MEP: Professional and legal issues: prescription-only medicines Flashcards
Name the 7 prescription requirements
- Signature of prescriber
- Address of the appropriate practitioner
- Date (must be within 6 months). For private prescriptions, the appropriate date will always be the date on which it was signed
- Particulars
- Name of the patient
- Address of the patient
- Age of the patient if under 12
What is an advanced electronic signature?
An advanced electronic signature is a signature that is linked uniquely to the signatory, capable of identifying the signatory and created using means over which the signatory can maintain sole control (Regulation 219(5) Human Medicines Regulations 2012).
What is the law around prescriptions written in welsh?
Medicines legislation describes the requirements which need to be on a legally valid prescription. Language is not specified. There is currently no law or act that specifies that prescriptions in Wales have to be bilingual.
If the pharmacist is not a Welsh speaker and can’t understand the prescription, the RPS advice is to put patient safety first.
What do you do if you receive PRESCRIPTIONS FROM THE CROWN DEPENDENCIES (JERSEY,GUERNSEY
AND ISLE OF MAN)?
You should be satisfied that all prescription requirements (Diagram 13, section 3.3.1) are present for the prescription to be legally valid. Please note: Prescriptions for Schedule 2 and
3 CDs, the prescriber’s address must be within the UK
A report published by the GMC regulation in Crown Dependencies and other overseas territories www.gmc-uk.org advises the following: “Crown Dependencies such as the Channel Islands and Isle of Man are not part of the UK. We have nevertheless established agreements with those territories to facilitate the revalidation of doctors within their jurisdiction using local system.” Therefore, doctors from Crown Dependencies are expected to be registered with GMC.
What are the different colour scripts and who are they for? (green)
Green: FP10SS GP Community Practitioner Nurse Prescriber Nurse Independent/Supplementary Prescriber Independent Prescribers Supplementary Prescribers Hospital Unit
What are the different colour scripts and who are they for? (BLUE)
Instalment: GP Nurse Independent/Supplementary Prescriber Independent Prescribers Supplementary Prescribers Hospital Unit
What are the different colour scripts and who are they for? (YELLOW)
Dentist
What are the different colour scripts and who are they for? (Lilac)
Community Practitioner Nurse Prescriber
Nurse Independent/Supplementary Prescriber
Out of Hours (OOH) Centre prescribers
What are the different colour scripts and who are they for? (White)
CD requisition form
What are the different colour scripts and who are they for? (Pink)
Prescribers of Schedule 2 and 3 controlled drugs prescribed in the private sector where prescriptions are dispensed by community pharmacy
What are ‘repeatable prescriptions’?
Repeatable prescriptions are private prescriptions which contain a direction that they can be dispensed more than once e.g. “repeat x 5”.
What to do if no number stated on a repeatable prescription?
If a number is not stated, they can only be repeated once (dispensed twice) unless the prescription is for an oral contraceptive in which case it can be repeated five times (dispensed six times in total)
Are prescriptions for CD SCH 2 + 3 repeatable?
Prescriptions for Schedule 2 and 3 CDs are not repeatable; however, those for Schedule 4 and 5 are repeatable
How long do you have to make first dispensing of repeatable script?
The first dispensing must be made within six months of the appropriate date, following which there is no legal time limit for the remaining repeats
While there is no time limit for remaining repeats, pharmacists should use professional judgement, taking into consideration clinical factors,
to determine whether further repeat dispensing is appropriate
If the prescription is for a Schedule 4 CD, the first dispensing must be made within ___ days
28 (of the appropriate date, following which there is no time limit for remaining repeats)
Can repeatable prescriptions be dispensed from different pharmacies?
The patient can choose to have repeats dispensed from different pharmacies and can retain the prescription. To maintain an audit trail mark on the prescription the name and address of the pharmacy from where supply has been made and the date of supply.
Are FP10 forms used for Prisons and other residential custodial secure environments?
No - a customised prescription form, generated by the clinical IT system, is used instead, however these are still considered a NHS prescription.
FP10s are available in these settings but are only used to access urgent medicines (e.g. out of hours) or are supplied to a released person to access medicines that couldn’t be supplied to them
on release. Therefore the NHS repeat dispensing scheme using FP10s or EPS cannot be used.
The word ‘repeat’ is also used in various contexts in relation to prescribing and dispensing: Aside from repeatable, what else is there?
Repeat slips
- These are not prescriptions, themselves, but a list of medications which patients can use to reorder their regular medication.
Instalment prescriptions
- These provide for a single prescription for
a CD to be dispensed in several instalments
NHS repeat dispensing service
- Where the prescriber authorises a prescription with a specified number of ‘batch’ issues that may be dispensed at specified intervals from a pharmacy (England and Wales only).
Does the NHS repeat dispensing service apply to Scotland?
(England and Wales only).
What is the validity of an owing for POMs and CDs Schedule 5?
Six months from the appropriate date
What is the validity of an owing for P and General Sale Medicines?
Six months from the appropriate date
What is the validity of an owing for schedule 2, 3 and 4 CD’s
28 days after the appropriate date
How long should a private prescription for a POM be retained for and what register would they go in?
Private prescriptions for a POM must be retained for two years from the date of the sale or supply (or for repeatable prescriptions from the date of the last sale or supply)
Records must be made in the POM register (written or electronically), which should be retained for two years from the date of the last entry in the register.
What must the POM record include?
• Supply date
The date on which the medicine was sold or supplied
• Prescription date
The date on the prescription
• Medicine details
The name, quantity, formulation and strength of medicine supplied (where not apparent from the name)
• Prescriber details
The name and address of the practitioner
• Patient details
The name and address of the patient.
When must the record for a POM be made?
The record should be made on the day the sale or supply takes place or if that is not practical, on the next day following.
Are records for oral contraceptives necessary?
Prescriptions for oral contraceptives are exempt from record keeping
If a CD entry for a schedule 2 CD has been made, does it need to go in the POM register?
No
Are strength, form, quantity and dose legal requirements for POM prescriptions?
NO
PRESCRIPTIONS FOR DISCHARGED PRISONERS: What details would go on an FP10? (note, FP10’s are only used in special circumstances)
These FP10 forms have the name and address of the prison printed on them and the patient is exempt from payment by virtue of having HMP in the address.
When prescribing on an NHS dental prescription, dentists are restricted to the medicines listed in the Dental Prescribers’ Formulary. True or false?
True
Is a faxed prescription legally valid?
A fax of a prescription does not fall within the definition of a legally valid prescription within human medicines legislation because it is not written in indelible ink and has not been signed in ink by an appropriate practitioner.
Supplying medicines against a fax is associated with considerable risks:
1) Uncertainty that the supply has been made in accordance with a legally valid prescription
2) Risks of poor reproduction
3) Risks of non-receipt of the original prescription and therefore inability to demonstrate that a supply had been made in accordance with a prescription
4) Risks that the original prescription is subsequently amended by the prescriber in which case the supply would not have been made in accordance with the prescription
5) Risks the fax is sent to multiple pharmacies and duplicate supplies are made.
6) Risks that the prescription is not genuine
7) Risks that the system of sending and receiving of the fax is not secure
What must you do if you decide to dispense a faxed prescription?
Pharmacists considering supplying medicines against a fax should make an informed decision and take steps to safeguard patient safety, and where possible mitigate the risks identified above.
Where appropriate, you should consider making a record of the decision-making process and your reasons leading to a particular course of action. The supply of Schedule 2 and 3 CDs without possession of a lawful prescription could be prosecuted as a criminal offence.
The following checklist may be useful to help detect fraudulent prescriptions and prompt further investigation:
- Is a large or excessive quantity prescribed and is this appropriate for the medicine and condition being treated?
- Is the prescriber known?
- Is the patient known?
- Has the title ‘Dr’ been inserted before the signature?
- Is the behaviour of the patient indicative? (e.g. nervous, agitated, aggressive, etc.)
- Is the medicine known to be commonly misused?
Who would you report concerns to about a forged prescription?
use your professional judgement
to assess whether or not it is a matter that requires referral to the police, NHS Counter Fraud Services (for NHS prescriptions only) or whether the matter can be resolved by discussions with the patient and prescriber.
PRESCRIPTIONS FROM THE EEA OR SWITZERLAND: Are they legally recognised?
Prescriptions and repeatable prescriptions issued by an approved health professional in an approved country are legally recognised in the UK. Emergency supplies for patients of these healthcare professionals are also permitted.
Approved health professionals include doctors
and dentists as well as other professions with prescribing rights i.e. chiropodists or podiatrists, nurses (including community nurses), optometrists, paramedics, pharmacists, physiotherapists and therapeutic radiographers.
Approved countries comprise EEA countries and Switzerland:
Austria, Belgium, Bulgaria, Croatia, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Republic
of Ireland, Italy, Latvia, Liechtenstein, Lithuania, Luxembourg, Malta, The Netherlands, Norway, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden, Switzerland.
If the prescription originates from a country
or prescriber not on the approved list, what should you do?
If the prescription originates from a country or prescriber not on the approved list the prescription is not valid and you should use your professional judgement (e.g. refer to local GP), in finding the best way to help the patient.
PRESCRIPTION REQUIREMENTS
What details are required on a prescription from an approved health professional from an approved country:
Patient details
Patient’s full first name(s), surname and date of birth
Prescriber details
Prescriber’s full first name(s), surname, professional qualifications, direct contact details including email address and telephone or fax number (with international prefix), work address (including the country they work in)
Prescribed medicine details
Name of the medicine (brand name where appropriate), pharmaceutical form, quantity, strength and dosage details
Prescriber signature
Date of issue
Prescriptions are valid for up to six months from the appropriate date (prescriptions for Schedule 4 CDs 28 days). For prescriptions from these countries the appropriate date is the date on which the prescription was signed.
Even if the prescription requirements have been written in a foreign language the prescription is still legally acceptable.
How do you go about confirming registration status of the approved EEA and Switzerland HCP’s?
An international database of prescribers does not exist and, indeed, not all of the approved countries have a register of practitioners or online registers in English. Therefore, it may not always be possible to check the registration of approved health professionals.
Up-to-date contact details for EEA competent authorities to check registration details of doctors and dentists can be obtained from:
• Doctors –> General Medical Council (GMC) www.gmc-uk.org
• Dentists –> General Dental Council (GDC) www.gdc-uk.org
(search for ‘List of EEA competent authorities’)
You can search regulated professions and competent authorities in the approved countries on the European Commission website
