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NPA viewpoint: robust procedures

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NPA viewpoint: robust procedures

Strict protocols must be in place regarding the sale of paracetamol, says Leyla Hannbeck, head of pharmacy at the NPA

Recently, an extremely dangerous craze known as the ‘paracetamol challenge’ began on social media, daring young people to take excessive amounts of paracetamol. At the time of TM going to press there is no evidence to suggest that this is a widespread issue. Nevertheless, pharmacy staff should be vigilant to the excessive use of paracetamol and make customers aware of the dangers associated with overuse.

As the most accessible healthcare providers, community pharmacy teams are often the first port of call for health advice. Therefore, teams must implement robust procedures when selling medicines and issuing advice. In particular, teams should be vigilant concerning requests for drugs that are liable for misuse.

As you will know, before selling a medicinal product, there is certain information you need to know to ensure it is safe and appropriate for the customer. This information can be gathered by asking the WWHAM questions:

  • W: Who is the patient?
  • W: What are the symptoms?
  • H: How long have the symptoms been present?
  • A: Action taken?
  • M: Medication being taken?

Asking these questions may be timeconsuming, but it is a key step in understanding the customer’s query and ensuring optimal treatment. Pharmacy teams should try to build a rapport with the customer and make them aware that the questions are for their own benefit, and not to judge or pry. In the case of paracetamol, it is important to establish who the patient is, their age and the purpose for use.

This is to ensure that a suitably licensed product is supplied in the correct dose. Customers should always be advised to follow the dosage guidelines as recommended by the manufacturer’s instructions. Knowing how long a customer has experienced their symptoms is also important, as it may indicate a different cause or condition, or warrant referral to the pharmacist.

For instance, a customer with long-standing symptoms of headache who regularly uses drugs such as paracetamol can develop a condition called medication overuse headache. Customers should also be made aware of the dangers of taking paracetamol with other medicines that also contain paracetamol, such as combination cough cold products, which could lead to exceeding the licensed maximum daily dose.

Also note, the number of noneffervescent paracetamol capsules or tablets sold to a person at any one time should not exceed 100. However, this is not a legal restriction. Pharmacy teams should refer requests for large quantities of such products to the pharmacist.

The ‘paracetamol challenge’ has reportedly led to the hospitalisation of at least one teenager. Pharmacy teams should be aware that the early symptoms of paracetamol poisoning include nausea and vomiting, though these may not appear in the first few days. Taking excessive amounts of paracetamol can result in liver damage, which could cause cerebral oedema, encephalopathy, haemorrhage, hypoglycaemia or even death.

Even if symptoms are not present, anyone who has taken a suspected overdose should be immediately referred to a hospital. Pharmacy support staff can test their knowledge of OTC sales using the NPA’s free online tool, Assess & Learn.

To access it, visit: npa.co.uk/assessandlearn. The NPA also offers the Pharmacy Interact course for medicines counter assistants to meet the minimum General Pharmaceutical Council (GPhC) training standards for staff working on the medicines counter. To enrol, call: 01727 800 402 or email professionaldevelopment@npa.co.uk.

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