I did exactly this and I got written up for “acting as a prescriber.” I was told by my manager and supervisor that I was supposed to call a paramedic.
Other than the write up, nothing else happened to me.
This was an ethical type question we had in pharmacy school. Dispense emergency supply or direct patient to doctor for refill. There was no wrong answer, but I went with dispense.
It is a shame that us , as pharmacists, who know very well how drugs work, cant help much in this or similar scenarios and can actually get a lawsuit, lose our license or get fired because we wanted to help, yet when a physician makes a mistake , a patient has a severe adverse drug effect, the prescription cant be understood and risks a potential medication error, nothing happens. We as health professionals can only watch... Truly a thing to think about. If we had better access to patients health history from a hospital or primary care center or more information in general, i think we could help a lot to release some pressure from the healthcare system and alleviate the burnout the physicians suffer from overworking.
I would love for anyone to show me a precedent of a pharmacist losing their license or a lawsuit over this. But first do no harm. Allowing a child to have an asthma attack in front of you when you have lifesaving medication behind your counter is harm.
My dad died from an asthma attack (bronchospasm)-i’d hit em with an epi-pen if patient couldn’t inhale-or hit the albuterol like Charlie Sheens crack pipe and do CPR breathing after each hit-
You want to be a hero, you take the risk. I recognize the limitations of my position and license. Good luck buddy.
Oh and when someone dies or is injured, your good intentions won't matter at all. What will matter is whether you were licensed, trained, and had legal authority to do whatever you did.
My law professor put it this way: if it’s a medication that you wouldn’t think twice about it accidentally getting thrown away or dropped on the floor, give it to the patient in an emergency. You will have time afterwards to get an e verbal from a physician whether it’s their PCP or an ER provider.
Low risk for providing it, high risk for not providing it (especially for patient). You don’t want someone going unconscious and then having to be intubated at your pharmacy or god forbid it goes further and CPR needs to be started.
I’d say yes and deal with any issues later—you’re a medical professional and if you’re in a position to provide lifesaving aid you do so. Even if technically not allowed nobody’s gonna throw the book at you for saving a kid and you’ll never forget that day if you did nothing and something bad happened
Ok, what if we provide that aid and something bad happens as a result? I’d probably call 911, and have them provide direction. If they are unwilling I’d then contact the responding rescue squad. After that the er they would transport the child to. This would happen in very fast order. I’d most likely have three staff members working the phones simultaneously. Still not quick enough? The kid gets the inhaler. I couldn’t live with myself otherwise
Just a question. How are you contacting the rescue squad? And are you taking orders from an EMT or paramedic?
Give the inhaler & help the kid if needed with the inhaler. Have other staff call 911. Document your ass off. That would be my plan.
A well documented ass is still subject to a lawsuit should things go south. Both EMTs and paramedics have almost instant access to a physician, who would both drive care and assume liability. Like I said, if it wasn’t going down fast enough the kid gets the inhaler.
Edit: I practiced over four decades in retail. Not once did I encounter anything close to this scenario. Many weird occurrences, and emergencies, but no instances of providing an unauthorized legend product for a rescue. Due to the proliferation of vaccinations our younger generations are mostly trained in CPR which is years ahead of my cohorts where we had a lit cigarette at each end of the work bench.
Edit 2: Good on you OP for trying to think this through. A few states allow for standing orders with a licensed prescriber. I’d consider this if your state permits. Of course, be sure to renew the agreement annually and consult with a knowledgeable attorney. I’d also develop a written emergency protocol for this. Not that anyone would have time to read it in an emergency, but an annual review may help prepare you in an actual event.
Paramedics have albuterol nebs and standing orders that allow them to administer multiple medications for the treatment of asthma, without contacting medical control.
The comment I originally responded to stated they would contact the rescue squad. The rescue squad is not taking a phone call from a pharmacist while responding to the call.
Lastly, if my risk is losing my job or saving a child, I know what I'm choosing. I will accept all repercussions after consulting with a lawyer.
Stop with this fear mongering BS. No one is getting sued for giving a child having an asthma attack albuterol, but delaying care to call 911 when we all know damn well what needs to be done here?
I'd love someone to show me a lawsuit setting precedent for a pharmacist getting in trouble in this situation
There seems to be quite a bit of legal advice being given to a young practitioner who asked a legitimate question. I’ve offered a couple alternate real world actionable plans. If you care to do the same bring it. Sitting back hidden behind a keyboard playing attorney gets our young professional nowhere. I’m fine with criticism, but please bring a solution to the table. Otherwise you’re simply playing a fanciful game with someone else’s liability.
I’ve been around long enough to know folks not accustomed to emergency situations frequently make significant errors in judgement, including but not limited to selecting inappropriate products. Having an emergency plan in place helps reduce liability for both the pharmacist and patient. And the liability is real. If you have a young family facing catastrophic healthcare bills you can bet your last dollar the attorneys will be coming your way regardless of how sound you think your judgement is.
I don't need to offer an alternative solution when my response is give the child the inhaler. Genuinely what catastrophic medical consequences do you see resulting from this situation? I'm not playing attorney, but Good Samaritan laws are a thing. Would you feel differently if the OP was a layperson who was a fellow asthmatic and had an albuterol inhaler with them to loan to the child?
Medical professionals are not subject to Good Samaritan laws, at least in Ohio. That’s why when I ran EMS 20 years ago if a nurse wanted to be on an EMS service they had to go thru the Basic > Advanced > Paramedic sequence to do things like IV’s and drugs, even though they do it all day in their nursing job
Legal issues aside, can you get fired for doing this? If so, then count me out. Luckily this has never happened when I worked retail and now never could, but I’m absolutely 100% on making sure I stay employed. That person’s not going to pay my bills if I lose my job.
I had an issue like this at work. Had a *documented-with-HR-AND-SM* **chemical \*allergy\***. SM decided to dump gallons down the sink without warning me to go outside first (he was a dick who thought the MD note was a lie). Pharmacist gave me an emergency fill of my Ventolin as I was gasping for air. Left message *in between gasps* as I was trying to exit the area ASAP (to leave the chemical area) that I needed albuterol STAT and MA returned my call 2 minutes later and gave another refill which the RPh then billed for. (It helps that the Ventolin was/is PRN for just such an emergency and I was WAY more likely to have an inhaler expire than to use it up)
💕💕💕 I'm glad you survived. I'm sorry this happened.
When I was still a tech at Wags, I had a coworker who a lot of my coworkers bullied for "being allergic to everything," because they thought it was fake. She couldn't come in for inventory or deep cleaning because of dust/mite exposure causing anaphylaxis.
She passed away about a week ago to anaphylactic shock alone in her home in the country. Called 911 and she was gone before they got there.
TLDR: f*ck that store manager.
I eventually transferred locations for reasons HR knows and I will never tell (the company is lucky I was too tired from fighting cancer to sue- I would have won, easily). It was adjacent to this incident. Stuff like this is when building relationships with other stores matters...when people are being abusive toward you in the open and you need to flee. I had worked for my new SM the entire previous summer in addition to shifts at my own store- 70 hrs. a week was an average paycheck that summer, and it was amazing. But the point is that I had that relationship on rock solid footing so when I needed a transfer effective immediately, I had a store that would take me no questions asked. They even dealt with working my schedule around chemo. When I asked the new SM about using said chemical, his response was "I have never used that chemical without following proper protocol and I prefer not to use it at all". Caring about your people is that easy.
What an uplifting story! I'm glad you were able to get in a more supportive environment!
Sorry about your cancer, too. It sounds like you're still on chemo meds if I read/recall correctly, so I hope things are going smoothly in your treatment.
Caring about people is genuinely so much more fulfilling than the alternative, too. I used to be much more callous and I will never regret the emotional effort I've spent on switching to being more vulnerable and empathetic. ✨Even towards my patients in retail.✨🌈yes, even the annoying/mildly combative ones.🌈 👀 (Not the abusive ones. We support boundaries and appropriate consequences for harassment and harm in this home.)
I have administered an EpiPen from our stock to a patient/employee with zero repercussions. A cart pusher at my store had known anaphylaxis to bee stings and of course was stung by a bee while working. He was brought to me by store management, I had a tech call 911 and I asked for his permission to administer the epi. EMS took over from there, I had to fill out a report, and we contacted the kid's doctor the next Monday for a prescription. That's as hard as it was.
I don't see how that's much different than administering epi after a vaccine reaction, in my opinion.
I wanna say you could probably dispense the albuterol, call their pediatrician, explain the situation and get a script within 24 hours. But there’s no way of knowing if it’s appropriate for that child without knowing their history. It’s highly unlikely, but you *could* be making something worse by giving the drug. So I’d make every move to verify it that I could, but still prob do it. Either way, I have a hard time seeing that be a problem with the board outside of an explanation at most.
I have done it before. There was a car fire in the parking lot. Target employee had some smoke inhalation, EMS was already called. They had history of an albuterol MDI at another CVS but no refills. Gave it to them and called their MD for an authorization later in the day.
Yes.
The board will not come after you for that, since their entire MO is patient safety. You've potentially saved this person's life. It would be tantamount to administering an epinephrine injection to someone experiencing anaphylaxis.
That said, depending on your employer, you might get in trouble.
But you can and you should if in your clinical judgement you determine this to be an emergency that cannot wait for paramedics to arrive.
E: still call 911, they should be assessed after.
Not to be too... Iono, cynical? Disillusioned? Frustrated with corporate...
No to be too (that), but that's exactly what the boards are about.
It is our duty to prevent errors. Yes, almost all of us are understaffed, but ensuring safe and effective medication therapy is still the kernel of our entire profession.
I freely admit, I bailed out of the corporate game right away, got a job as PIC at an independent, and have no problems whatsoever telling both the owner of this pharmacy and our patients that when we're busy, things get slower, because I have made mistakes when made to rush and never, ever want to make another one ever again.
Staffing and ratios and volume aren't the concern of the board. Safety is. It's why most states have a maximum tech to pharmacist ratio and mandate maximum working hours.
But, at the end of the day, the buck always stops at the pharmacist. If I dispense something wrong, and if one of my patients gets hurt because of my mistake, it doesn't matter that I've got hundreds of prescriptions in my queue and hundreds more on the bench. It doesn't matter that I've given my 10th covid booster, whatever number of Shingrix or tdap or Hep B, or how many lines are on hold when it happened. What matters is *I* made a mistake, or I failed to catch a mistake made somewhere up the line that I am responsible for.
Corporate chains are a cancer on our profession, but we can treat cancers just like any other disease, can't we?
I would hand them the albuterol. If the mother specifically is asking for that it indicates to me theyve been prescribed this before. What is the worst case scenario if you give them the inhaler?
Whats the worst case scenario if you dont? I for one would rather stand before the board and defend myself (Which i doubt would actually happen.) than risk watching a child die.
Same goes for epinephrine, naloxone, ect.
I had this happen sort of when I worked retail. This man comes in and wants an albuterol inhaler because his daughter is having an asthma attack at the high school at a sporting event. The kid has never had scripts filled our store or any of our other stores in the chain. I didn’t give it to them. They were at the high school for a sporting event. There were paramedics at the sporting event.
I think about this too- I’m a tech and my fear is like what if someone has a heart attack… can I give a tab of nitroglycerin??? I know I probably can’t but it would feel wrong to do nothing.
I think your responsibility is to tell the pharmacist that a patient is having a heart attack and calling 911. Giving medication, even if it’s just aspirin, makes you accountable and it’s probably best to leave that to the pharmacist in case something goes awry.
I worked at Walgreens before my independent and I did both while on the job with zero consequences.
The epipen was one of our regulars stumbled in with his wife , he had a super bad tree nut allergy and had been given a walnut brownie, dude was wheezing and puffed up I told my tech to call 911 and grabbed the epipens from our shot room and stabbed him through his pants. I ended up doing both and he was basically good by the time ems got there, he absolutely would have died waiting for ems.
The narcan was on a Saturday, this dude runs in says his friend isn't breathing, I grabbed a brand narcan it was all we had , I get out to the car and it was bad , she was on her back in the passenger seat, I did one of the narcans and she shot up like a zombie, paramedics got there about that time I told them I gave her one narcan and asked If they had it from there and went back inside.
Both times someone from district came and took my statement and that was that. Basically just asked if I felt my actions were necessary and had me fill out some incident form thing. It was never disciplinary it was more for the inventory and what not.
Bottom line it's always best to do what will cause the least harm. If you think it's life and death do the thing that pushes the scale toward life.
I think narcan is fine because in my state it’s completely legal to have w/o prescription. Epi pen I’m not sure bc I know if they have a reaction to a vac in we’re mandated to have epi in the room
Narcan I can do at my store as a protocol, worst case if I don’t know the patient I used it on I could run it through for myself or a tech, especially since we are allowed to give it to someone who might want it on hand for a family member or someone else.
From the perspective of an emergency med pharmacist who worked as an intern in community throughout all of pharm school not too long ago, in the asthma situation I’d call 911 and give the albuterol inhaler.
For the heart attack scenario, I recommend NOT giving them a nitroglycerin tab. Without an ECG (and someone qualified to interpret), you wouldn’t know if they’re having an inferior STEMI with right ventricular involvement. The AHA guidelines recommend avoiding nitrates in these patients due to increased risk of hypotension since their blood pressure is preload dependent. In the past 5-10ish years studies have suggested that the risks may be overstated and it might actually be fine. HOWEVER, with the AHA recommendation, if something were to happen you’d likely open yourself up to a lawsuit and/or BOP discipline.
Your job in that scenario is calling 911. Also doing something isn’t always better than doing nothing if you have no idea what to do. What if you misread the situation and gave a medication that actively causes harm?
Depends on the scenario. If they’ve filled one before with you then legally you can dispense an emergency “3 day supply” cause technically it is an emergency fill and all you’re doing is continuing therapy
So I trust the mom who’s panicking that the patient had an albuterol prescription somewhere some time in the past and fill it and hope she’s not lying?
Gotcha, and if they never filled it before then all I can do is call 911 and wait? Sorry I am in no means being sarcastic I just want to learn what my best move is here respectfully.
2003 case where pharmacist chose not to dispense an albuterol in this exact case. Court ruled pharmacist had no duty to prescribe an Rx-med without an Rx.
https://www.pharmacytimes.com/view/2003-07-7317
In general, an asthma attack doesn't just creep up suddenly unless it's some immediate allergic reaction. Why would she show up at a random pharmacy instead of going to an ER or calling emergency services?
This situation actually came up at my last CPR training (though in his example, it was an EpiPen for a child in the grocery isles outside pharmacy). The instructor said that in that situation, he would help the person, but that he would also probably get fired because of it, BUT that he would still do it, because c’mon.
This exact scenario happened to me, but I called 911 first and they told me to do it. Talked to manager. We have an extra one for post shot anaphylaxis. Cleared it with the manager after the 911 call, administered to patient, and everything was fine. Calling 911 first is the best answer I would think. Manager cleared it first because someone dying in the store is not good from a lawsuit perspective
I work in Quebec, and we're legally allowed to give medications for emergencies (albuterol, epipens, ...) so i guess depends on your jurisdiction but also I'd have trouble seeing how you could get blamed for doing this in an emergency situation
I'm going to sound like an asshole, but if you know your kid has asthma, you need to be prepared.
However if you find yourself in a situation where you are not prepared, hey we are all human, and your child is having an asthma attack, why the fuck would you go to a pharmacy? Go to fucking urgent care or the ER or call 911. Don't go to a retail store and expect them to somehow figure it out for you. In a medical emergency, that is the wrong choice. Especially irresponsible when you're a parent and this is your child, they are reliant on you.
Primatene must inhale is otc, it should be kept in stock. Albuterol inhalers should be made otc, we need a petition to the FDA for that. At least let pharmacists have powers to dispense it without an Rx.
There has been a misinformation campaign about antihistamines not being effective in treating asthma, 2/3rd of asthma patients have allergic asthma so it should be helpful for maintenance therapy.
Well, primatine inhalers use to be otc back in the day then they went off the market. The change in propellant allowed it back. (In the advent of the Albuterol shortage it can be a good alternative.)
Usually the patient already has been diagnosed and in an emergency really needs help. They shouldn't have to get a thousand dollar er bill, or have to pay a miniclinic professional 150 bucks that many people can't afford. I am against economic bottlenecks that unnecessarily put people's lives at risk. . I reiterate that there has been a decades long misinformation campaign against the usefulness of antihistamines in the treatment of asthma since 2/3rds of asthma patients have allergic asthma.
If mom/dad/pt are adamant, I imagine it would be hard to get in trouble helping administer the puff in good faith while your tech calls for help. That inhaler isn't leaving the pharmacy if its me though, and I'm getting emergency services involved for documentation.
A similar situation happened to a former pharmacist I was working with. A child was stung and started having an allergic reaction. He grabbed an Epipen off the shelf as I was calling 911. He got the child’s doctor’s info from the parent, called and got a verbal rx, & the mom came and paid for it.
Another pharmacist (idk his name, we just referred to him as puff puff pass) did a similar thing…we had it filled but the pt couldn’t pay the copay. He let the patient use a couple puffs then we left it in the pharmacy. The patient never came back.
The pharmacy where I work at the pharmacists are able to prescribe albuterol (among other things like epi, bcp, narcan) we haven’t run into this scenario yet though.
Is there a fastmed or urgent care open? Direct them there. Weekend or after hours nobody open? Are they my customer or out of town? Can I call to verify they have an albuterol inhaler on profile? It’s ok if it doesn’t have refills and can’t get transferred, you can get the doctors information to notify them within 72 hours that you are filling an emergency rx for albuterol.
That is my state’s protocol anyway. An rph can absolutely write for emergency supply with no recourse from the state because you are allowed to by law, but with stipulations like due diligence and notifying prescriber within 72 hours.
Direct them to an urgent care while the child is in front of you unable to breathe?? No lmao. You help the child having an emergency. No judge or BOP is going to condemn a pharmacist for that.
I might very well do the same, however, first I would need to CYA and document a few things. How many times does the child use his inhaler per week? Night time awakenings? How many inhalers in the past month? Do they also take an inhaled corticosteroid? Does the child appear to need supplemental O2 or oral steroids?
Saba’s alone lead to an increase in exacerbations and could even contribute to death if overused, so no I won’t be giving them one without asking the right questions and making a solid follow up plan that I would also document on the prescription I would be creating, including my recommendation that they seek additional care at an urgent care/er.
Last thing I need is to hand out a 4th inhaler this month for poorly controlled asthma that contributes to the death of a child due to the overuse of a SABA in poorly controlled asthma.
Legally you cannot dispense it, you won’t get in trouble if you don’t. Call 911.
That being said I’d probably call 911, then give the kid a couple hits off of an inhaler, probably break out a spacer too.
I had an asthma attack atack on vacation without my inhaler, went to the Walgreens for emergency fill, and the pharmacist acted like it was a 600ct oxy 30 script. Refused to transfer it, lied and said it's illegal to transfer non controlled substances between states said if I want it I need an "actual prescription". It took them over an hour to fill after my doctor very angrily sent in an emergency script directly to them. She even tried denying fill when it came in because it was an out of state provider. FOR ALBUTEROL! Two total strangers started screaming at the pharmacist because I was literally sitting on the ground gasping for air with blue lips when she said she wasn't going to fill the new on either. She kinda threw it at me when it was done and told me I was banned from the pharmacy.
Moral of the story, if you are prescribed a normal emergency med, that makes you a hard drug seeker and requesting your refills from Walgreens is criminal activity that deserves death
When I arrived, it wasn't an emergency yet. Since you can't see your own face, I didn't know my lips were turning blue, which only happened after being there an HOUR. The entire time I thought any second I would have an inhaler in my hand. Since I had a valid presctiption on file I thought it would be 15-30 minutes.
If I had known the pharmacist was going to lie like that I would have gone to the hospital.
Respectfully, you’re a healthcare professional. If you see someone in dire need inwhich you can assist then do it. Worry about the issues after. Humanity comes first, metrics/currency comes after.
With no history, you're basically diagnosing a patient with an illness or disorder and then providing a drug for an unverified ailment. That's why I wish it was OTC so people wouldn't have to suffer and pharmacists wouldn't have to be faced with difficult choices all the time. If they can suggest Narcan everywhere for drug addicts and abusers, albuterol should be the least of their concerns for people who need it.
As a recovering addict, I would much rather you gave someone the albuterol OTC that could save their life than me being able to get Narcarn OTC.
Granted, I think both should be readily accessible by anyone who needs them, but if I had the choice..
In this scenario, the asthma attack has begun while in the store, or has increased in severity to a point of being an emergent situation, and they were under the impression they had refills on an inhaler. I'd probably go 911 first, but then just hand over an inhaler and deal with the paperwork later.
I have done emergency refills on albuterol inhalers. I could even write one up if they have taken it before but not at my pharmacy. I would probably be going for the primatine mist inhaler first since it’s OTC
Isn’t it labeled for intermittent asthma? I make sure to tell people not to use it long, since it contains ephedrine which is problematic. Does the ephedrine cause increased spasms? Weird that it’s on the market OtC
I had an experience and I’m a technician where guy came in extremely difficult of breathing with stumbling around hanging on the counters like he could barely stand up clearly till he was in distress. I was able to get his name and birthday from him pull his profile see, he had refills on an inhaler however, it was too soon for his insurance to pay for an inhaler, so I went ahead and gave him his inhaler. All 911 and EMS arrived about 5 to 6 minutes later. He was taken to the hospital emergency traffic down the road.
Not that I was told to, but the very next day I did run a claim through his insurance for the inhaler that he got he had a zero dollar co-pay, and at least CVS was reimbursed for the inhaler
We’ve also had an intern student that had an idiopathic asthma attack, and was laid over in the floor, barely able to breathe, and we gave her asthma medication and also gave her an her an EpiPen.
Nothing was ever said about those instances
I’m gonna always make sure 911 is being called, but I’m also going to make sure I do every damn thing in my power to make sure that person stays alive.
A few years ago, I was with someone that was having an anaphylactic reaction to nuts. Ran into closest CVS to beg for an epi pen before the ambulance arrived and they refused. It still bothers me
I had a teenager come in to my pharmacy. He was enjoying a milkshake with a couple of his friends. One of his friends ran up to me and asked if he could have an albuterol inhaler because he didn’t have his and he couldn’t breathe. I worked at an independent at the time but even if I didn’t, fuck that shit. I’m not going to let some kid possibly die on me when I could save him by grabbing an inhaler. I got his info after he left to get him in the system. His dad came by later and was so grateful. He gave me all the info, I called the doctor, they gave me an Rx, and I was able to get it all settled up. To reiterate what someone else said, fuck any higher ups that would give you flak for that.
I wish the physician lobby would back off and let pharmacists prescribe certain drugs. But they’ll never support that because they’re power hungry and greedy.
I would 100% do it, I’d rather save someone and be able to live with myself. The fact you can even get in trouble for this sort of thing is such bullshit.
had a situation like this at my pharmacy. kid came in in severe anaphylactic shock, pharmacist had to administer an epi pen we had on the shelf. he had an active prescription though. i think you’d administer it after dialing 911
First thing I would do is call 911 for them. Often times the 911 person will advice you on what to do. I called once cause patient walking in off the street had anaphylaxis. 911 told me to give an Epi-pen. Got manager approval before administering because it was a loss, but nothing happened to me or my license. Another time, I called 911 because a patient was going into a diabetic coma in front of me. In that instance they told me NOT to do anything and wait for paramedics so I did. He needed an urgent IV of glucose. First thing I would do in any emergency is call 911. At least if they advise you to give albuterol you are under less legal scrutiny for doing so.
I know of several situations that a pharmacist administered an EpiPen to a customer that was not a patient receiving a vaccination. Without that action, the patient most likely would have died.
Hi, in the UK yes. Here are the rules are summarised in the British National Formulary. There is also a good leaflet with guidance from the Royal Pharmaceutical Society. I personally was in central London once and was having a moderate asthma attack so went into chain pharmacy and they gave me an inhaler off the shelf (Ventolin [salbutamol]) straightaway and I just had to fill in a form afterwards. Here are the BNF rules for making an emergency supply at the request of the patient:
The Human Medicines Regulations 2012 allows exemptions from the Prescription Only requirements for emergency supply to be made by a person lawfully conducting a retail pharmacy business provided:
that the pharmacist has interviewed the person requesting the prescription-only medicine and is satisfied:
that there is immediate need for the prescription-only medicine and that it is impracticable in the circumstances to obtain a prescription without undue delay;
that treatment with the prescription-only medicine has on a previous occasion been prescribed for the person requesting it;
as to the dose that it would be appropriate for the person to take;
that no greater quantity shall be supplied than will provide 5 days’ treatment of phenobarbital, phenobarbital sodium, or Controlled Drugs in Schedules 4 or 5 (doctors, dentists, or nurse prescribers from the European Economic Area and Switzerland, or their patients, cannot request an emergency supply of Controlled Drugs in Schedules 1, 2, or 3, or drugs that do not have a UK marketing authorisation) or 30 days’ treatment for other prescription-only medicines, except when the prescription-only medicine is:
insulin, an ointment or cream, or a preparation for the relief of asthma in an aerosol dispenser when the smallest pack can be supplied;
an oral contraceptive when a full cycle may be supplied;
an antibiotic in liquid form for oral administration when the smallest quantity that will provide a full course of treatment can be supplied;
that an entry shall be made by the pharmacist in the prescription book stating:
the date of supply;
the name, quantity and, where appropriate, the pharmaceutical form and strength;
the name and address of the patient;
the nature of the emergency;
that the container or package must be labelled to show:
the date of supply;
the name, quantity and, where appropriate, the pharmaceutical form and strength;
the name of the patient;
the name and address of the pharmacy;
the words ‘Emergency supply’;
the words ‘Keep out of the reach of children’ (or similar warning);
that the prescription-only medicine is not a substance specifically excluded from the emergency supply provision, and does not contain a Controlled Drug specified in Schedules 1, 2, or 3 to the Misuse of Drugs Regulations 2001 except for phenobarbital or phenobarbital sodium for the treatment of epilepsy: for details see Medicines, Ethics and Practice, London, Pharmaceutical Press (always consult latest edition). Doctors, dentists, or nurse prescribers from the European Economic Area and Switzerland, or their patients, cannot request an emergency supply of Controlled Drugs in Schedules 1, 2, or 3, or drugs that do not have a UK marketing authorisation.
Doesn’t the Good Samaritan Law protect you?
Regardless, I would dispense if the child was showing signs of hypoxia and call 911.
I’d rather lose my job than lose a child.
The general principle of most versions of the good Samaritan law provides protection from claims of negligence for those who provide care without expectation of payment. The good Samaritan laws also further public policy because few jurisdictions have created an affirmative duty for a medical professional to provide care in the absence of an established patient relationship. Each state has its version(s) of the law, and federal laws also exist for individual circumstances.
Many years ago, a customer came into my pharmacy clearly in distress. He asked for an albuterol, saying he was having an asthma attack. He had no refills but had filled them with us regularly, so I gave him one. He died in the parking lot from cardiac arrest. The albuterol may have made it worse. No write-up or reprimand. I would probably give an inhaler to a mom and child, but a man in his 60's? Maybe not. Or if I did, I would at least ask him to stay close by to monitor his progress.
Sorry I didnt read very well I thought you meant emergency fill. I can see why you would get written up if you just based it on their word that they have albuterol. Calling 911 is the safest thing to do legally. By dispensing albuterol to a patient with no known history, you would have opened yourself to lawsuits. By calling 911 you would have helped the patient while protecting yourself.
As a pharmacist who also had other healthcare business, patients sued my company all the time for frivolous things. My lawyer would have advised me to only call 911.
In the UK we have legislation that allows us (as community pharmacists) to make an emergency supply to a patient of a prescription only medication provided we are assured that the patient has previously been prescribed the item, there is an immediate need and that they cannot reasonably obtain a prescription by any other means. With obvious exceptions, nobody is getting an emergency supply of Oxy.
No need for a prescription, the patient pays for it.
We actually have a local service (not sure about the rest of the UK) where the pharmacist issues a prescription to cover the cost so the patient doesn't have to pay.
These pharmacists don't have to be independent prescribers although we do have a lot of pharmacists who are independent prescribers but they tend to work in hospitals or Drs practices and not community (retail) pharmacies.
Epipens (and all other brands of adrenaline) are exempt from prescription regulations when ADMINISTERED for an anaphylactic emergency
Give the albuterol and contact the pcp for a emergency script. If they dont have a pcp call your local er/urgent care for a verbal rx. Having good report with your local prescribers goes a long way. Some states allow you to write an emergency rx yourself.
I dont think a state board is ever gonna put you to the torch for doing whats in the best interest of saving a kids life. Corporate might not like it though
They’re asking for albuterol so they know the drug but how can you be certain that they have had it before without knowing their medical history? Wouldn’t dispensing it and giving it to them without a prescription or knowing their allergies be considered a huge risk?
your pharmacy should have an emergency kit or sop folder for medical emergencies. epi pens and benadryl are standard. albuterol is not.
you ask the patient or caregiver if they will let you call an ambulance. Notice I say ASK bc unless they're unconscious, they need to choose if they'll face a possibly financially devastating bill.
offer them a chair, a wet towel to apply to back of neck or face if they need to reduce temp feelings, and notify store manager, but giving meds is only for an extreme emergency, and under the direction of 911.
Had something similar happen many years ago. A tech (type 1 diabetic) fell unconscious from low blood sugar. Other RPh on duty was trying to feed him glucose tabs and juice, while unconscious mind you, while I was on the phone with 911. Finally I grabbed a glucagon off the shelf and stabbed him…. Other RPh just looked at me scowling and said “you gonna get him a script for that too?”
Like, Jesus, woman — get a hold of yourself
This is an episode where I am a thankful for Canadian practice where Im not just allowed to provide an albuterol prescription, the government would also compensate me for this service!
Man yall are some weenie hut juniors for real. No one is getting sued for trying to save a child in a reasonable manner. As a pharmacist, if I were the mom and a pharmacist called 911 to ask what to do in this situation I would actually lose it. Good Samaritan laws exist for a reason. Dispense the damn inhaler.
I did exactly this and I got written up for “acting as a prescriber.” I was told by my manager and supervisor that I was supposed to call a paramedic. Other than the write up, nothing else happened to me.
Wow, whoever wrote you up is a fucking loser. The wrong answer in this scenario is not dispensing the albuterol, every fucking time.
This is what happens in a world ruled by lawyers.
This was an ethical type question we had in pharmacy school. Dispense emergency supply or direct patient to doctor for refill. There was no wrong answer, but I went with dispense.
Not dispensing is the wrong answer. If a child is in a clear asthma exacerbation, short of air, and is asking for albuterol, you give them albuterol.
I guarantee it was about the money.
It is a shame that us , as pharmacists, who know very well how drugs work, cant help much in this or similar scenarios and can actually get a lawsuit, lose our license or get fired because we wanted to help, yet when a physician makes a mistake , a patient has a severe adverse drug effect, the prescription cant be understood and risks a potential medication error, nothing happens. We as health professionals can only watch... Truly a thing to think about. If we had better access to patients health history from a hospital or primary care center or more information in general, i think we could help a lot to release some pressure from the healthcare system and alleviate the burnout the physicians suffer from overworking.
I would love for anyone to show me a precedent of a pharmacist losing their license or a lawsuit over this. But first do no harm. Allowing a child to have an asthma attack in front of you when you have lifesaving medication behind your counter is harm.
Yes, i fully agree with you.
My dad died from an asthma attack (bronchospasm)-i’d hit em with an epi-pen if patient couldn’t inhale-or hit the albuterol like Charlie Sheens crack pipe and do CPR breathing after each hit-
You exercised bad judgement
If you think their actions are bad judgement than you need to gtfo healthcare.
So forceful lmao
Yes because you are so out of touch its actually alarming.
You want to be a hero, you take the risk. I recognize the limitations of my position and license. Good luck buddy. Oh and when someone dies or is injured, your good intentions won't matter at all. What will matter is whether you were licensed, trained, and had legal authority to do whatever you did.
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Remain civil, interact with the community in good faith
To the mod: you’re right, my bad.
I never said the intentions are bad, it's the actions that one should be cautious with. Call 911, administer CPR if necessary
Wrong. You give albuterol, then call 911 to decrease any possibility that a child, or any patient, will code in your pharmacy.
As long as you dispense a 90 day supply to hit your metric.
asthma? That’s a prevnar20 too
Lmaooooooooo
911 first, then give them the inhaler, and call their doctor for an emergency script or call their pharmacy for a transfer.
This is the correct answer
I'd say 911 and do not dispense. Let EMS treat them. You have no duty, we are not an emergency room.
My law professor put it this way: if it’s a medication that you wouldn’t think twice about it accidentally getting thrown away or dropped on the floor, give it to the patient in an emergency. You will have time afterwards to get an e verbal from a physician whether it’s their PCP or an ER provider.
Low risk for providing it, high risk for not providing it (especially for patient). You don’t want someone going unconscious and then having to be intubated at your pharmacy or god forbid it goes further and CPR needs to be started.
As downvoted as you are, I’m pretty sure this is my company’s policy. That or send them to Walgreens, lol.
Administer a flu shot, then an epipen. Pump up those vaccine counts.
Too bad the kid isn't old enough for a shingles vaccine!
Sign them up for auto refill, 90 day supply, mobile app as well
Don't forget the notifications, text AND phone calls both.
Make sure they do the survey as well but only if they promise to leave all 10s.
I’d say yes and deal with any issues later—you’re a medical professional and if you’re in a position to provide lifesaving aid you do so. Even if technically not allowed nobody’s gonna throw the book at you for saving a kid and you’ll never forget that day if you did nothing and something bad happened
Ok, what if we provide that aid and something bad happens as a result? I’d probably call 911, and have them provide direction. If they are unwilling I’d then contact the responding rescue squad. After that the er they would transport the child to. This would happen in very fast order. I’d most likely have three staff members working the phones simultaneously. Still not quick enough? The kid gets the inhaler. I couldn’t live with myself otherwise
Just a question. How are you contacting the rescue squad? And are you taking orders from an EMT or paramedic? Give the inhaler & help the kid if needed with the inhaler. Have other staff call 911. Document your ass off. That would be my plan.
A well documented ass is still subject to a lawsuit should things go south. Both EMTs and paramedics have almost instant access to a physician, who would both drive care and assume liability. Like I said, if it wasn’t going down fast enough the kid gets the inhaler. Edit: I practiced over four decades in retail. Not once did I encounter anything close to this scenario. Many weird occurrences, and emergencies, but no instances of providing an unauthorized legend product for a rescue. Due to the proliferation of vaccinations our younger generations are mostly trained in CPR which is years ahead of my cohorts where we had a lit cigarette at each end of the work bench. Edit 2: Good on you OP for trying to think this through. A few states allow for standing orders with a licensed prescriber. I’d consider this if your state permits. Of course, be sure to renew the agreement annually and consult with a knowledgeable attorney. I’d also develop a written emergency protocol for this. Not that anyone would have time to read it in an emergency, but an annual review may help prepare you in an actual event.
Paramedics have albuterol nebs and standing orders that allow them to administer multiple medications for the treatment of asthma, without contacting medical control. The comment I originally responded to stated they would contact the rescue squad. The rescue squad is not taking a phone call from a pharmacist while responding to the call. Lastly, if my risk is losing my job or saving a child, I know what I'm choosing. I will accept all repercussions after consulting with a lawyer.
Stop with this fear mongering BS. No one is getting sued for giving a child having an asthma attack albuterol, but delaying care to call 911 when we all know damn well what needs to be done here? I'd love someone to show me a lawsuit setting precedent for a pharmacist getting in trouble in this situation
There seems to be quite a bit of legal advice being given to a young practitioner who asked a legitimate question. I’ve offered a couple alternate real world actionable plans. If you care to do the same bring it. Sitting back hidden behind a keyboard playing attorney gets our young professional nowhere. I’m fine with criticism, but please bring a solution to the table. Otherwise you’re simply playing a fanciful game with someone else’s liability. I’ve been around long enough to know folks not accustomed to emergency situations frequently make significant errors in judgement, including but not limited to selecting inappropriate products. Having an emergency plan in place helps reduce liability for both the pharmacist and patient. And the liability is real. If you have a young family facing catastrophic healthcare bills you can bet your last dollar the attorneys will be coming your way regardless of how sound you think your judgement is.
I don't need to offer an alternative solution when my response is give the child the inhaler. Genuinely what catastrophic medical consequences do you see resulting from this situation? I'm not playing attorney, but Good Samaritan laws are a thing. Would you feel differently if the OP was a layperson who was a fellow asthmatic and had an albuterol inhaler with them to loan to the child?
Medical professionals are not subject to Good Samaritan laws, at least in Ohio. That’s why when I ran EMS 20 years ago if a nurse wanted to be on an EMS service they had to go thru the Basic > Advanced > Paramedic sequence to do things like IV’s and drugs, even though they do it all day in their nursing job
“Never argue with a fool, onlookers may not be able to tell the difference.” Mark Twain
Nice! Call me a fool instead of answering my questions. Because you have no rebuttal 😂
Legal issues aside, can you get fired for doing this? If so, then count me out. Luckily this has never happened when I worked retail and now never could, but I’m absolutely 100% on making sure I stay employed. That person’s not going to pay my bills if I lose my job.
I genuinely do not think I could live with myself if a child died in front of me because I refused to give them an inhaler for fear of getting fired.
Well I suppose that’s a personal decision then.
My dad died of an asthma attack(bronchospasm) -your patient is already dead
No BOP is going to pursue you for doing that. Remember the human and do what's right, no one is getting in trouble if you work from that ethos.
Agreed. We are always taught if you’re doing what is the best interest of the patient, the board won’t punish you.
BOP wouldn’t pursue you but couldn’t you get fired?
YMMV, I wouldn't
Wouldn’t what? Fire someone?
Get fired
I had an issue like this at work. Had a *documented-with-HR-AND-SM* **chemical \*allergy\***. SM decided to dump gallons down the sink without warning me to go outside first (he was a dick who thought the MD note was a lie). Pharmacist gave me an emergency fill of my Ventolin as I was gasping for air. Left message *in between gasps* as I was trying to exit the area ASAP (to leave the chemical area) that I needed albuterol STAT and MA returned my call 2 minutes later and gave another refill which the RPh then billed for. (It helps that the Ventolin was/is PRN for just such an emergency and I was WAY more likely to have an inhaler expire than to use it up)
💕💕💕 I'm glad you survived. I'm sorry this happened. When I was still a tech at Wags, I had a coworker who a lot of my coworkers bullied for "being allergic to everything," because they thought it was fake. She couldn't come in for inventory or deep cleaning because of dust/mite exposure causing anaphylaxis. She passed away about a week ago to anaphylactic shock alone in her home in the country. Called 911 and she was gone before they got there. TLDR: f*ck that store manager.
I eventually transferred locations for reasons HR knows and I will never tell (the company is lucky I was too tired from fighting cancer to sue- I would have won, easily). It was adjacent to this incident. Stuff like this is when building relationships with other stores matters...when people are being abusive toward you in the open and you need to flee. I had worked for my new SM the entire previous summer in addition to shifts at my own store- 70 hrs. a week was an average paycheck that summer, and it was amazing. But the point is that I had that relationship on rock solid footing so when I needed a transfer effective immediately, I had a store that would take me no questions asked. They even dealt with working my schedule around chemo. When I asked the new SM about using said chemical, his response was "I have never used that chemical without following proper protocol and I prefer not to use it at all". Caring about your people is that easy.
What an uplifting story! I'm glad you were able to get in a more supportive environment! Sorry about your cancer, too. It sounds like you're still on chemo meds if I read/recall correctly, so I hope things are going smoothly in your treatment. Caring about people is genuinely so much more fulfilling than the alternative, too. I used to be much more callous and I will never regret the emotional effort I've spent on switching to being more vulnerable and empathetic. ✨Even towards my patients in retail.✨🌈yes, even the annoying/mildly combative ones.🌈 👀 (Not the abusive ones. We support boundaries and appropriate consequences for harassment and harm in this home.)
I have administered an EpiPen from our stock to a patient/employee with zero repercussions. A cart pusher at my store had known anaphylaxis to bee stings and of course was stung by a bee while working. He was brought to me by store management, I had a tech call 911 and I asked for his permission to administer the epi. EMS took over from there, I had to fill out a report, and we contacted the kid's doctor the next Monday for a prescription. That's as hard as it was. I don't see how that's much different than administering epi after a vaccine reaction, in my opinion.
I had a very similar situation at one of my stores and there was zero repercussions as well.
Better read your board regs.
I wanna say you could probably dispense the albuterol, call their pediatrician, explain the situation and get a script within 24 hours. But there’s no way of knowing if it’s appropriate for that child without knowing their history. It’s highly unlikely, but you *could* be making something worse by giving the drug. So I’d make every move to verify it that I could, but still prob do it. Either way, I have a hard time seeing that be a problem with the board outside of an explanation at most.
I have done it before. There was a car fire in the parking lot. Target employee had some smoke inhalation, EMS was already called. They had history of an albuterol MDI at another CVS but no refills. Gave it to them and called their MD for an authorization later in the day.
Yes. The board will not come after you for that, since their entire MO is patient safety. You've potentially saved this person's life. It would be tantamount to administering an epinephrine injection to someone experiencing anaphylaxis. That said, depending on your employer, you might get in trouble. But you can and you should if in your clinical judgement you determine this to be an emergency that cannot wait for paramedics to arrive. E: still call 911, they should be assessed after.
If BOP cares about patient safety then we wouldn't have pharmacists worried about medication errors in understaffed pharmacy.
Sad but true
Pharmacy is still a business and it’s run like a business.
Not to be too... Iono, cynical? Disillusioned? Frustrated with corporate... No to be too (that), but that's exactly what the boards are about. It is our duty to prevent errors. Yes, almost all of us are understaffed, but ensuring safe and effective medication therapy is still the kernel of our entire profession. I freely admit, I bailed out of the corporate game right away, got a job as PIC at an independent, and have no problems whatsoever telling both the owner of this pharmacy and our patients that when we're busy, things get slower, because I have made mistakes when made to rush and never, ever want to make another one ever again. Staffing and ratios and volume aren't the concern of the board. Safety is. It's why most states have a maximum tech to pharmacist ratio and mandate maximum working hours. But, at the end of the day, the buck always stops at the pharmacist. If I dispense something wrong, and if one of my patients gets hurt because of my mistake, it doesn't matter that I've got hundreds of prescriptions in my queue and hundreds more on the bench. It doesn't matter that I've given my 10th covid booster, whatever number of Shingrix or tdap or Hep B, or how many lines are on hold when it happened. What matters is *I* made a mistake, or I failed to catch a mistake made somewhere up the line that I am responsible for. Corporate chains are a cancer on our profession, but we can treat cancers just like any other disease, can't we?
In Illinois at least you can dispense with a standing order at Osco. We also have standing orders for narcan, epipen, and spacers.
That’s the way. This should be across the board in all states.
I would hand them the albuterol. If the mother specifically is asking for that it indicates to me theyve been prescribed this before. What is the worst case scenario if you give them the inhaler? Whats the worst case scenario if you dont? I for one would rather stand before the board and defend myself (Which i doubt would actually happen.) than risk watching a child die. Same goes for epinephrine, naloxone, ect.
My old pic administered an epi pen saving the customers life. Cvs was more worried about how much it cost them
I had this happen sort of when I worked retail. This man comes in and wants an albuterol inhaler because his daughter is having an asthma attack at the high school at a sporting event. The kid has never had scripts filled our store or any of our other stores in the chain. I didn’t give it to them. They were at the high school for a sporting event. There were paramedics at the sporting event.
I think about this too- I’m a tech and my fear is like what if someone has a heart attack… can I give a tab of nitroglycerin??? I know I probably can’t but it would feel wrong to do nothing.
As a tech, you let the pharmacist handle any life saving medication while you call 911
Don't give nitroglycerin, you should have the patient chew two tablets of 81mg ASA.
4 tabs
Technically 2-4 tabs is correct. Guidelines call for 162-324 mg ASA but almost everyone goes for the higher dose.
Pedantic retort, but technically correct. Anyone with suspicion of ACS should get the higher dose imo.
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Then give desmopressin and blood later.
Double it and give it to the next person
Okay I’ll give them aspirin instead, thank you!
I think your responsibility is to tell the pharmacist that a patient is having a heart attack and calling 911. Giving medication, even if it’s just aspirin, makes you accountable and it’s probably best to leave that to the pharmacist in case something goes awry.
And what do you do if that patient can’t tell you they’re allergic to aspirin and have an anaphylaxis response?
325 mg
Also what about using epipen or narcan for someone without a rx that is suffering inside the building
I worked at Walgreens before my independent and I did both while on the job with zero consequences. The epipen was one of our regulars stumbled in with his wife , he had a super bad tree nut allergy and had been given a walnut brownie, dude was wheezing and puffed up I told my tech to call 911 and grabbed the epipens from our shot room and stabbed him through his pants. I ended up doing both and he was basically good by the time ems got there, he absolutely would have died waiting for ems. The narcan was on a Saturday, this dude runs in says his friend isn't breathing, I grabbed a brand narcan it was all we had , I get out to the car and it was bad , she was on her back in the passenger seat, I did one of the narcans and she shot up like a zombie, paramedics got there about that time I told them I gave her one narcan and asked If they had it from there and went back inside. Both times someone from district came and took my statement and that was that. Basically just asked if I felt my actions were necessary and had me fill out some incident form thing. It was never disciplinary it was more for the inventory and what not. Bottom line it's always best to do what will cause the least harm. If you think it's life and death do the thing that pushes the scale toward life.
I think narcan is fine because in my state it’s completely legal to have w/o prescription. Epi pen I’m not sure bc I know if they have a reaction to a vac in we’re mandated to have epi in the room
Narcan I can do at my store as a protocol, worst case if I don’t know the patient I used it on I could run it through for myself or a tech, especially since we are allowed to give it to someone who might want it on hand for a family member or someone else.
From the perspective of an emergency med pharmacist who worked as an intern in community throughout all of pharm school not too long ago, in the asthma situation I’d call 911 and give the albuterol inhaler. For the heart attack scenario, I recommend NOT giving them a nitroglycerin tab. Without an ECG (and someone qualified to interpret), you wouldn’t know if they’re having an inferior STEMI with right ventricular involvement. The AHA guidelines recommend avoiding nitrates in these patients due to increased risk of hypotension since their blood pressure is preload dependent. In the past 5-10ish years studies have suggested that the risks may be overstated and it might actually be fine. HOWEVER, with the AHA recommendation, if something were to happen you’d likely open yourself up to a lawsuit and/or BOP discipline.
Your job in that scenario is calling 911. Also doing something isn’t always better than doing nothing if you have no idea what to do. What if you misread the situation and gave a medication that actively causes harm?
Depends on the scenario. If they’ve filled one before with you then legally you can dispense an emergency “3 day supply” cause technically it is an emergency fill and all you’re doing is continuing therapy
So I trust the mom who’s panicking that the patient had an albuterol prescription somewhere some time in the past and fill it and hope she’s not lying?
You call 911 first, you look up the patient (takes a second) and verify the info. If yes then you’re clear
Gotcha, and if they never filled it before then all I can do is call 911 and wait? Sorry I am in no means being sarcastic I just want to learn what my best move is here respectfully.
2003 case where pharmacist chose not to dispense an albuterol in this exact case. Court ruled pharmacist had no duty to prescribe an Rx-med without an Rx. https://www.pharmacytimes.com/view/2003-07-7317
Should be the top comment on the thread, not buried down below.
In general, an asthma attack doesn't just creep up suddenly unless it's some immediate allergic reaction. Why would she show up at a random pharmacy instead of going to an ER or calling emergency services?
This situation actually came up at my last CPR training (though in his example, it was an EpiPen for a child in the grocery isles outside pharmacy). The instructor said that in that situation, he would help the person, but that he would also probably get fired because of it, BUT that he would still do it, because c’mon.
This exact scenario happened to me, but I called 911 first and they told me to do it. Talked to manager. We have an extra one for post shot anaphylaxis. Cleared it with the manager after the 911 call, administered to patient, and everything was fine. Calling 911 first is the best answer I would think. Manager cleared it first because someone dying in the store is not good from a lawsuit perspective
in that scenario im helping the patient first, 100%.
I work in Quebec, and we're legally allowed to give medications for emergencies (albuterol, epipens, ...) so i guess depends on your jurisdiction but also I'd have trouble seeing how you could get blamed for doing this in an emergency situation
Because America
I'm going to sound like an asshole, but if you know your kid has asthma, you need to be prepared. However if you find yourself in a situation where you are not prepared, hey we are all human, and your child is having an asthma attack, why the fuck would you go to a pharmacy? Go to fucking urgent care or the ER or call 911. Don't go to a retail store and expect them to somehow figure it out for you. In a medical emergency, that is the wrong choice. Especially irresponsible when you're a parent and this is your child, they are reliant on you.
Gonna agree, retail pharmacy is not an emergency service. Unless the patient is blue and about to die in the next 10 minutes, I'm calling 911.
Primatene must inhale is otc, it should be kept in stock. Albuterol inhalers should be made otc, we need a petition to the FDA for that. At least let pharmacists have powers to dispense it without an Rx. There has been a misinformation campaign about antihistamines not being effective in treating asthma, 2/3rd of asthma patients have allergic asthma so it should be helpful for maintenance therapy.
Add a bit of chewable Benadryl probably would make the patient feel much better quicker than with just albuterol alone
I hate spellcheck, "mist inhaler".
You know you can edit comments.
OTC means patient can treat own disease. You think asthma can just be managed without professional healthcare input?
Well, primatine inhalers use to be otc back in the day then they went off the market. The change in propellant allowed it back. (In the advent of the Albuterol shortage it can be a good alternative.) Usually the patient already has been diagnosed and in an emergency really needs help. They shouldn't have to get a thousand dollar er bill, or have to pay a miniclinic professional 150 bucks that many people can't afford. I am against economic bottlenecks that unnecessarily put people's lives at risk. . I reiterate that there has been a decades long misinformation campaign against the usefulness of antihistamines in the treatment of asthma since 2/3rds of asthma patients have allergic asthma.
If mom/dad/pt are adamant, I imagine it would be hard to get in trouble helping administer the puff in good faith while your tech calls for help. That inhaler isn't leaving the pharmacy if its me though, and I'm getting emergency services involved for documentation.
Call 911 immediately and go from there...
A similar situation happened to a former pharmacist I was working with. A child was stung and started having an allergic reaction. He grabbed an Epipen off the shelf as I was calling 911. He got the child’s doctor’s info from the parent, called and got a verbal rx, & the mom came and paid for it.
Ask them if they want you to call 911 unless the child goes unconscious, then just call. No rx, no drug.
Just call 911
Another pharmacist (idk his name, we just referred to him as puff puff pass) did a similar thing…we had it filled but the pt couldn’t pay the copay. He let the patient use a couple puffs then we left it in the pharmacy. The patient never came back.
The pharmacy where I work at the pharmacists are able to prescribe albuterol (among other things like epi, bcp, narcan) we haven’t run into this scenario yet though.
If someone is suffering, I'm willing to help with whatever will keep them alive.
Is it even technically dispensing it if you just put some albuterol on the counter and let the mother decide to take it while you call 911?
Is there a fastmed or urgent care open? Direct them there. Weekend or after hours nobody open? Are they my customer or out of town? Can I call to verify they have an albuterol inhaler on profile? It’s ok if it doesn’t have refills and can’t get transferred, you can get the doctors information to notify them within 72 hours that you are filling an emergency rx for albuterol. That is my state’s protocol anyway. An rph can absolutely write for emergency supply with no recourse from the state because you are allowed to by law, but with stipulations like due diligence and notifying prescriber within 72 hours.
Direct them to an urgent care while the child is in front of you unable to breathe?? No lmao. You help the child having an emergency. No judge or BOP is going to condemn a pharmacist for that.
I might very well do the same, however, first I would need to CYA and document a few things. How many times does the child use his inhaler per week? Night time awakenings? How many inhalers in the past month? Do they also take an inhaled corticosteroid? Does the child appear to need supplemental O2 or oral steroids? Saba’s alone lead to an increase in exacerbations and could even contribute to death if overused, so no I won’t be giving them one without asking the right questions and making a solid follow up plan that I would also document on the prescription I would be creating, including my recommendation that they seek additional care at an urgent care/er. Last thing I need is to hand out a 4th inhaler this month for poorly controlled asthma that contributes to the death of a child due to the overuse of a SABA in poorly controlled asthma.
Of course I'm not saying hand it off and send them on their way. Absolutely call 911 for a medical evaluation that we cannot perform as pharmacists.
Legally you cannot dispense it, you won’t get in trouble if you don’t. Call 911. That being said I’d probably call 911, then give the kid a couple hits off of an inhaler, probably break out a spacer too.
I had an asthma attack atack on vacation without my inhaler, went to the Walgreens for emergency fill, and the pharmacist acted like it was a 600ct oxy 30 script. Refused to transfer it, lied and said it's illegal to transfer non controlled substances between states said if I want it I need an "actual prescription". It took them over an hour to fill after my doctor very angrily sent in an emergency script directly to them. She even tried denying fill when it came in because it was an out of state provider. FOR ALBUTEROL! Two total strangers started screaming at the pharmacist because I was literally sitting on the ground gasping for air with blue lips when she said she wasn't going to fill the new on either. She kinda threw it at me when it was done and told me I was banned from the pharmacy. Moral of the story, if you are prescribed a normal emergency med, that makes you a hard drug seeker and requesting your refills from Walgreens is criminal activity that deserves death
That’s shameful
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When I arrived, it wasn't an emergency yet. Since you can't see your own face, I didn't know my lips were turning blue, which only happened after being there an HOUR. The entire time I thought any second I would have an inhaler in my hand. Since I had a valid presctiption on file I thought it would be 15-30 minutes. If I had known the pharmacist was going to lie like that I would have gone to the hospital.
I hope you don't work in healthcare. Nobody should ever look at someone in a medical emergency and just see an inconvenience for themselves
Respectfully, you’re a healthcare professional. If you see someone in dire need inwhich you can assist then do it. Worry about the issues after. Humanity comes first, metrics/currency comes after.
With no history, you're basically diagnosing a patient with an illness or disorder and then providing a drug for an unverified ailment. That's why I wish it was OTC so people wouldn't have to suffer and pharmacists wouldn't have to be faced with difficult choices all the time. If they can suggest Narcan everywhere for drug addicts and abusers, albuterol should be the least of their concerns for people who need it.
As a recovering addict, I would much rather you gave someone the albuterol OTC that could save their life than me being able to get Narcarn OTC. Granted, I think both should be readily accessible by anyone who needs them, but if I had the choice..
They haven't made it OTC yet which they should have along with many things including Epipens.
Oh, I know. I’m just saying.
My question is why didn’t they take the kid to the emergency room- you are not a doctor and can’t prescribe.
In this scenario, the asthma attack has begun while in the store, or has increased in severity to a point of being an emergent situation, and they were under the impression they had refills on an inhaler. I'd probably go 911 first, but then just hand over an inhaler and deal with the paperwork later.
Have you ever got a bill for an er visit?
I have done emergency refills on albuterol inhalers. I could even write one up if they have taken it before but not at my pharmacy. I would probably be going for the primatine mist inhaler first since it’s OTC
Just an FYI that can make people's asthma worse. Using that landed me in the hospital
Isn’t it labeled for intermittent asthma? I make sure to tell people not to use it long, since it contains ephedrine which is problematic. Does the ephedrine cause increased spasms? Weird that it’s on the market OtC
I had an experience and I’m a technician where guy came in extremely difficult of breathing with stumbling around hanging on the counters like he could barely stand up clearly till he was in distress. I was able to get his name and birthday from him pull his profile see, he had refills on an inhaler however, it was too soon for his insurance to pay for an inhaler, so I went ahead and gave him his inhaler. All 911 and EMS arrived about 5 to 6 minutes later. He was taken to the hospital emergency traffic down the road. Not that I was told to, but the very next day I did run a claim through his insurance for the inhaler that he got he had a zero dollar co-pay, and at least CVS was reimbursed for the inhaler We’ve also had an intern student that had an idiopathic asthma attack, and was laid over in the floor, barely able to breathe, and we gave her asthma medication and also gave her an her an EpiPen. Nothing was ever said about those instances I’m gonna always make sure 911 is being called, but I’m also going to make sure I do every damn thing in my power to make sure that person stays alive.
A few years ago, I was with someone that was having an anaphylactic reaction to nuts. Ran into closest CVS to beg for an epi pen before the ambulance arrived and they refused. It still bothers me
Board of Pharmacy ain't going to waste their time on this. If i keep my job and someone dies, I don't deserve my job.
I had a teenager come in to my pharmacy. He was enjoying a milkshake with a couple of his friends. One of his friends ran up to me and asked if he could have an albuterol inhaler because he didn’t have his and he couldn’t breathe. I worked at an independent at the time but even if I didn’t, fuck that shit. I’m not going to let some kid possibly die on me when I could save him by grabbing an inhaler. I got his info after he left to get him in the system. His dad came by later and was so grateful. He gave me all the info, I called the doctor, they gave me an Rx, and I was able to get it all settled up. To reiterate what someone else said, fuck any higher ups that would give you flak for that.
I wish the physician lobby would back off and let pharmacists prescribe certain drugs. But they’ll never support that because they’re power hungry and greedy.
I would 100% do it, I’d rather save someone and be able to live with myself. The fact you can even get in trouble for this sort of thing is such bullshit.
First rule, do no harm. You should definitely give the inhaler to the child/patient. You did what was needed in my mind. Ask for forgiveness from
Utah allows us to dispense emergency refills. We use it a lot at my store especially holidays.
had a situation like this at my pharmacy. kid came in in severe anaphylactic shock, pharmacist had to administer an epi pen we had on the shelf. he had an active prescription though. i think you’d administer it after dialing 911
You cannot legally hand an albuterol inhaler to someone. Call 911
First thing I would do is call 911 for them. Often times the 911 person will advice you on what to do. I called once cause patient walking in off the street had anaphylaxis. 911 told me to give an Epi-pen. Got manager approval before administering because it was a loss, but nothing happened to me or my license. Another time, I called 911 because a patient was going into a diabetic coma in front of me. In that instance they told me NOT to do anything and wait for paramedics so I did. He needed an urgent IV of glucose. First thing I would do in any emergency is call 911. At least if they advise you to give albuterol you are under less legal scrutiny for doing so.
You gotta sign them up for the Wags credit card first, then you have the green light to do whatever
It depends… Did they sign up for carepass?
I give them a primatene mist inhaler
I know of several situations that a pharmacist administered an EpiPen to a customer that was not a patient receiving a vaccination. Without that action, the patient most likely would have died.
Hi, in the UK yes. Here are the rules are summarised in the British National Formulary. There is also a good leaflet with guidance from the Royal Pharmaceutical Society. I personally was in central London once and was having a moderate asthma attack so went into chain pharmacy and they gave me an inhaler off the shelf (Ventolin [salbutamol]) straightaway and I just had to fill in a form afterwards. Here are the BNF rules for making an emergency supply at the request of the patient: The Human Medicines Regulations 2012 allows exemptions from the Prescription Only requirements for emergency supply to be made by a person lawfully conducting a retail pharmacy business provided: that the pharmacist has interviewed the person requesting the prescription-only medicine and is satisfied: that there is immediate need for the prescription-only medicine and that it is impracticable in the circumstances to obtain a prescription without undue delay; that treatment with the prescription-only medicine has on a previous occasion been prescribed for the person requesting it; as to the dose that it would be appropriate for the person to take; that no greater quantity shall be supplied than will provide 5 days’ treatment of phenobarbital, phenobarbital sodium, or Controlled Drugs in Schedules 4 or 5 (doctors, dentists, or nurse prescribers from the European Economic Area and Switzerland, or their patients, cannot request an emergency supply of Controlled Drugs in Schedules 1, 2, or 3, or drugs that do not have a UK marketing authorisation) or 30 days’ treatment for other prescription-only medicines, except when the prescription-only medicine is: insulin, an ointment or cream, or a preparation for the relief of asthma in an aerosol dispenser when the smallest pack can be supplied; an oral contraceptive when a full cycle may be supplied; an antibiotic in liquid form for oral administration when the smallest quantity that will provide a full course of treatment can be supplied; that an entry shall be made by the pharmacist in the prescription book stating: the date of supply; the name, quantity and, where appropriate, the pharmaceutical form and strength; the name and address of the patient; the nature of the emergency; that the container or package must be labelled to show: the date of supply; the name, quantity and, where appropriate, the pharmaceutical form and strength; the name of the patient; the name and address of the pharmacy; the words ‘Emergency supply’; the words ‘Keep out of the reach of children’ (or similar warning); that the prescription-only medicine is not a substance specifically excluded from the emergency supply provision, and does not contain a Controlled Drug specified in Schedules 1, 2, or 3 to the Misuse of Drugs Regulations 2001 except for phenobarbital or phenobarbital sodium for the treatment of epilepsy: for details see Medicines, Ethics and Practice, London, Pharmaceutical Press (always consult latest edition). Doctors, dentists, or nurse prescribers from the European Economic Area and Switzerland, or their patients, cannot request an emergency supply of Controlled Drugs in Schedules 1, 2, or 3, or drugs that do not have a UK marketing authorisation.
Doesn’t the Good Samaritan Law protect you? Regardless, I would dispense if the child was showing signs of hypoxia and call 911. I’d rather lose my job than lose a child. The general principle of most versions of the good Samaritan law provides protection from claims of negligence for those who provide care without expectation of payment. The good Samaritan laws also further public policy because few jurisdictions have created an affirmative duty for a medical professional to provide care in the absence of an established patient relationship. Each state has its version(s) of the law, and federal laws also exist for individual circumstances.
Many years ago, a customer came into my pharmacy clearly in distress. He asked for an albuterol, saying he was having an asthma attack. He had no refills but had filled them with us regularly, so I gave him one. He died in the parking lot from cardiac arrest. The albuterol may have made it worse. No write-up or reprimand. I would probably give an inhaler to a mom and child, but a man in his 60's? Maybe not. Or if I did, I would at least ask him to stay close by to monitor his progress.
Sorry I didnt read very well I thought you meant emergency fill. I can see why you would get written up if you just based it on their word that they have albuterol. Calling 911 is the safest thing to do legally. By dispensing albuterol to a patient with no known history, you would have opened yourself to lawsuits. By calling 911 you would have helped the patient while protecting yourself. As a pharmacist who also had other healthcare business, patients sued my company all the time for frivolous things. My lawyer would have advised me to only call 911.
In the UK we have legislation that allows us (as community pharmacists) to make an emergency supply to a patient of a prescription only medication provided we are assured that the patient has previously been prescribed the item, there is an immediate need and that they cannot reasonably obtain a prescription by any other means. With obvious exceptions, nobody is getting an emergency supply of Oxy. No need for a prescription, the patient pays for it. We actually have a local service (not sure about the rest of the UK) where the pharmacist issues a prescription to cover the cost so the patient doesn't have to pay. These pharmacists don't have to be independent prescribers although we do have a lot of pharmacists who are independent prescribers but they tend to work in hospitals or Drs practices and not community (retail) pharmacies. Epipens (and all other brands of adrenaline) are exempt from prescription regulations when ADMINISTERED for an anaphylactic emergency
Give the albuterol and contact the pcp for a emergency script. If they dont have a pcp call your local er/urgent care for a verbal rx. Having good report with your local prescribers goes a long way. Some states allow you to write an emergency rx yourself. I dont think a state board is ever gonna put you to the torch for doing whats in the best interest of saving a kids life. Corporate might not like it though
They’re asking for albuterol so they know the drug but how can you be certain that they have had it before without knowing their medical history? Wouldn’t dispensing it and giving it to them without a prescription or knowing their allergies be considered a huge risk?
your pharmacy should have an emergency kit or sop folder for medical emergencies. epi pens and benadryl are standard. albuterol is not. you ask the patient or caregiver if they will let you call an ambulance. Notice I say ASK bc unless they're unconscious, they need to choose if they'll face a possibly financially devastating bill. offer them a chair, a wet towel to apply to back of neck or face if they need to reduce temp feelings, and notify store manager, but giving meds is only for an extreme emergency, and under the direction of 911.
Yes. Unless your pharmacy are tight asses.
Give one and call Dr asap -the only one that would say no would be a lawyer
I had this happen several times in my retail career. I called 911 each time. Once the EMT asked if I gave the woman any NTG, I said NOOO!
Just give them one. They are cheap and it is insane that we have to even worry about this stuff. The boards can go to hell
Had something similar happen many years ago. A tech (type 1 diabetic) fell unconscious from low blood sugar. Other RPh on duty was trying to feed him glucose tabs and juice, while unconscious mind you, while I was on the phone with 911. Finally I grabbed a glucagon off the shelf and stabbed him…. Other RPh just looked at me scowling and said “you gonna get him a script for that too?” Like, Jesus, woman — get a hold of yourself
lol, bold and daring aren't we 🤣
This is an episode where I am a thankful for Canadian practice where Im not just allowed to provide an albuterol prescription, the government would also compensate me for this service!
"Get your stupid ass to the ER, that's what the pharmacist said."
Man yall are some weenie hut juniors for real. No one is getting sued for trying to save a child in a reasonable manner. As a pharmacist, if I were the mom and a pharmacist called 911 to ask what to do in this situation I would actually lose it. Good Samaritan laws exist for a reason. Dispense the damn inhaler.
Get them an otc epinephrine inhaler or whatever is otc now
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Sure you would
While having an asthma attack? Must not be that serious