I worry. I worry too much. But when Chief Pharmacists come out with stuff like what I quote below, I realise that my worries are, unfortunately, well-founded.
(This is just an extract of the document - the full document is readily available from the link.)
West Suffolk NHS Foundation Trust
Trust Policy and Procedure
Substitution of Medicines Policy Document ref. no: PP(15)210
For use in: All clinical areas
For use by: Pharmacists and authorised Pharmacy Technicians
For use for: For use in ensuring that Trust prescribing meets the medicines management agenda of the Trust in an efficient manner
Document owner: Chief Pharmacist
4. Rationalisation of Time of Administration of Other Medication
A change of timing of administration of the following products to achieve more rational drug therapy:-
Levothyroxine – Change of time of administration to before breakfast
They are telling all pharmacists and pharmacy technicians to change the timing of levothyroxine doses on the basis of achieving more rational drug therapy. Trouble is:
No recognition that "before breakfast" means any of a rainbow of possibilities from four hours before, to two minutes before.
Implicit assumption that the only other timing possibility is "after breakfast".
No recognition of the possibility that this change will conflict with other medicines.
(The document also suggests changing timing of iron to avoid quinolone.)
No recognition that changes of timing can result in change of biochemical impact and the possibility of a change of dose being required.
Frankly, no recognition that this sort of change needs to be explained - at least to the people who are charged with implementing it!
I'll stop there, but there are surely other points also to be made...