Key considerations and a recommended course of action when a pharmacist is asked to supply medication to a third party.
Scenario:
A 20-year-old man approaches a community pharmacist, requesting the emergency contraceptive pill (EC) for his 18-year-old girlfriend.
The man tells the pharmacist his girlfriend is unable to come into the pharmacy in the next few days as she is working.
Upon questioning, the pharmacist identifies that the girlfriend has never taken this medicine previously.
Key considerations
Refusal of supply is not appropriate
A pharmacist is required to respond to patients, authorised representatives and other healthcare professionals in a timely manner to ensure patients or community healthcare service needs are met in a consistent manner (Professional Practice Standards (PPS) criterion 1.1.3).
Refusing to supply because the patient is not present in the pharmacy, without exploring other options to meet her needs, compromises the patient’s ability to access treatment in a timely manner.
Supplying without contacting the patient may not be appropriate
Pharmacists are required to ensure they have a thorough, accurate and systematic approach to history taking and, in particular, need to consider the reliability of any third party as an accurate historian (PPS criterion 4.6).
The pharmacist should use their professional judgment to consider whether the boyfriend is able to accurately provide the information required to ensure safe and appropriate use of the EC.
Pharmacists should also ensure that the provision of the EC to the boyfriend aligns with relevant clinical guidelines (PPS criterion 4.2.1).
Although there are no specific contraindications to the use of EC, the boyfriend may not be able to provide specific information about the patient’s menstrual cycle, any regular oral contraceptives being taken and the patient’s other regular medicines.
This means the pharmacist may not be able to determine:
• the risk of pregnancy
• whether the EC is the most appropriate treatment for the patient (e.g. if they are taking liver enzyme-inducing medicines, a higher EC dose or copper intrauterine device may be more appropriate)
• what appropriate follow-up advice to provide (e.g. how to restart the regular oral contraceptive, how long to use an additional barrier method of contraception).
An additional concern related to third-party supply of EC is the possibility of sexual assault or coercion.
Recommended course of action
Supply following communication with the patient is the most appropriate action
If the patient is unable to come into the pharmacy in a timely manner, the most appropriate method of communication would be to talk to her over the phone (PPS criterion 4.7.2).
This would enable the pharmacist to provide primary health care to the patient through accurate history taking (PPS criterion 4.6), assessment of risks and benefits (PPS criterion 4.7.3) and advising on the optimal use of this medicine (PPS criterion 4.8.2).
To ensure the quality use of medicines, the pharmacist should also facilitate appropriate patient follow-up (PPS criterion 1.7.5).
In this case, the pharmacist should encourage the patient to visit the pharmacy for follow-up when she is able. The pharmacist should confirm that the patient is aware of ongoing arrangements and access to healthcare professionals (PPS criterion 4.10.3).
Relevant Professional Practice Standards
Standard 1 – Fundamental Pharmacy Practice
Standard 4 – Provision of Non-prescription Medicines and Therapeutic Devices
Further resources
PSA Emergency Contraception: S3 guidance document
Visit: apf.psa.org.au
PSA gratefully acknowledges the Australian Government Department of Health for providing funding for the original development of this case study as part of the PBS Access and Sustainability Package including the Sixth Community Pharmacy Agreement.
