“Close-Up on Complaints” explores incidents reported to the College that have occurred in the provision of patient care and which present learning opportunities. Ideally, pharmacists and pharmacy technicians will be able to identify areas of potential concern within their own practice, and plan and implement measures to help avoid similar incidents from occurring in the future.
EFFECTIVE COMMUNICATION BENEFITS STAFF AND PATIENTS
SUMMARY OF THE INCIDENT
This incident involves two staff from the same pharmacy – the designated manager (DM) and a pharmacist.
A woman (patient), her husband and son made an evening visit to a community pharmacy and requested flu shots. When the patient was told by pharmacy staff that flu shots were no longer being administered for the day, she challenged the decision, insisting the hours for flu shots should be posted to avoid patients being turned away.
At this point, the pharmacist agreed to administer the flu shot to the patient and her family that evening. The patient claimed that the pharmacist, when agreeing to administer the vaccine, complained about a busy work load, saying that she didn’t get paid extra for administering injections.
The patient reported that, within hours of receiving the vaccine, she experienced pain in her shoulder and arm. She eventually contacted her doctor because she was unable to move her arm and was losing sleep. The patient subsequently reported the issue to the pharmacist-on-duty at the same pharmacy (not the pharmacist who had administered the shot). She also submitted a formal complaint to Public Health Ontario, noting her significant pain required medication and visits to a physiotherapist, a doctor and a specialist.
The patient subsequently filed two complaints with the College. One complaint was related to the DM’s handling of the patient’s concerns and the other related to the pharmacist’s administration of the flu shot and her alleged verbal objections as she did so.
The College’s Inquiries, Complaints & Reports Committee oversees investigations of each complaint the College receives. A committee panel considers a pharmacy professional’s conduct, competence and capacity by assessing the facts of each case, reviewing submissions from both the complainant and the professional(s) and evaluating available records and documents related to the case.
Complaint against the member who administered the flu shot
Regarding the patient’s post-injection pain, the panel observed there was no proof to indicate that the administration of the vaccine by the pharmacist was the direct cause of her discomfort. However, the panel indicated that the pharmacist should have advised the patient of the potential side effects of influenza vaccinations, including the possibility of an injection injury, which could have related to the issues the patient experienced. The DM of the pharmacy reported, based on available documentation, she could not determine if the patient’s sore arm was due to the administration of the vaccine.
Both parties offered divergent accounts of the pharmacist’s conversation with the patient and her family and there was no evidence to determine if the pharmacist behaved inappropriately. However, the panel pointed out that, while the content of the interaction cannot be determined, the patient was left with the unfortunate impression that the pharmacist was being inconvenienced by providing the vaccine.
Complaint against the DM regarding the management of the patient’s concerns:
In the matter of unposted flu shot hours, the panel ruled that the DM is responsible for ensuring that staff are aware of the operational details of the pharmacy. While most pharmacies have increased patient volumes during the flu season, appropriate management and professional practice should help prevent confusion and ensure that staff are able to manage with increased patient volumes.
The panel noted that the DM indicated that she did not notify the pharmacist of the vaccine administration concern raised by the patient. This further emphasized that the DM should have communicated the patient’s concern to the administering pharmacist, apologized to the patient and determined how to better address such situations in the future. The DM, the panel noted, is ultimately responsible for the standards of practice in the pharmacy.
WHY DID THIS HAPPEN?
While the posting of flu shot hours is not a requirement, the lack of direction surrounding the administration of flu shots created confusion for staff who were unable to determine if the pharmacy could accommodate the patient and her family’s request. This subsequently impacted the patient’s overall experience at the pharmacy.
The pharmacist who administered the shot pointed out that the patient likely first spoke with another member of pharmacy staff who was under the incorrect assumption that the vaccine would only be administered by another pharmacist who had since left for the day. The administering pharmacist further pointed out that she would never have turned the complainant and her family away had she been the first to encounter them at the pharmacy.
The patient’s discomfort following receipt of the flu shot could have been better addressed by both the DM and the pharmacist. The pharmacist did not adequately communicate possible side effects of the vaccine injection and the DM did not adequately address the expressed concerns with both the patient and the administering pharmacist prior to the complaint being made.
LEARNINGS FOR PHARMACY PROFESSIONALS
The Standards of Practice state that pharmacists must demonstrate effective communication, including the use of effective verbal, non-verbal, listening and written communications. The DM should have empathically addressed the issues presented by the patient and extended an apology. As a pharmacist, the DM should have recognized a general Standard of Practice that required her to promptly disclose incidents and potentially unsafe practices to those affected in accordance with legal and professional requirements.
Model Standards of Practice also dictate that pharmacists who manage a pharmacy must also develop policies and standard operating procedures that support staff’s ability to continuously improve the safety and quality of patient care provided.
Pharmacists must also demonstrate professionalism and apply ethical principles in their daily work. The DM would have better served the patient and her staff had she accepted responsibility for actions taken and decisions made, and maintained the patient’s best interest as the core of all activities.
When administering the influenza vaccine, the pharmacist should have advised her patients of potential side effects.
Additionally, pharmacists are required to use evidence from relevant sources to inform their activities, critically evaluate medication and related information and adhere to current laws, regulations and policies applicable to pharmacy practice. By complying with the Standard pertaining to effective communication skills, the pharmacist would have conveyed flu injection information to patients while also maintaining the patient’s best interest as the core of all activities.
- Reporting Adverse Reactions to Vaccines and Medications, Pharmacy Connection, Summer 2017 issue
- Fact sheet: Adverse Event Following Immunization Reporting for Health Providers, Public Health Ontario
- Model Standards of Practice for Pharmacists
- Guideline - Administering a Substance by Injection or Inhalation