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Should pharmacists be on the counter?

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After spending about 12 years in community pharmacy, it’s safe to say I have seen a lot of transactions between counter staff and customers.  But are these always 100% safe and effective?

Counter staff, although very good at their job and often with a lot of experience, aren’t trained to think in the same way as a pharmacist. 

Mrs Jones comes in and asks for potassium citrate mixture for warding off the start of cystitis......ok, but is she asked if she is on any antihypertensives?  Although she might have had it before, the questions that were asked by the counter staff didn’t ascertain if it was to be used by herself; could it be for someone who was pregnant?  Was the patient’s renal function chronically impaired?  All these were opportunities to get more information from Mrs Jones and make sure that the potassium citrate was clinically appropriate.

Mr Taylor, who comes to the counter with a shopping basket full of toiletries, also has a box of Beechams powders for his cold symptoms.  They’re only a GSL, he’s had them before, he must know what he’s doing – right?  Not always.  Has he been asked if he’s on warfarin or aspirin?  Does he know not to have them on an empty stomach?  It’s very easy as a counter assistant to ask if the patient has had them before, and if they have, assume that it must have been checked before.

Does every patient that buys ibuprofen tablets get asked if they are on ACE inhibitors and diuretics to reduce the chance of acute kidney injury, an incredibly common cause of hospital admissions.

With more and more medicines being available over the counter, are pharmacists better placed on the counter?  I think that the number of adverse events and even hospital admissions could be reduced if pharmacists were giving advice on over the counter sales, rather than only being there is a counter assistant needs help and needs some advice.

Simple interventions such as explaining that effervescent tablets (paracetamol, vitamin C tablets, co-codamol etc) contain a lot of sodium and shouldn’t be used long term if a patient is on antihypertensives may seem insignificant but may even save a patient being put on unnecessary additional medication.  The extra sodium in the effervescent Vitamin C, that Mrs Smith takes all the way through winter to stop her getting a cold, may be enough to raise her blood pressure significantly enough to be put on ramipril in addition to her normal medication.  But could this cause her BP to drop too low when she stops them in spring?  Could she be one of the elderly patients being admitted to hospital after having a fall due to low blood pressure?

All this gives us food for thought.  I’m not saying that more and more medicines should not be available to buy over the counter, just that pharmacists should be more involved in every day, run of the mill over the counter sales.  Where is the pharmacist in your community pharmacy?

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From: Tomorrow's pharmacist blog

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