharmacist....extremely important that they’re attentive to detail, cos you are the final check before the patient gets the drugs, so from a safety point of view it’s important that you are a little bit bothered about making sure that you do your job right. (Hospital pharmacist Q)

... they’re all very thorough, and you have to be, erm, and they’re all very accurate in what they do and what they write, again which is pretty essential, and I don’t think you can be a good pharmacist without having those characteristics. (Hospital doctor C)

Interviewees who worked in the community setting expressed similar ideas:

They have to be very alert...very methodical...a bit like how I think of airline pilots, they have to be able to deliver something at the same level all the time, you know, you can’t have a good day or a bad day with those sort of things can you? There’s got to be a certain minimum...they have to be quite disciplined...(GP D)

…you have to be, you know, accurate and just concentrate all day basically, that’s how I think about it, just be alert. (Community pharmacist N)

Participants in a stage one group interview also described a pharmacist with very good attention to detail:

CP D: Yes, her checking will be absolutely bob-on...attention to detail...(Focus group 7, persona 02)

However, some variation in this respect was perceived - although the hospital pharmacist quoted above referred to being precise as an ‘underlying trait’ of most pharmacists, she did think that there were some pharmacists who were not as attentive to detail as they needed to be:

There are some slap-dash ones I think, then errors still creep on through and...you lose the point of having a pharmacist then. (Hospital pharmacist Q)

Also, the same participants from the group interview described another pharmacist who does not pay enough attention to detail – this seems to relate to his attitude and being less committed to the task in hand than his ability:

CP C: [with some locum pharmacists] you’d just get the minimum checking, sitting on the chair and just signing it off (laugh)

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Interviewer: Yeah?

CP D: Oh yeah...they check with their mobile phones...Which is worrying seeing as you know you’re not supposed to drive with mobile phones.

The data presented above suggest that pharmacists in both hospital and community are widely seen as having good attention to detail, and that this is valued because it enables them to fulfil a very important function in checking that medicines are supplied safely. However, people who take medicines, or have had medicines administered to them, can suffer allergies or side effects which may not have been possible to prevent, for example if was the first time that a patient was exposed to a particular drug – in cases such as these the adverse effect would certainly be an unintended consequence, but it is not due to a ‘mistake’. Pharmacists can be good at spotting these – the following two quotes are from interviewees who worked in an intensive care setting:

...they’re very good if you’ve got... side effects...maybe a patient develops like a new, problem...then they might say, ‘well that could actually be a side effect of this.’ And it’s not something you would generally think about, it’s not high on your list...(Hospital nurse A)

I had a chat with one of the doctors the other day, she said ‘it’s really helpful to have somebody like you who has a different angle from what we do’. Because I’m coming from the drug point of view and they’re much more...from the kind of clinical disease state point of view, my priority is the drugs - Are the drugs contributing to this problem? Is it working for them?...certainly in intensive care, because the patients are you know walking a very fine line, the drugs can have quite a dramatic impact...so that’s the angle...I mean there are consultants...I’ve come across to them and said, ‘look this patient’s suffering these symptoms and it’s probably because of this drug’, and they’re ‘oh right I didn’t realise that’. (Hospital pharmacist T)

As well as having good attention to detail, pharmacists were seen as having an overall ‘focus’ on medicines:

...the doctor kind of is a jack of all trades...whereas all we’ve got to focus on is the medicines...there’s more and more drugs and...complex interactions and side effects and things like that to consider these days...so we can make sure that with all these dangerous drugs...that everyone is on the right thing and it’s safe and appropriate...So I think because drugs area such a high-risk component to peoples’ care...it’s useful having a group that specialises just in that...(Hospital pharmacist P)

…the unique thing that the pharmacists have is being able to sort of look at the drug chart…they’re thinking, ‘well is this the right treatment for this condition?’ (Hospital nurse A)