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SAMPLE CASE SCENARIO

25 August 2020

CASE SCENARIO NUMBER 1

• Jen is the new pharmacist-in-charge in a drugstore, her superior asked her
to call a patient named John, because she wants to go home already after
a night duty. John is a married man with two children and he needs to get
his refill of Lithium immediately, because it’s been already 2 days after the
last dose of the first treatment. So, Jen call the patient and asked him to
come and he answered, “yes.”

• While waiting for the patient, she served other people in the community
and at 12 noon, a police officer approached her and asked where’s the
pharmacist that called him this morning. He is agitated and quite
exasperated. Jen tried to calm him down by talking to him calmly and
politely.

• He asked the officer what does he need and he said that he is John that
she called this morning. Then Jen remembered that he is the patient that
needs to take Lithium.

• During the interview, the police officer is not in the good mood and he
wants to go immediately, Jen said to her that he needs to take his refill, but
he said that he wants to stop it because he’s not feeling well and he will go
in a vacation with his family, in a low tone voice.

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• John also tells Jen not to tell to his doctor that he will stop taking the drugs
because he can overcome his problem soon.

• Jen saw the doctor’s name on the data and she knew him, so, she’s
thinking of what she can do for the patient and if she will ask about patient
John. Also, Jen knew the head of the station where he is working when
asked where his station is during interview.

CASE SCENARIO NUMBER 2

Juana is a community pharmacist serving a pregnant customer who wants
to refill her prescription.

Upon receiving the medication, she notices that the medication she just
bought is different from what she previously bought from another pharmacy.

Covered for data privacy

She expresses her

Covered for data privacy dismay in social
Covered for media where she
data privacy exposed the details of
the incident.

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Based on the comments on her social media post, the pregnant

customer realizes that she had been taking the wrong medication
for 26 days already.

She becomes aggressive and demands an explanation on the

possible harm the wrong medication caused to her unborn child.

Furthermore, she intends to report this incident to the

authorities but she does not have the receipt from the other
pharmacy where she received the wrong medication.

She asks for Juana’s assistance in reporting her case. How can
Juana help the pregnant customer?

CASE SCENARIO NUMBER 3

Pharmacist ABC is a senior pharmacist in a private hospital. Chief Pharmacist

DEF is on a vacation leave and assigned Pharmacist ABC to be the officer-in-
charge for one week in her absence.

During his supervision in the department, an emergency meeting was called by

the Board of Directors. He was mandated to attend the said meeting.

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The agenda for the said emergency meeting was the case of a certain
Patient GHI who is a known breast cancer patient undergoing
chemotherapy.

In the middle of her cycle, it was detected that Patient GHI is pregnant
on her first trimester. Her oncologist has explained to her all the risks
and complications that may arise in her situation. She was also
referred to an OB-Gynecologist for further assistance.

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However despite her pregnancy, she wishes to continue her ongoing

chemotherapy cycles with the institution as scheduled. Upon careful
investigation and evaluation with the patient, it was found out that she
does not want the baby because the supposedly father of the unborn
already has a family of his own.

Comments and suggestions of the team are being asked by the CEO.
What will be the standpoint of Pharmacist ABC?

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CASE SCENARIO NUMBER 4

A customer approaches the pharmacy counter

and presents a prescription written in a foreign

language. She asks in broken English for the

prescription to be dispensed. When you inquire

where the prescription is from, you discover that

she is a Nigerian and is here in the Philippines to

pursue her studies.

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She said that she cannot go back to Nigeria until she finishes her degree. You
suggested that she should consult a licensed physician working in the Philippines

because you cannot dispense a prescription written outside the country.

However, she argued that she only have enough money to buy the
medicines and that she has no more money left to consult a physician. She
is just depending on her scholarship grant covering only her tuition fees.

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She works as a part-time janitor (showing her ID indicating the date she
was hired last month) and told you that her monthly allowance from her
work is hardly enough for her food and accommodation because most of
her money goes for the additional expenses in school.

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She narrated that most of the time, she only eats during
lunch and has an outstanding accumulated rental debts.

She disclosed that her school clinic had no physician and

only one nurse is working there.

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She also explained that she already tried the free consultation
programs of some public hospitals but the line was too long and
that she cannot afford to miss her classes because of the possibility
that her scholarship grant might be lost and also she elaborated
that after her class she goes immediately to work keeping her
attendance maintained so as to avoid deductions from her below
minimum salary (provincial rate) to keep her budget aligned with
her needs.
She also already went to the city hall for health assistance but she
did not passed the requirement of indigency.

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Neither you or your staffs read or

speak Nigerian. But you are able to
read the generic name of the drug
which is Metoprolol, but cannot
understand the dose, dosage
strength and other instructions. She
tries to explain what was written in
the prescription and argue that she
is taking the drug for almost 3
years for her hypertension.

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What should you do and how will you assist her?

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CASE SCENARIO NUMBER 5

A Medication Error on the Oncology Unit:

Who Has the Final Word?
Since Edward Strunk, Pharm.D., was a new clinical
pharmacist on the oncology unit, this was literally the first
time he had ever discovered a medication error. At first he
wasn’t sure what to do.
Dr. Strunk was in the process of reviewing the medical
records of the patients on his unit and updating orders
when he noted the error.

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It appeared that the physician had written an order for “L-PAM 2

mg.” Lorazepam, an antianxiety agent, was mistakenly
dispensed instead of melphalan, an antineoplastic agent.

The patient had received lorazepam for 6 days instead of the

melphalan. “L-PAM” was the formal and correct abbreviation for
melphalan, but lorazepam was often incorrectly abbreviated as
“L-Pam” as well, which caused considerable confusion and in
this case the medication error was originally filled by him.

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The physician had renewed the order for “L-PAM 2

mg.” After confirming with the physician that a
mistake had been made, Dr. Strunk dispensed the
correct medication. He also reviewed the medical
record to see if the patient had suffered any ill
effects from the lorazepam. It did not appear that the
patient had suffered any adverse drug reactions.

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Yet Dr. Strunk wondered how one could measure

the harm that was done by not receiving the
appropriate antineoplastic drug, especially since
the patient was diagnosed with ovarian cancer?

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Dr. Strunk decided to approach his supervisor with his

discovery. The clinical supervisor told Dr. Strunk that it was
hospital policy to complete a medication error report but
NOT TO INFORM PATIENTS OF ERRORS such as this on
the grounds that it would only upset the patients and
undermine their confidence in the hospital and their
caregivers. The supervisor claimed that the risk-
management committee reasoned that it was morally
unacceptable to disturb patients if they had not been
injured.

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In this particular case, NO ONE would ever know that an

error was made, as the melphalan and lorazepam look
remarkably similar, and the nurses recorded that “L-Pam
2mg and L-PAM 2 mg” was given to the patient. Dr.
Strunk was troubled that the patient was unaware of the
mistake and felt that she had a right to be informed. He
was also not certain that the hospital’s policy was
ethically sound.

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CASE SCENARIO NUMBER 6

At midnight, a 19-year-old primigravida (woman who is

pregnant for the first time), Emelina Peña, at 14 weeks,
was seen in a general hospital emergency room with
complaints of dizziness, decreased urine output, and
difficulty breathing.

Ms. Peña was accompanied by her husband, Manuel, who

reported that his wife had a history of systemic lupus
erythematosus.

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Before her pregnancy, Ms. Peña had been hospitalized because of cardiac
involvement and pleural effusion.

She had been on high-dose corticosteroids prior to her pregnancy to

control rheumatic flares. She had discontinued all of her medications when
she found out she was pregnant.

She had also avoided seeing her physician because, as she told her
husband, “He will want me to be on those drugs, and that is no good for
the baby.”

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The past few days, Ms. Peña had become sicker and sicker, so
her husband decided to bring her to the emergency room.

The ER physician diagnosed possible pericarditis, serious

hypertension, and pending renal failure.

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Perry Sledge, Pharm.D., was the clinical pharmacist for the intensive care
units of the hospital. Dr. Sledge knew there was an SLE patient in the unit when
the first order appeared for high-dose glucocorticoids in the pharmacy.

When Dr. Sledge delivered the medications to the unit, Roger Bishop, M.D.,
the obstetrician on call, asked him to join the rest of the team for a family
conference regarding Ms. Peña’s case.

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Dr. Bishop began the conference by stating, “The best treatment for
your wife is delivery of the baby. At this stage of gestation, the baby will
not survive. If we treat your wife with the proper medications to control
her numerous systemic problems, the baby will most certainly be
irreversibly harmed anyway.”

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Mr. Peña responded, “So there is no way to save my Emelina and the baby?”

Dr. Bishop replied, “I believe that the delivery of the baby is the only way to
guarantee your wife’s life.”

Dr. Sledge was extremely uncomfortable with what Dr. Bishop told Mr. Peña.

Dr. Sledge was opposed to abortion, but he knew that Ms. Peña could die from
renal failure if a caesarean section was not performed soon.

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