"Boots" is the name of an outpatient chain pharmacy in the UK (like Rite Aid, Kroger, Walgreens, etc in the states) Today Elise and I went our separate ways and got to visit two of their stores. Elise was at one of their flagship stores today and I was at a smaller one in a little town called Didsbury that is really close to where our flat is. We will swap places on Thursday so we get an idea of a bigger store in comparison to a smaller one.
My store in Didsbury had one pharmacist and two technicians; however, one was just what they call "a dispensary" and the other was a name that I can't remember! Oops! I just know that she was essentially certified and had to take a course to get her title. I liken this to the certified vs. non-certified techs in the states. Each store has SOPs (Standard Operating Procedures) that they have in place to prevent errors from occurring. I familiarized myself with the stores SOPs when I got there and then observed the dispensing process from the time the prescription was dropped off.
All prescriptions are hand written which is completely different than what I am used to. Aside from C-IIs, I would say the majority of prescriptions I see are electronic. Also, pharmacists do not take prescriptions over the phone so if they need to change the drug that was prescribed (i.e. the dose was wrong, the formulation is incorrect, or there is a drug interaction) they have to contact the prescriber and the patient has to pick up a new script to bring in. So much different than the process in the states.
I spent a lot of time perusing the various drugs that they have in stock. They are pretty similar to what we have except most of the brand names are very different. They do not bulk order so the drugs that they get in are typically in a 28 or 30 day supply and the drug is dispensed in the original box. Rarely do they ever count out pills and put them in separate vials. Controlled drug scripts are only good for 28 days. Also patients rarely get refills on their prescriptions..aka "repeats." I think I like this idea. I'm sure patients and doctors in the states would find this absolutely crazy to have to be seen every month but perhaps patient's disease states would be better managed.
Although I'm not sure how we would fund a system like the NHS, it makes sense to have a system that slots patients to ONE family practitioner. That way patients would be restricted to going to the ER unless it was an absolute emergency and would not be able to see a specialist whenever they wanted which would also cut down on costs hopefully.
Patients on warfarin and lithium also are supposed to have their most recent INR and lithium level before getting prescriptions dispensed which I find to be a really awesome concept.
Most patients get NHS prescriptions which are little green sheets of paper that have a list of exemptions on the back. For example, if you're over 60, younger than 16, or 16/17/18 and are in school then you are exempt from paying. Prices are pre-defined by the NHS and based on the number of prescriptions. Each prescription is 7.65 pounds. Elise and I are extremely curious how they derived this number.
The other thing that stuck out was the fact that they only use a computer to print a label and so they do not have any interaction or allergy checker. Although I think we often rely too heavily on the computer to check those things for us, I do think that it's a good thing to have as part of the dispensing process. I suppose since we have several doctors writing prescriptions for one patient in the states that it's a bit more crucial.
I got to witness an emergency contraceptive counseling session as well today. Not every pharmacy in the UK can dispense emergency contraceptives (aka plan B) You have to have a pharmacist that has been certified to do the counseling in order to provide the service. Pharmacists have to go through a questionnaire with the patient. AWESOME idea in my mind. I feel like we have a lot of patients who use emergency contraception like regular birth control. This counseling session forces patients to hear some really valuable information & adequately assess whether the patient really could benefit from getting the pill. Also, interestingly enough, the patient has to take the pill in front of the pharmacist. The pill is completely free if the patient does not have any contraindications discovered through the questionnaire process.
Some patients that receive methadone or buprenorphine also have to take their medications in front of the pharmacist. The pharmacist I worked with today had never dispensed or seen a prescription for Suboxone! So different than Kentucky!
All in all, today was really interesting getting to witness first hand how the outpatient world of pharmacy functions in the UK. Some other interesting things I noted:
- Pharmacy employees also take tea breaks during the day
- Stomach gas is referred to as "wind." I noticed a product with Simethicone that was called "Wind Settlers"
-Bandaids are plasters
-Voltaren gel is over the counter
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