The pharmacist's role in emergency situations

[All4MyDaughter]

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I would argue that if you have the knowledge/equipment to save some one's life but choose not to due to possible legal consequences, that is not what is best for the patient. Yes the best thing is for every bad thing to happen when close range of trained medical personnel, but that's not always the case and is not really what is being discussed.

On the other hand if she saved your life, you would thank her. You are taking it to an illogical extreme anyway. She would give the heimlich maneuver not try to trach you. Giving life saving intervention (heimlich)and trying to play MAcGyver with some one's life (emergency trach) are not the same thing.

You can choose to think my examples are too extreme or illogical or whatever. I deliberately picked the trach example b/c I thought it would be easier to grasp b/c it's CLEARLY outside the standard of care/scope of practice. My point remains the same, if you act outside of your scope of practice/training, whether it is a LITTLE outside of your scope or a LOT outside of your scope AND there is a bad outcome that can be attributed to your action, you will be held liable.

RE: your example - A nurse giving the heimlich manuever is not outside of scope. A civilian can do the heimlich, at least in my state. The Red Cross puts posters with the heimlich manuever on them in every restaurant. Anyone performing the heimlich manuever would be shielded by Good Samaritan laws.

We can debate all night about what SHOULD be done, ethically or morally or whatever. I'm just talking about what the law allows and doesn't allow. There may be times where it is ethically acceptable to break the law, but one should do so knowing that there can be consequences.

 

[Old Timer]

Ohio Revised Code: 2305.23

Liability for emergency care.
No person shall be liable in civil damages for administering emergency care or treatment at the scene of an emergency outside of a hospital, doctor’s office, or other place having proper medical equipment, for acts performed at the scene of such emergency, unless such acts constitute willful or wanton misconduct.

Nothing in this section applies to the administering of such care or treatment where the same is rendered for remuneration, or with the expectation of remuneration, from the recipient of such care or treatment or someone on his behalf. The administering of such care or treatment by one as a part of his duties as a paid member of any organization of law enforcement officers or fire fighters does not cause such to be a rendering for remuneration or expectation of remuneration.

Do you see where it says "no person."

In addition I have a multi-million dollar umbrella liabilty policy. I shall continue to give away Epi-pens in emergency situations in the great state of Ohio for all-time.

I am not from Ohio, so I don't know Ohio law. But I bet if you look carefully the section you quote is about good samaritans. There are separate regulations for health care professionals. You are performing a duty no matter how noble, outside the scope of your practice which is the classic definition of negligence. Most if not all insurance polices do not cover you for negligent behavior. But hey, you know if the guy with bee sting is also on amidarone for a ventricular arrhythmia so when he croaks, well maybe if you waited for the EMT;s or the ER they could have cardioverted before he died from epi induced Torsades-de points.

In other words as has been pointed out you are unqualified to make the diagnosis, select the drug and administer the drug the patient in question. After what they did to Eric Crop, I would be very careful what I did in Ohio.

 

[owlegrad]

You can choose to think my examples are too extreme or illogical or whatever. I deliberately picked the trach example b/c I thought it would be easier to grasp b/c it's CLEARLY outside the standard of care/scope of practice. My point remains the same, if you act outside of your scope of practice/training, whether it is a LITTLE outside of your scope or a LOT outside of your scope AND there is a bad outcome that can be attributed to your action, you will be held liable.

RE: your example - A nurse giving the heimlich manuever is not outside of scope. A civilian can do the heimlich, at least in my state. The Red Cross puts posters with the heimlich manuever on them in every restaurant. Anyone performing the heimlich manuever would be shielded by Good Samaritan laws.

We can debate all night about what SHOULD be done, ethically or morally or whatever. I'm just talking about what the law allows and doesn't allow. There may be times where it is ethically acceptable to break the law, but one should do so knowing that there can be consequences.

The nurse was your example, not mine. Other than that I basically agree with your post. Ethically, I can't imagine ignoring someone I believe I can help. Might that have legal consequences if I fall to save them? Of course. I mean doctors get sued while doing their job, I can only imagine how much worse it is for non-MDs. And I agree that is an individual's choice and should be made with the knowledge of possible consequences, including legal. I just hope given a choice I would choose to try and help.

 

[Sparda29]

No. Scope of practice is defined by what someone is trained to do. If health care professionals are allowed to throw caution to the wind and go outside of scope in an emergency, who is going to be liable for the inevitable bad outcomes?

No one should be liable for the bad outcome. Liability, law suits, etc are everything that's wrong with this country.

 

[Ackj]

RE: your example - A nurse giving the heimlich manuever is not outside of scope. A civilian can do the heimlich, at least in my state. The Red Cross puts posters with the heimlich manuever on them in every restaurant. Anyone performing the heimlich manuever would be shielded by Good Samaritan laws.

What about another civilian using an Epipen? Lots of people carry them around, so how would that case go? Let's just say the person is an electrician, no medical training at all. They're allergic to bee stings, so they carry the Epipen. If they see somebody gasping for air, swelled up in hives, etc, what would the case/liabilities be against our Good Samaritan electrician?

 

[Old Timer]

What about another civilian using an Epipen? Lots of people carry them around, so how would that case go? Let's just say the person is an electrician, no medical training at all. They're allergic to bee stings, so they carry the Epipen. If they see somebody gasping for air, swelled up in hives, etc, what would the case/liabilities be against our Good Samaritan electrician?

Their liability would be less. You as a health professional know that there are contraindications to the use of epinephrine or the use of epinephrine without the proper equipment to quickly ameliorate those effects. Since you should and do know better the consequences for you would be greater.

 

[Ackj]

Their liability would be less. You as a health professional know that there are contraindications to the use of epinephrine or the use of epinephrine without the proper equipment to quickly ameliorate those effects. Since you should and do know better the consequences for you would be greater.

Ignorance is bliss 😀

 

[All4MyDaughter]

The nurse was your example, not mine. Other than that I basically agree with your post. Ethically, I can't imagine ignoring someone I believe I can help. Might that have legal consequences if I fall to save them? Of course. I mean doctors get sued while doing their job, I can only imagine how much worse it is for non-MDs. And I agree that is an individual's choice and should be made with the knowledge of possible consequences, including legal. I just hope given a choice I would choose to try and help.

Good lord, no one is suggesting you IGNORE someone who needs help. You should call 911, use First Aid and CPR if you are trained in it and do whatever else you are trained/certified to do.

The other issue I see with doing something outside your scope of practice to "try and help" someone is you AREN'T trained to do it. Putting liability aside, is it ETHICAL to attempt an intervention that you don't really know how to do and that might harm or kill someone should your attempt go wrong? I don't believe that it is, in most cases. There could be exceptions.

No one should be liable for the bad outcome. Liability, law suits, etc are everything that's wrong with this country.

I'm currently the plaintiff in a wrongful death lawsuit that alleges negligence and professional misconduct contributed to the deaths of my daughter and niece, so I am not objective. But I believe that the legal system is often the best and sometimes the ONLY way victims and survivors can be compensated for their losses. It's also often the only way to get laws and policies that contribute to unsafe situations changed. People should be held accountable when their negligent actions harm others.

 

[rph3664]

What about another civilian using an Epipen? Lots of people carry them around, so how would that case go? Let's just say the person is an electrician, no medical training at all. They're allergic to bee stings, so they carry the Epipen. If they see somebody gasping for air, swelled up in hives, etc, what would the case/liabilities be against our Good Samaritan electrician?

If he carried an Epi-Pen in his laptop case, that's one thing. Grabbing one off the pharmacy shelf and administering it without a prescription is another.

 

[rph3664]

I don't know about this, who is held liable for the bad outcomes of not intervening? I hate to sound like a naive student, but what about what's best for the patient? Seems like there must be a duty to do all you can to save a life. If intervening has the potential to save a life, I can't imagine ignoring them. Sorry about your father kid he was outside my scope of practice. The obsession with liability seems unhealthy (says the student who doesn't have to worry about it yet).

Pharmacists cannot diagnose. End of story.

 

[rph3664]

The great state of Ohio recently put a pharmacist in jail. I'd be cautious.

Are you talking about that case where a technician mixed chemo with 23.4% NaCl, the pharmacist checked it, and a small child died?

There's a lot more to that story. This pharmacist belongs in jail, and should never darken the door of a pharmacy again except as a customer.

 

[All4MyDaughter]

What about another civilian using an Epipen? Lots of people carry them around, so how would that case go? Let's just say the person is an electrician, no medical training at all. They're allergic to bee stings, so they carry the Epipen. If they see somebody gasping for air, swelled up in hives, etc, what would the case/liabilities be against our Good Samaritan electrician?

Their liability would be less. You as a health professional know that there are contraindications to the use of epinephrine or the use of epinephrine without the proper equipment to quickly ameliorate those effects. Since you should and do know better the consequences for you would be greater.

If he carried an Epi-Pen in his laptop case, that's one thing. Grabbing one off the pharmacy shelf and administering it without a prescription is another.

The Good Samaritan Electrician would not lose his electrician's license, but if he used his own Epi-Pen on another individual and it harmed or killed them, I think there is potential civil and criminal liability. But I agree that the liability is less for a civilian vs a trained health care professional.

 

[loveoforganic]

This type of thing has come up in one of the medical subforums and the gist was, if you want to be the person who can provide emergency care, keep up to date on your ACLS. Idk if nonclinical pharmicists would be in their scope with ACLS or not, but I'm sure someone here does.

 

[rph3664]

Let me clarify. If the patient with anaphylaxis had an Epi-Pen in their own laptop case, it would be ethical for a pharmacist to administer it. I didn't mean the pharmacist's case.

 

[confettiflyer]

The great state of Ohio recently put a pharmacist in jail. I'd be cautious.

i was about to mention this...great state my ass! ohio is the poster child for "failures in health care laws/justice" only in this backwards state can a lowly technician planning her wedding cause a fatal mistake, lie about it, and successfully throw her pharmacist under the bus without consequences. 👎

 

[awval999]

Hmm. I am rethinking my position. Or at least understanding where some of the dissenters are coming from.

I just hate the fact that some pharmacists are to the "letter" of the law and not the "spirit" of the law.

Like for example if a patient has been on monthly Percocet 5/325 scripts and the doctor doesn't write the quanity out some pharmacists would just hand the rx back. That stuff annoys me. I work in a hospital setting so I doubt the Epi-Pen scenario will come up but I would much rather take the risk that the albuterol or Epi-Pen will save the person's life instead of thinking that it may make his/her heart explode. If one of you could watch a man die of anaphlaxis writhing and seizing on the floor of your Walgreens then so be it. Obviously this is an obvious "reach" scenario.

Anyway. Done ranting.

 

[WVUPharm2007]

This pharmacist belongs in jail, and should never darken the door of a pharmacy again except as a customer.

I read all the court documents...and, no, he doesn't deserve to be in jail. It was an error anyone could make. Especially considering the lack of industry control over workload limits in hospital pharmacies where pharmacists need to rely on competent technicians.

It is a disgusting, pathetic ruling that infuriates me. If I lived in Ohio, I would have been in the street in front of the judge's house with signs, screaming at all hours of the night.

 

[owlegrad]

Good lord, no one is suggesting you IGNORE someone who needs help. You should call 911, use First Aid and CPR if you are trained in it and do whatever else you are trained/certified to do.

The other issue I see with doing something outside your scope of practice to "try and help" someone is you AREN'T trained to do it. Putting liability aside, is it ETHICAL to attempt an intervention that you don't really know how to do and that might harm or kill someone should your attempt go wrong? I don't believe that it is, in most cases. There could be exceptions.

Alright ignore is too strong a word. Forgive my hyperbole.

How about if you have someone complaining about chest pain with a history of heart attach. Would you recommend some aspirin while seeking medical aid? More basically, would you be comfortable recommending something or reacting in a way that anyone can, unlike in the Epi-pen scenario? As for the ethics, I would save it is ethical to try and intervene only when their is a reasonable reason to do so, such as when the risk of delaying help can be significantly detrimental. Obviously, I am not talking about pushing EMT's out of the way so I can administer the shot myself.

 

[Old Timer]

Alright ignore is too strong a word. Forgive my hyperbole.

How about if you have someone complaining about chest pain with a history of heart attach. Would you recommend some aspirin while seeking medical aid? More basically, would you be comfortable recommending something or reacting in a way that anyone can, unlike in the Epi-pen scenario? As for the ethics, I would save it is ethical to try and intervene only when their is a reasonable reason to do so, such as when the risk of delaying help can be significantly detrimental. Obviously, I am not talking about pushing EMT's out of the way so I can administer the shot myself.

Do you know if the MI patient is on Coumadin? What is their INR? How will this effect them if they need emergency angioplasty? In other words. Call 911, do CPR (if you are trained) and otherwise, put the superman cape away and get the hell out of the way.

 

[owlegrad]

Do you know if the MI patient is on Coumadin? What is their INR? How will this effect them if they need emergency angioplasty? In other words. Call 911, do CPR (if you are trained) and otherwise, put the superman cape away and get the hell out of the way.

Well if the person is a regular of your pharmacy I would say that you do know if he is on Coumadin. But I take your point. Do not intervien other than CPR/calling 911.

Boring.👎

 

[Old Timer]

Well if the person is a regular of your pharmacy I would say that you do know if he is on Coumadin. But I take your point. Do not intervien other than CPR/calling 911.

Boring.👎

The first rule is the same as the teach physicians. DO NO HARM

 

[owlegrad]

The first rule is the same as the teach physicians. DO NO HARM

I agree. What if the harm is from not intervening?

 

[All4MyDaughter]

I agree. What if the harm is from not intervening?

 

[owlegrad]

😛

 

[Pharmacy Kid]

Don't forget your ABC's

The the challenge comes when something happens in your pharmacy and you
are faced with taking care of your ailing customer or covering your butt.

Case in point; a woman came into my pharmacy with an impending allergic
reaction to shellfish. She was barely able to make it to the waiting area chairs
with assistance. Paramedics arrived before she really went south, but the thought crossed my mind that benadryl and an epi-pen were only 15 feet away. What would YOU have done had she stopped breathing? Keep counting and pouring? Do basic life support? Or jump over the counter and administer the epi-pen thus breaking the law?

Well, it's not strictly speaking legal.

 

[Pharmacy Kid]

What about another civilian using an Epipen? Lots of people carry them around, so how would that case go? Let's just say the person is an electrician, no medical training at all. They're allergic to bee stings, so they carry the Epipen. If they see somebody gasping for air, swelled up in hives, etc, what would the case/liabilities be against our Good Samaritan electrician?

This was your responsibility! You are not prepared for this!

 

[FruitFly]

This was your responsibility! You are not prepared for this!

Depends on the pharmacist's level of training. Some are certified in PALS and ACLS, have prior EMT experience, may even have been to war... Others, just need to call 911.

If it were me, I would call 911, call local hospital, speak to an ER physician, present the situation, and get a verbal for epi-pen. 👍

What would allow a pharmacist to perform a Heimlich maneuver if someone in their pharmacy were choking? Common sense perhaps? Response to emergency? I believe health care providers should be duty-bound to properly respond to emergencies. It is patient abandonment to not take appropriate measures to give a patient their best chance at survival during an emergency if they are in your pharmacy.

 

[Pharmacy Kid]

Depends on the pharmacist's level of training. Some are certified in PALS and ACLS, have prior EMT experience, may even have been to war... Others, just need to call 911.

If it were me, I would call 911, call local hospital, speak to an ER physician, present the situation, and get a verbal for epi-pen. 👍

What would allow a pharmacist to perform a Heimlich maneuver if someone in their pharmacy were choking? Common sense perhaps? Response to emergency? I believe health care providers should be duty-bound to properly respond to emergencies. It is patient abandonment to not take appropriate measures to give a patient their best chance at survival during an emergency if they are in your pharmacy.

Don't you want to take a leap of faith? Or become an old man, filled with regret, waiting to die alone!

 

[Old Timer]

Depends on the pharmacist's level of training. Some are certified in PALS and ACLS, have prior EMT experience, may even have been to war... Others, just need to call 911.

If it were me, I would call 911, call local hospital, speak to an ER physician, present the situation, and get a verbal for epi-pen. 👍

They would be dead before you got the doc on the phone. OK, in real life, you are not getting an ER doc on the phone. If you do, they will not give you a verbal order for a patient they have not seen. This is without a doubt the most unrealistic thing I have heard in a long time.

What would allow a pharmacist to perform a Heimlich maneuver if someone in their pharmacy were choking? Common sense perhaps? Response to emergency?

Training. You take a course for training in how to perform any of these procedures.

I believe health care providers should be duty-bound to properly respond to emergencies. It is patient abandonment to not take appropriate measures to give a patient their best chance at survival during an emergency if they are in your pharmacy.

You are duty bound to do what you are trained to do. If you have not been trained to perform a procedure, you do not perform it. You are doing something outside the scope of your practice....

 

[confettiflyer]

They would be dead before you got the doc on the phone. OK, in real life, you are not getting an ER doc on the phone. If you do, they will not give you a verbal order for a patient they have not seen. This is without a doubt the most unrealistic thing I have heard in a long time.

i know right...hell, i work at a hospital, it's hard enough getting a nurse on the phone, much less a physician.

 

[Sparda29]

Don't you want to take a leap of faith? Or become an old man, filled with regret, waiting to die alone!

 

[Pharmacy Kid]

Finally, someone gets that ALL my posts in this thread (not just the last one) reference Inception.