Last month I finished up with a little grumble on the shortage of bumetanide. In it, I expressed the deep frustration of every pharmacist in the country that the HSE/PCRS/HPRA/DoHC hadn’t found a temporary solution to the shortage of this critical drug. The plot thickens. The closest direct alternative to bumetanide 1mg is, drumroll, furosemide 40mg. Guess what drug is now short? If this was some sort of farce at least we would have a good laugh. Unfortunately, it is deadly serious. Fortuitously, in some sort of gaslighting, bumetanide is now back, months before the original return date of October.

Shortages of common medicines have continued to deteriorate. As I look at my everyday list of frustration it would be fair to say that I am, no different to any of you, deeply annoyed. We were told the issue of drug medicine shortages was being addressed at the highest level. High-powered committees have met. Yet here I am, a modest pharmacy on the edge of Europe, and I find patient safety is getting compromised every day in the search for missing drugs. Frequently we can procure unlicensed alternatives, often at exorbitant costs, that may fill a gap. Yet, there is no fair process for ensuring the hard-pressed, tax paying public, will not have to pay considerably extra for these vital medicines. Additionally, while we know that the vast majority of unlicensed medicines arrive to this country as a licenced product in another EU country, this doesn’t mean all are. As we all know, we cannot check these imported medicines for authenticity using that colossal waste of resources, FMD, thus precluding the only safety check that we have to protect the public.

HIQA are in the process of updating and reviewing standards for the transmission of electronic prescriptions, the dispense record, and other ancillary standards. There is a chicken and egg situation about this, as we are told that some electronic record systems are nearly ready to be trialled — whatever that means. Perhaps they want to backfill standards into the delivered product. Of particular consequence is that HIQA are also creating a standard for the summary care record, the ‘Patient Summary’. This, almost mythical beast, is proposed to be the first port of call for any medical professional looking for an up-to-date overview of a patient’s medical status. In theory, it will be read-only, based on underlying standardised data. I call it mythical, not in the Odyssean way, but because it has been talked about for so long. Yet, we seem to be no closer to having a working standard Electronic Health Record model as we rapidly approach 2030, than we were in 2007, when it was the hot topic.

Over the next few weeks, the Patient Summary record final draft will go out for public comment. If you do nothing else, I recommend that you look at this, particularly the sections in relation to prescription medication, and give feedback to HIQA. The draft looks a way more complex than it actually is. The first part of all these standards is scene setting and is almost a cut and paste job from related documents. The meat is in the relevant sections. While it may look slightly technical, it isn’t. It’s all plain English in nice little columns to give it some structure. Why is this important? While I don’t need to explain to any pharmacist, nor any frontline medical worker, that a prescription is not the same as a dispense record, this is not always understood. There is a perception that if a drug is prescribed for a patient, that somehow it magically must be something they are taking. Compliance embraces a complex set of behaviours for most patients. Yes, there are people who religiously take what is on their prescription. Yet, it is much more common to see people adopt a hybrid approach towards their prescriptions — à la carte. For instance, most of us will note that many patients have a loaves and fishes approach towards cholesterol medication. I am constantly amazed at how patients seem to have sufficient statin and, yet, are out of all their other routine meds. So, when a standard is being developed, it is important that there isn’t bias in both the professionals and the public as to who is being consulted.

It is not enough to ask a group of hospital doctors and pharmacists about current medication records. It is important to include those that are at the coalface of community medicine. When this goes out for public consultation, you have your shot. The importance of these standards is that they may be used as a reference for the Department of Health to deliver the working product. Some of you might question why we are only developing standards now for something that is supposedly around the corner, and we will leave that to the higher powers. Rant over.