An ethical scenario for a community pharmacist and to decide what to do

Duty to protect patients You are a community pharmacist who has recently started a postgraduate professional degree. As part of the course work you need to carry out a medication review for a patient with diabetes. You ask the nurse to select a patient. She suggests Mrs Abbott, an elderly lady who started on insulin two months ago as her diabetes was not controlled by metformin alone. While reviewing the patient’s history, you realise that her creatinine levels indicate mild renal failure at the start of her treatment and that this has become worse. You draw the attention of the nurse to the contraindication and recommend that Mrs Abbott be managed on insulin alone. The nurse responds by saying that Mrs Abbott cannot manage without the metformin and gives the impression that your recommendation will not be acted upon. Guidelines: 1) Gather relevant facts a. Use of metformin + insulin? b. Use of metformin in patient with renal failure? c. Will the pharmacist be held liable if s/he fails to intervene when errors could potentially harm patients? d. What guidance does the Code of Ethics give here? i. Using one’s knowledge for the safety and well-being of patients ii. Working with other HCPs iii. Professional indemnity 2) Prioritising a. Patient as first priority b. Relatives; you can be held accountable by relatives if her condition deteriorates c. Other HCPs: Treatment alternatives? d. Employer e. Yourself: you owe it to yourself to intervene 3) Generate Options a. What could you do? 4) Choose an Option a. What should you do?