GPhC Patient Safety — Questions and Answers
Question 1: A pharmacist identifies that a patient has been prescribed methotrexate 10mg daily instead of 10mg weekly. What is the most critical immediate action?
- Dispense as written and advise the patient to take it weekly
- Contact the prescriber immediately to clarify the dosing frequency before dispensing (Correct answer)
- Dispense a reduced quantity to limit potential harm
- Refer the patient to A&E as a precaution
Correct answer: Contact the prescriber immediately to clarify the dosing frequency before dispensing
Daily methotrexate dosing (instead of weekly) is a well-known fatal prescribing error that has caused multiple patient deaths. The pharmacist must contact the prescriber immediately to clarify and correct the prescription. This is a never-event in the NHS. Dispensing as written, even with verbal advice, is not acceptable.
Question 2: The Yellow Card Scheme is used to report suspected adverse drug reactions (ADRs) to which UK organisation?
- National Institute for Health and Care Excellence (NICE)
- Medicines and Healthcare products Regulatory Agency (MHRA) (Correct answer)
- General Pharmaceutical Council (GPhC)
- NHS England
Correct answer: Medicines and Healthcare products Regulatory Agency (MHRA)
The Yellow Card Scheme is operated by the MHRA and is the UK system for collecting information on suspected adverse drug reactions. Healthcare professionals and patients can report via yellow cards, online, or through the Yellow Card app. It is vital for post-marketing surveillance.
Question 3: A patient collecting a dispensed prescription notices that the tablets look different from their usual supply. What should the pharmacist do?
- Tell the patient all generic tablets look the same and not to worry
- Check the dispensed item against the prescription, confirm it is correct, and explain any changes such as a different generic brand (Correct answer)
- Ask the patient to try the tablets and come back if there are problems
- Refuse to discuss the matter due to time constraints
Correct answer: Check the dispensed item against the prescription, confirm it is correct, and explain any changes such as a different generic brand
Patients often receive different generic brands due to supply chain changes. The pharmacist should verify the dispensed item is correct, then clearly explain to the patient why the appearance has changed whilst confirming it contains the same active ingredient at the same dose. This builds trust and reduces non-adherence.
Question 4: Which of the following is an example of a high-risk medicine that requires additional safety checks in community pharmacy, as identified by NHS patient safety alerts?
- Paracetamol 500mg tablets
- Ibuprofen 400mg tablets
- Warfarin tablets (Correct answer)
- Cetirizine 10mg tablets
Correct answer: Warfarin tablets
Warfarin is classified as a high-risk medicine due to its narrow therapeutic index, need for INR monitoring, significant drug and food interactions, and potential for serious bleeding. NHS patient safety alerts require additional checks for high-risk medicines including anticoagulants, insulin, opioids, and methotrexate.
Question 5: A dispensing error has occurred in the pharmacy. According to best practice, what should the pharmacy do after ensuring patient safety?
- Discipline the staff member responsible immediately
- Conduct a root cause analysis and report the error through the local incident reporting system (Correct answer)
- Keep the error confidential to protect staff morale
- Only report if the patient was actually harmed
Correct answer: Conduct a root cause analysis and report the error through the local incident reporting system
A just culture approach requires root cause analysis to identify system failures rather than blaming individuals. All errors should be reported through the incident reporting system (such as NRLS/LFPSE) regardless of whether harm occurred, as near-misses provide valuable learning opportunities for preventing future errors.
Question 6: A patient on atorvastatin is prescribed a course of fluconazole by their GP. What patient safety concern should the pharmacist raise?
- Fluconazole reduces the effectiveness of atorvastatin
- Fluconazole inhibits CYP3A4, increasing atorvastatin levels and the risk of myopathy/rhabdomyolysis (Correct answer)
- Atorvastatin reduces the antifungal effect of fluconazole
- There is no significant interaction between these drugs
Correct answer: Fluconazole inhibits CYP3A4, increasing atorvastatin levels and the risk of myopathy/rhabdomyolysis
Fluconazole is a potent inhibitor of CYP3A4 and CYP2C9. Atorvastatin is metabolised by CYP3A4. Co-administration can significantly increase atorvastatin plasma concentrations, raising the risk of statin-related myopathy and rhabdomyolysis. The pharmacist should contact the prescriber to discuss alternatives or temporary statin suspension.
GPhC Patient Safety
A pharmacist identifies that a patient has been prescribed methotrexate 10mg daily instead of 10mg weekly.
What is the most critical immediate action?