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Flashcards in Law and Ethics MDA lectures; Jenny Scott Deck (133):
0

What is a controlled drug?

One that is controlled under the Misuse of Drugs act (1971)
Controlled drugs in healthcare are medicines subject to both the Medicines act and the MDA (misuse of drugs act).

1

When dispensing CDs, what act requirements apply?

Medicines act requirements apply, PLUS additional requirements of the Misuse of drugs act (MDA)

2

The MDA places additional controls on certain substances that are likely to be misused or abused. What two substances omit this? (ignored?)

Nicotine
& alcohol
Two of the most harmful and commonly used drugs

3

The misuse of drugs act makes total prohibition (totally bans) possession, supply, manufacture, import and export of certain substances, except as allowed in ___________________ regulations, or under ______.

Allowed in the Misuse of drugs act regulations
Or under LISCENCE

4

How many schedules are CDs classified into?
What does this depend on?

5 schedules
Depends on their perceived likelihood to be misused and the potential risks that misuse may present to the individual or society.

5

Tricky question: what are the 5 different CD schedules abbreviations?!

Sch 1: CD Lic POM
Sch 2: CD POM
Sch 3: CD no register POM
Sch 4: Part I (CD Benz POM)
Part II (CD Anab POM)
Sch 5: CD Inv POM or CD Inv P

6

How to find out what schedule a CD is?

Look up RPS (royal pharmaceutical society)
Look up list of medicines for human use
Their classes will be listed

7

What are the Schedule 1 drugs? (CD Lic POMs)

These drugs have no current therapeutic use
Such as LSD, Ecstasy, MDMA, also cannabis
Production, supply and possession of these drugs needs home office Liscense

8

What about patients confidentiality when handing in schedule 1 controlled drugs such as cannabis and LSD?

patient's confidentiality should normally be maintained and the police should be called on the understanding that the source will not be identified. If, however, the quantity is so large that the drug could not be purely for personal use the pharmacist may decide that the greater interests of the public require identification and the identity of the person should be asked.

9

Can you just grab a schedule 1 CD off a patient, as the shouldn't have it on them anyway?

No, The patient should give authority for the drug to be removed and destroyed.
If the patient refuses, the pharmacist may feel that they have no alternative other than to call in the police. ☎

10

Are there any circumstances when you can give a schedule 1 controlled drug (eg LSD, cannabis) back to a patient?

NO
Under no circumstances can a suspected illicit drug be handed back to a patient.

11

When can a pharmacist possess schedule 1 controlled drugs without a home office LISCENCE?

When possession is for destruction
When possession is for handing to police

12

What is the only exception to schedule 1 requirements?
Why?

Sativex
It does have therapeutic use
Pharmacists DO NOT need a Liscence to possess or supply this
Sativex is a cannabinoid medicine for multiple sclerosis

13

What are schedule 2 drugs?

Opiates, major stimulants, quinalbarbitone
Eg of opiate: Methadone

14

Do pharmacists have legal authority to handle schedule 2 CDs? (CD POMS)

They have general authority to possess, supply, and procure (obtain) schedule2 CDs when Acting professionally.
can only supply if a VALID prescription is present.
License is needed to import or export.
Production or compounding (making up in the pharmacy) can be done by a pharmacist, practitioner or Liscence holder.

15

Who can schedule 2 drugs be administered to patients by

Doctor, dentist, nurse IP, pharmacist IP (independent prescriber)

16

What are schedule 3 controlled drugs? (CD No register POM)

Minor stimulants such as benzphetamine
Buprenorphine
Temazepam
Phenobarbital
Midazolam

Less overdose risk with these, less risk of misuse/ harm than with Sch 2 drugs.

17

Do schedule 2 drugs require a CD register?

Yes!!!
CD registers need to be kept for 5 years

18

Do schedule 3 drugs require a CD register?

No!
These are CD No Register POMs

19

Are there controls over destruction of Sch2 and Sch3 drugs?

There are for schedule 2 drugs,
But not for schedule 3 drugs

20

Do safe custody rules apply to schedule 2 and schedule 3 drugs?

They do for schedule 2 drugs...
But many schedule 3 drugs are exempt to safe custody requirements

21

How long should invoices (prescriptions?) of schedule 3 drugs be kept ?

Retained for 2 years
(don't need to do this for Sch 2 drugs)

22

Schedule 3 drugs have the same controls as schedule 2 drugs except....

Different groups can possess and supply
No requirements for CD register records
No MDA controls for destruction
Many are exempt from safe custody requirement

23

Schedule 4 CDs: what are the two parts and examples of drugs in those parts?

Part I (CD Benz POM): most benzodiazepines and ketamine.
Part II (CD Anab POM) anabolic and androgenic steroids, clenbuterol, growth hormones

24

Schedule 4 CDs have same restrictions/ controls as schedule 3, but what are the exceptions?

No special labelling required with Sch 4
No safe custody at all
No CD register (same as with Sch 3)
No need by law to keep invoices for 2 years

25

What are schedule 5 controlled drugs? (CD InvP or CD InvPOM)

Preparations containing CDs in low strength (eg codeine, morphine, pholcodeine)
(how much of certain drugs is in the formulation determines what schedule a drug is, Sch 5 contain low amounts of CDs)

26

What are the restrictions/ controls on Sch 5 drugs?

No MDA restrictions on import, export, possession, supply or administration
Pharmacists can make up/ compound schedule 5 drugs
Note: a drug may be contained in a schedule 2 product and also in a schedule 5 product but in lower amounts (how you manage the schedule depends on the Quantity, not just the drug!!)

27

What is the schedule of a drug determined by?

Not only the drug itself but the quantity of that drug In the Formulation. Ie you may have a schedule 2 drug and 5 drug containing the same drug such as morphine, but the schedule 5 drug will contain much lower concentrations,therefore there is less liability for abuse/ misuse
Eg: sevredol tablets containing morphine salt 10mg, a Sch 2 CD POM
Diocalm dual action tablets containing 0.4mg morphine HCL, a Sch 5 CD Inv P ☺☺

28

Are CD registers need for Sch5 CDs?

No, unless they have been made up from Sch2 drug stock (from the CD cabinet)!

29

How long should invoices be kept with Sch5 CDs?

For 2 years, as inspectors may make checks if any excessive ordering or sales are done.

Sch 5: CD Inv POM or CD Inv P

30

What are the requirements for labelling and safe custody for schedule 5 drugs?

No special label requirements (other than those in Medicines act)
No requirements for safe custody
No witness needed for destruction ☺

31

What's the only CD sch1 controlled drug pharmacists can possess without having a Liscence?

Sativex 

32

How can you check the authorisation of someone to possess , supply and obtain CDs? Eg if you suspect that a prescription isn't valid or want to know if the prescriber has a right to prescribe it?

Contact the Home office 

33

What are the rules for importing an exporting CDs for a pharmacist?

Importing or exporting 1,2,3,4 (part I)CDs: pharmacist needs a LISCENCE to do so.

Sch 4 part II or Sch 5 drugs can be imported or exported without a Liscence

34

What Happens with patients going abroad?

MDA is UK legislation only.
A patient does not need an export license if they're taking less that 3 MONTHS supply of a CD abroad.
(if they're going away for longer than this they'll need to register with a doctor there and get their supplies abroad)
Depending on the laws of the country visited, the person may need an import License, you should check with the embassy of the country in advance to travel.

35

For patients taking drugs abroad, how's it best to take them?

Carry in their original pack
Take letter from prescriber with details of name, quantity etc

36

What does "safe custody" mean?

Stored in a CD cabinet or other approved storage facility.
Follows the MDA Safe custody Regulations 

37

Sch 2 of the MDA safe custody regulations specify the CD storage specifications. There must be no indication as so what's in the cabinet.

You could also have a secure room, but mustn't be viewable to the public and you're responsible to ensure it follows the regulations  may be more likely to have a secure room in a hospital where more CDs are dispensed.

38

In prisons and hospitals, what standard must be met for CD cabinets and rooms? Why?

The "Sold Secure silver standard" (a lot more secure)
This is because quantities of CDs will be larger 

39

Pharmacies must have a written policy in place which describes access to CDs (Seperate from the SOP that describes dispensing of CDs!) what should the policy prevent? What does it require there to be means of identity of?

 policy prevents unauthorised access to CDs
should identify everyone who has had access to the CDs in that pharmacy and when, you can get electronic access which keeps and electronic log 
It's normal practice for the pharmacist to have key in their pocket 

40

Which Sch 1 CDs should be kept in the CD cabinet?

ALL!
Exception: Sativex: should be stored in a lockable fridge 

41

Which Sch 2 CDs should be kept on the CD cabinet/ room? Exceptions?!

All of them,
Except for quinalbarbitone and some liquids (unless they're in injection form )
It's still good practice to put these in CD cabinet to prompt you to still do a CD register

42

Which Sch3 CDs should the kept in CD cabinet? Can you think of the 4 which definitely should be?

Many exceptions with Sch 3 drugs.
The ones that definitely should be are;
Tamezepam, buprenorphine, flunitrazepam, diethylproprion (expected to know these for exam! )

43

Are Sch 4 and Sch 5 CDs kept in the Cd safe/cabinet?

No

44

When CDs are not in the safe where must they be?

Under direct personal supervision of the pharmacist
If you hand over the keys to someone else, must have record of when and to who!

45

What about out of date CDs? And unwanted CDs returned by patients? What applies?

Safe custody still applies
Still need to keep in the safe, but if you only have one safe, make sure you have a Seperate shelf for these so you don't accidentally dispense these.

46

What's the difference between a prescription and a Requisition?

Prescription is a request to supply one individual patient
A requisition is a request from a proffessional to obtain a supply of medicines so they can supply a number of patients themselves, eg a person in charge of a care home may request this, or a nurse in charge of a ward, or a doctor for his on call medical bag. 
Requisitions are more of a formal written request

47

When does a prescription have to be present to supply a CD?

All the time, for all schedules, except Sch 5, although some Sch 5 CDs are POM so these need a prescription.

48

In community, what kind of prescription form needs to be presented in order to dispense Sch 2+3 CDs?

In England its an FP10PCD which is Pink, MUST be on one of these, illegal to be written on normal private Rx paper, APART from in hospitals where the CDs are being dispensed in the same hospital.
in Wales; WP10PCD, In Scotland: PPCD(1)

49

Could you have a CD and a Non CD on the same Pink form?

No must be Seperate, as this would not meet MA requirements

50

What number must be on CD prescriptions?

Private prescriber Identification number

51

What must be done with the FP10PCD after the items dispensed?

Submit original to payment authority (NHS BSA)
And keep a photocopy for your records for 2 yearsfor good practice!
Keep CD register for 2 years
Date of SUPPLY must be put on CD Rx(for Sch 2& 3)

52

Exceptions with Vetinary Rxs for Sch 2 and 3 CDs?

Don't need to be on standardised forms (pink forms),
Don't need to be submitted to NHS BSA
Don't need prescribers ID number
Keep Rx for 5 years in pharmacy!


53

Who can prescribe CDs?

Doctors, Dentists, vets, nurse Independent prescribers, pharmacist IPs, 
Also supplementary nurse/ pharmacist prescribers, subject to having the clinical management plan (CMP) in place

54

What happens with date validity on CDs? When can they be supplied?

Only valid 28 days from date given on the Rx
If the signature date and supply date aren't the same, the 28 day validity runs from the later date.
All items the patient is owed on the Rx must be supplied within 28 days
Date can be hand written or compiterised

55

Did you know..

A CD prescription can be signed by a different prescriber to the one named on the form, but they must have the same address (be from Same practice) ✒

56

Is the drug name/ brand name a legal requirement on a CD Rx?

Not legal, but must be on there anyway so the pharmacist knows what to supply!!

57

Must the formulation be stated on a CD Rx? What if only one forms available?

Must always be stated!
Tabs or Caps is accepted, but T. Or C. Would not be.

58

What must quantity be written in on CD Rxs?

Words and figures
Liquids should be expressed as millilitres(not just ml)
note: dose does not need to be in words and figures

59

Examples of directions on CD Rxs that are NOT legally acceptable .....

As directed
When required
PRN
As per chart
Titration dose
Weekly (this is just a frequency and not a dose)
Decrease dose by 3.5ml every four days

60

Examples of directions that ARE acceptable on CDs:...

One as directed
Two when required
One PRN
Three ampoules to be given as directed (better still – three ampoules to be given over 24 hours as directed)

61

What is required for the directions with instalment dispensing? (where medicines are supplied to patients in instalments)

instalment direction combines two pieces of information:
1. Amount of medicine per instalment
2. Interval between each time the medicine can be supplied
Eg supply 200mls on Monday and 280 mls on Thursday, daily dose 70mls

62

What does the department of health recommend for the limit on the time to supply Sch 2,3 and 4 CDs ?

30 days, unless the pharmacist uses their professional judgement where it's clinically appropriate to supply after this, ie this isn't a legal requirement.

63

What 5 things must be present on a CD Prescription?

✔ name of drug (not legal, but needs to be on there!), should have salt name eg morphine sulphate
✔ form (capsules, tablets must he written, even if only one form available)
✔ strength (unless only one available)
✔ total quantity in words and figures
✔ directions

64

What extra sentence do dental CD prescriptions need on them for Sch2 and 3 CDs?

For dental treatment only 

65

Which CD drug is exempt from the usual Sch 2 & 3 requirements? What's the one rule it does have to follow?

Tamezepam
Must still follow 28 validity from appropriate date

66

Can you have repeat CD prescriptions?

No
Instalment prescribing can instead facilitate repeat supplies

67

What are the additional prescription requirements with schedule 4 and 5 CDs?

No additional Rx requirements
Medicines act requirements still apply
MDA mainly controls import/ export of these schedules

68

What kind of errors can pharmacists amend on CD prescriptions?

minor typographical errors or spelling mistake, or where either the words or figures (but not both) of the total quantity has been omitted.
Pharmacists cannot correct other omissions; eg missing date, incorrect dose. These should be corrected by the original prescriber or, in an emergency, another prescriber authorised to prescribe controlled drugs. No cover letters can be accepted.

69

Who can prescribe things like cocaine to treat addiction?

Only medical prescribers (but NOT pharmacist or nurse IPs) who hold a special licence from the Home Secretary  can prescribe cocaine, diamorphine or dipipanone for treating addiction.
This special licence is not required if treating organic disease or injury.

70

For what schedule CD drugs is good practice (not legally required) to get the person to sign the back of the prescription on collection?

Schedule 2 and 3,
And for Sch 2 CDs it is legally required for you to find out who is collecting the drug (patient, representative)

71

When do you need a requisition to supply a larger number of CDs than just one?

Requisition needed before supply of Sch1, 2, and 3 CDs from a a pharmacy, to eg care homes, doctors for their on call bag, midwifes etc note; any person supplied a Sch1 needs to be a Home office Liscence holder.
You don't legally need a requisition to supply one pharmacy to another pharmacy (but good practice to do so)
No requisition needed when a pharmacy is supplied by a wholesaler

72

In emergencies when a CD is needed urgently by a doctor or dentist, can you supply them? When would a requisition be required?

Must supply requisition in 24 hours
It's an offence if not

73

What are the requisition forms in community? Where can you get them?

Standardised forms available from primary care trusts
These aren't legal requirements but should be used for good practice.
Vets don't use special forms
No faxes or photocopys allowed
Messengers can collect requisition supplies on behalf of a doctor, but need a written authorisation- keep this in pharmacy for 2 years.

74

What are the legal requirements of a requisition?

Recipients (person requesting) name and address, profession, occupation, signature
Total quantity (no need for words and figs)
Purpose for which drug is needed

75

What CDs can be supplied to midwives?

Diamorphine, morphine, pethidine, pentazocine

76

What is the name of the requisition needed by midwives to obtain CDs?

Midwife supply order

77

Midwife supply orders need to meet all the legal requirements of standard requisitions, what additional signature is needed?

Need to be signed by "appropriate medical officer" ie the person who supervises midwives in that local area.

Note: it's also good practice for midwife to keep records of her supplies and uses.

78

What does a pharmacist need to do after making a requisition supply? What to do with the form?

Mark form as "spent", with pharmacy stamp
Photocopy requisition form and retain for 2 years 
Send original requisition form to NHS BSA
Keep original form if it's a midwife supply order, don't send it off.

79

With the Emergency supply of CDs, what are the rules?

Emergency supplies of Sch 2 or 3 CDs cannot be made.
(only exception is phenobarbital for treatment of epilepsy )
The only time an emergency supply can be made is to a doctor for his used in practice (eg on call medical bag ), providing the requisition forms supplied in 24 hours.

80

What schedule CDs does the MDA set very little guidance on? What should you do?

Schedule 5 CDs
Make sure you keep note of how much OTC Sch 5 CDs you sell to people, as some people may be developing dependence.

81

How long should you keep invoices for orders coming into the pharmacy for?

Good practice to keep ALL invoices for 2 years, but this is NOT a legal requirement!
MDA requires invoices for Sch 3 & 5 to be kept for 2 years. So only for Sch 3: CD no register POM &
Sch 5: CD Inv POM or CD Inv P

82

When should a CD register be filled out? ✍

✍ to record details of any Schedule 1 or 2 CDs received or supplied by your pharmacy!! Only exception: Sativex 

83

What must be in Seperate sections of a CD register? ✍

Seperate sections for each drug class
Within each drug class section, need a Seperate page for each different strength and form of that drug
Eg you couldn't have morphine and diamorphine on the same page, these are different classes so need different sections of the book! ✍

84

What needs to be written at the top of the page in the CD register?

Class of drug, product name/brand, strength, form (we saw this in class)
This shows a Seperate page is also done for each brand
Basically use Seperate pages for everything!✍✍

85

In what order must entries go into the CD register?

Chronologically, In order of time when each is collected, if someone collects a CD earlier than expected, you still have to enter this into the CD register at that time.
Should always aim to make entries on the day of transaction, or next day if ran out of time.

86

What isn't allowed in the CD register?

No pencil!!, can only be ink or computerised. ✒✑
No crossing out, use [] and do footnote, date and sign change made

87

Remember both supplies and receipts (things received into pharmacy from eg wholesalers) must be kept in your CD register in chronological order✒

This is so you can maintain a running balance, ie look at the last entry and see how much you must have left now without having to count it all up! Makes life easier ☺

88

Running balances of the CD cabinet should be frequently checked. If any discrepancies crop up (ie missing CDs), who should be notified? Hint 3 different people can be notified 

Superintendent (police)
GPhC inspector 
Accountable officer/ controlled drug liason officer 
These should be notified of missing CDs

89

With computerised CD register entries, if you realise you entered something wrong, you can just easily change it whenever. Is this true or false?

False
Entries CANNOT be altered at a later date
Shouldn't really delete anything

90

What number do you need in your CD register entry? What code?

Prescribers ID number (their name too!)
Code of authorising document (prescription) so FP10CD for example.

91

If its a healthcare professional collecting a CD, what must be recorded?

Their name and address

92

If you receive an FP10PCD, for a schedule 2, what should be filled out?

A CD register - legal requirement
Good practice to also do a POM entry (should include POM ref no in CD register)

93

What must the SOP for your practice cover with regards to CDs?

Who has access
Where stored
Security in relation to storage and transport
Disposal & destruction
Who to alert if problem arises e.g. stock balance wrong
Record keeping re. register maintenance and Sch 2 returns by patients e.g. no longer needed

94

Accountable officers can inspect CD registers. Where can you find info on their role, suggested by the MEP?

Handbook of controlled drug accountable officers in England
A register of accountable officers in england is published on the Care Quality Commission website

95

Who can destroy CDs?

Usually a Liscence is needed, but pharmacists are exempt to this. They just need to register for this exemption with the Environment Agency.

96

What does the Home office recommend on disposal of CDs?

All CDs in Sch 2, 3, and 4 should be denatured and rendered "irretrievable" ie no way someone could use them again, before disposal.

97

How should CDs be destroyed?

It's recommended you use special kits to destroy the CDs

98

What happens with CDs returned to the pharmacy by patients who don't need them?

These should be destroyed, cannot be re-used!
Don't enter the return into your CD register as these will not contribute to your balance of usable CDs.
Must document returned CD and destruction in Seperate book, with a witness signing to show you have destroyed it.

99

What happens with out of date CD stock?

These need WITNESSED DESTRUCTION
Destruction needs to be witnessed by an 'authorised person'
Date of destruction and quantity destroyed must be recorded in the CD register and the authorised person must have signed.✍✍✍✍

100

Who are the "authorised persons" required to witness destruction of CDs?

Authorisation is derived from the home secretary including police chemist liason officers

102

Why is it bad practice to re-use CDs returned from patients or hospital wards to the pharmacy?

It's not recommended by the RPS and MHRA as you don't know what has happened to the CDs whilst they have left the pharmacy, Eg temperature, packaging, ingredients being tampered with..

103

What must ships do with CDs to be destroyed? 

They are not allowed to destroy the CDs, they must return them to a pharmacy to be destroyed

104

Can a policeman walk into your pharmacy and ask to see your CD register? 

No

105

What drugs can be given as opiate substitution for people dependent on eg amphetamine?

Methadone (Sch 2)
Buprenorphine (Sch 3- CD no reg) eg Subutex
Diamorphine (Sch 2, specialist prescribers)

106

What can be given for opiate withdrawal symptom relief?

Egs:
Mebeverine
Ibuprofen
Anti diahhoreals
Lofexidine
Note: these aren't part of the misuse of drugs act

107

A schedule 4 drug that can be given to people with alcohol dependence ?

Sch4 benzodiazepine


Also could give non MDA treatment: disulferam, acamprosate, naltrexone

108

How is the role of a pharmacist in drug dependence expanding?

They will supply prescriptions given by doctor to treat people dependent on drugs
Needle exchange 
Give appropriate advice with OTCs
Naloxone supply- an opiate antagonist
Hepatitis B vaccination
Hepatitis C and HIV screening
Pharmacist prescribers

109

What does Opiate substitution therapy drug dependency services involve in a pharmacy ?

Substituting an illicit drug with a legal drug
Most common: methadone or buprenorphine replacing heroin
These drugs both have longer half life than heroin, only needed once a day.

110

What is the purpose of instalment prescribing?

Try's to prevent leakage of medicine onto black market: people aren't allowed more than a certain amount.

111

What does supervised consumption with opiate substitution therapy entail?

The patient has to take the medication in the pharmacy under supervision, this ensures the medicine goes to the right person. (not a legal requirement)

112

Who can prescribe CDs to drug dependent people for treatment of organic diseases eg opiates for a broken leg, cancer?

Any doctor/ prescriber, as long as its for an organic disease, not for drug dependence....

113

Who can prescribe diamorphine, cocaine, dipipanone for addiction treatment?

Only prescribers that are on the DH list of doctors, covered by a direct liscence!!

114

Who can prescribe methadone (Sch2) and buprenorphine (Sch3) for dependence management?

Any Dr can prescribe these!
No need for a general Liscence

115

What can pharmacists and nurse independent prescriber prescribe in relation to CDs for addiction?

They can prescribe any CD for addiction, as long as its not diamorphine, cocaine or dipipanone!
Note: pharmacist and nurse IPs can't be added to the DH list

116

What kind of prescription form must instalment dispensing of CDs for addiction/ dependence be written on?

FP10MDA
It's a blue form
But you can only prescribe any schedule 2 CD, buprenorphine, and diazepam in instalments on FP10MDA
(can put other drugs on these forms, but not in instalments)

117

What's the maximum supply on FP10MDA forms for drug dependence if its not given in instalments? (instalments are where patient has to come in for it every day or so)

A maximum of 14 days supply on FP10MDA

118

Who pays dispensing fee for instalments of CDs given to drug dependent/ addicts?

NHS pays fee for each instalment

119

What are Repeat private prescriptions not allowed for? Which drugs CDs?

Schedule 3 or schedule 2 drugs
This is under the MDA
But can be prescribed in instalments on FP10PCD (note: this is for private dispensing of instalments, for NHS dispensing, you'd need FP10MDA for instalments

120

When must FP10MDA prescriptions for instalments of CDs be dispensed?

Must dispense first instalment within 28 days of date of signing, or if indicated, within 28 days of the appropriate date prescriber has specified on Rx (so in this case, not before this date)
There is NO LEGAL requirement for the start date of CDs in instalments to be specified, but if a dates stated you must stick to it.

121

What will be the standard requirements on the CD instalment prescription?

Name
Form
Strength
Total quantity (words and figures)
Directions

This is standard for all CDs

122

With instalments the quantity to be dispensed in each instalments needs to be stated, and the interval between each instalment too eg "every third day"

Legally you need the dose specified with instalment prescriptions, even if it's the same as the instalment amount, eg;
"90mls to be taken once a day, dispense 90mls daily"
Or "90mls to be taken once a day, dispense 630mls weekly"

123

Can instalments be requested on regular FP10 forms?

NO
Must be on FP10MDA forms or Private FP10PCD forms

124

The quantity of instalments to be dispensed to cover weekends/ bank holidays must be stated on the prescription, ie when the pharmacy is closed. What is the statement that can be written that will cover this?

Instalments due on days when pharmacy is closed should be dispensed on the day immediately prior(before) closure

125

Payments for pharmacies for instalment CD dispensing....

get paid cost of medicine
 get paid professional fee plus CD fee for Sch 2 or 3 CDs
 get 'item level fee' for methadone of £4.05 per Rx

126

If _ or more opiate doses in a row are missed, there may be a loss of tolerance to the prescribed dose. What happens if a patient misses this many doses?

3 doses
If this happens you should NOT dispense any more medication before referring to the prescriber for guidance.
(5 missed doses may require complete re-titration of dose

127

How long is supervised consumption recommended for?

First 3 months of treatment
Not legal requirement
Should always offer private consultation room for this
Prescriber decides if these needs to be done for patient or not, Rx will state "supervised consumption"

128

What about if the RX says consumed consumption, but the prescriber tells you it's ok for this not to occur one time?

You don't need to get the Rx ammended
Just document the discussion with the prescriber and reason, and give the CD to the patient without asking them to take it in the pharmacy.

129

When are "take away doses" recommended for patients taking instalments of CDs for their drug addiction/ dependence?

After stabilisation phase, usually 3 months
Go from supervised daily consumption -- daily take away dose --- then can increase length of instalments eg --weekly take away dose.

130

Can other people collect take away CD doses for drug addiction instalments on the patients behalf?

Yes, when take away doses are allowed (ie after supervised consumption phase)
Remember with Sch2 and Sch3 CDs you need to ask for ID
But it's recommended that patient gives person collecting a letter of permission to collect  keep these letters of permission

131

When should the CD register be filled out with people collecting installments?

Same rule applies as usual; Should be completed at point of collection (when CD leaves the CD cabinet) or as soon as possible afterwards, should be by next day.
Remember by law the CD register must be in chronological order. This could mean filling the register out every day for a patient collecting installments each day!

132

What is injection paraphernalia ? 

The equipment used in the injection of injected illicit drugs 
Needles should NOT be shared: pharmacys can therefore supply the following to prevent this and allow harm reduction;
Swabs, cookers, citric acid, filters, ascorbic acid.
Can also supply sterile water ampoules with needle exchange 

133

How long should invoices be kept for If a CD register entry is made?

Don't need to keep invoices if a CD register entry is made!
Remember we don't make entries for Sc5 or SC4 CDs so invoices for these would have to be kept for 2 years..

Decks in Pharmacy flashcards Class (52):