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The fatal 2 for 1 deal

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A couple of weeks ago, I started my first rotation for my pre-registration training at a hospital.  The rotation? Extemporaneous dispensing. The mere sight of it brought all those dispensing practicals flooding back; the mixing of the creams, tarring of the bottles, zeroing the balance- all this nostalgia got me feeling excited. The first day consisted of reading standard operating procedures (SOPs). Now this may seem a mundane task, however it cannot be avoided and a lot can be learnt from those bad boys. After two days of shadowing and perfecting the hand washing technique with hibiscrub, I was ready to make my first product. Equipped with a blue suit, a white hairnet, gloves and a face mask (looking like a scientific smurf- if they existed, that is, and unfortunately, I have been assured that they don’t), I was taken to the manufacturing unit, or as my new colleagues called it; ‘the inside’.

I was given a method consisting of 30 steps, each one had to be signed by a supervisor, after double-checking, to ensure that the each procedure was completed accurately. This included cleaning of the workstation, gathering the right equipment, correct weighing of any drugs-every aspect of the process was double-checked. Yes, this hospital took quality control seriously; which is exactly how it should be. This tedium ensures that the product dispensed is consistently produced at its required quality. The whole week consisted of echoes of the same terms: good manufacturing practice (GMP), quality control (QC) and quality assurance (QA). By the end of the week my entire pharmacy module on these aspects were thoroughly revised.

Near the end of the week I came across an interesting headline in the broadsheets: “urgent product recall by a drug manufacturing company” called Reckitt Benckiser. Now, unless you’re living under a rock, everyone is aware of the mixing of Seroquel and Nurofen plus tablets. Unfortunately some Nurofen packets also contained Neurontin capsules, a drug that is licensed for use with patients with epilepsy. My first thoughts were; how is this even possible? With so many guidelines in place, everything is double checked, the random sampling after production, QC, QA, the orange guide-how could it have gone so wrong? At the moment investigations are on the way and the only details that are clear are that thousands of 32-tablet packs are affected. So if you happen to have a packet of Nurofen plus tablets, the best thing to do is to hand them in to your nearest pharmacy. 

 I think this incident teaches us that whilst the manufacturing process is a through one, it is prone to error.  Of course we should not demean drug-manufacturing companies- mistakes happen, but what we, as pro-active pharmacists, should do is investigate ways in which we can reduce the negative impact of such incident. Pharmacists should not limit themselves to only to providing oral counselling points; instead we should channel our expertise in providing the community with tools to aid patient treatment. As well as teaching patients and carers on how to take medication properly, we should also train them on recognising what the medication looks like, instead of relying on the box to do the job. Not only will this lessen the morbidities caused by manufacturing errors, but will also minimise the potential harm that can be caused at home- where medication is kept in a box/cupboard and can easily be mixed. As pharmacists, we should aid patients to be more involved in their treatment, this will not only improve patient-healthcare professional relationships, but will allow pharmacies to play a stronger role in the community.

 

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