Home' Australian Pharmacist : Australian Pharmacist November 2012 Contents 860 Australian Pharmacist November 2012 I ©Pharmaceutical Society of Australia Ltd.
ACCREDITED PHARMACIST SPECIAL INTEREST GROUP
Con dentiality and privacy
By Trish Russell
There have been several posts on the accredited pharmacist special interest
group (APSIG) online forum in recent months discussing concerns with
confidentiality and privacy.
One of the posts asked if it was necessary
to obtain consent to view the medication
chart, dose administration aid and
dispensing history when performing
residential medication management
reviews (RMMRs). Residents in an
aged care facility (ACF) have rights to
confidentiality and privacy. As part of
the admission procedure to the ACF,
the resident should sign for consent to
sharing information between health
care providers, and to the provision
of RMMR and quality use of medicine
(QUM) services. New residents should
have a RMMR as soon as possible after
admission. Ideally the RMMR should
take place once the information from
the comprehensive medical assessment
(CMA) is available.
As an approved provider of RMMR and
QUM services you should confirm with
the ACF that consent is obtained as part
of their routine admission procedures.
This will ensure that the resident's
rights to confidentiality and privacy are
protected, and you will be able to gather
information without obtaining consent
Many accredited pharmacists have
conducted home medication reviews
(HMRs) with a third person present.
Some circumstances where this is helpful
may include a HMR for a child, a person
with some memory problems or where
the third person is routinely involved in
the consumer's medication dosing. Good
practice would be to record the presence
of the third person and the contribution
they made to the HMR. If the consumer is
able to give consent for the third person
to be present this should be noted in
Some situations may breach the patient's
privacy. It is surprisingly common for the
consumer to allow a visiting friend or
neighbour to remain in the room while
the HMR takes place. However they
would not consider asking that person
to accompany them to an appointment
with their general practitioner (GP).
The information given by the consumer
might be affected by the presence of
the third person e.g. they might be less
willing to divulge alcohol use.
If you would prefer to conduct the HMR
without the third person then state your
case and ask the consumer to consider
your opinion. For example, 'Although I
believe Mrs X has a close relationship with
you, we will be discussing your health and
medication at length and this might be
better in private'.
The presence of the consumer's spouse
during the HMR is a perennial problem.
It is more difficult to ask a spouse to leave
as the couple may not see this as a privacy
issue. The dynamics of the relationship
may impact on the responses you receive
during the HMR.
Problems created by a consumer who
visits two different GP surgeries were
raised recently on the APSIG forum.
Whenever the consumer had difficulty
making an appointment at surgery A,
they went to surgery B. They were not
a 'doctor-shopper', just someone with
many health problems. Doctor B had
requested the HMR so the accredited
pharmacist sent the report to doctor B.
In order to send the report to doctor A
the patient needed to give additional
consent. Consumers, who consult a
number of different doctors, are at risk of
medication related adverse events. Open
communication will benefit all parties
involved in the consumer's healthcare and
it is logical in this case to send the report
to both GPs with the consumer's consent.
The method used to send reports to GPs
can potentially breach consumer privacy.
Paper based communication by mail
allows confidentiality to be maintained if
the letter is sealed and addressed to the
referring GP. Sending reports by facsimile
(fax) may create problems as many fax
machines are in a general office and the
information may be seen by many people.
Similarly, communication by email is
often not private as a GP may just use the
practice's address. Pharmacists should
ensure that all faxes and emails have a
covering letter that states the intended
recipient as well as a confidentiality
statement. Using encryption software for
electronic communication can help to
overcome problems with confidentiality
You can refresh your understanding of
the privacy and confidentiality issues
in HMR and RMMR at: www.psa.org.au/
consult a number
of different doctors,
are at risk of
Trish Russell is a PSA Professional Practice
Pharmacist. She can be contacted at:
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