W6 Getting the right medicine to the right person l and ll Flashcards
(35 cards)
1
Q
What are Dispensing Doctors?
A
- Exception to the rules
- Certain rural areas with little to no CP to supply (controlled localities)
- GPs may apply to dispense NHS prescriptions
- No “prejudice” to existing service
2
Q
Which Overseas prescriptions can UK receive?
A
Switzerland & EEA (European Economic Area)
* Prescriptions and repeatable prescriptions issued by an approved health professional in an approved country are legally recognised in the UK
* 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
3
Q
What are the Switzerland & EEA prescription requirements?
A
- Patient’s full first name(s), surname and DATE OF BIRTH REQUIRED unlike UK
- 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)
- Name of the medicine (brand name where appropriate), pharmaceutical form, quantity, strength and dosage details
- Prescriber signature
- Date of issue (valid for up to six months)
- Even if the prescription requirements have been written in a foreign language the prescription is still legally acceptable. However, you will need to have enough information to enable the safe supply of medicines considering patient care and wellbeing.
- If it is not possible to confirm the registration status, then it may still be possible to make a safe and legal supply in the interests of patient care
- No obligation to supply if uncomfortable- although if patient is harmed then you could be questioned
4
Q
Which countries are part of the EEA? (for info)
A
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
5
Q
Private Prescriptions
What are the requirements? (7)
A
- Outside the NHS
- Patient is charged the cost of the item(s) plus a mark-up, and a fee levied by the pharmacist as payment for dispensing the item(s).
- Requirements:
- the patient’s details
- details of the medication to be supplied
- the signature of the prescriber
- the address of the prescriber
- an indication of the prescriber type
- an appropriate date.
- It is a legal requirement to record the sale or supply of all prescription-only medicines (POMs) not supplied via the NHS
6
Q
Repeat Prescriptions (NHS)
What is it labelled as so that you know it is a repeat?
How long is this prescription valid for?
A
- An authorising prescription will have ‘RA’ printed on it and will be signed by the doctor.
- This prescription is valid for up to one year
- The associated Repeat Dispensing issue forms will be marked ‘RD’ and are only valid for the period indicated on the repeat authorisation prescription.
- Pharmacist will keep the authorising form and the first repeat issue form after dispensing for the first time.
- Patient can look after the remaining repeat issue forms or pharmacist can store
7
Q
Repeat Prescriptions (Private)
A
- Written/printed statement on prescription. E.g. Repeat x 3
- In this example, the item may be supplied a total of four times
- the one original dispensing, followed by three repeats
- The first dispensing must take place within 6 months of the date on the 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)
- No time limit for remaining repeats, use professional judgement
- 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 the supply has been made and the date of supply
8
Q
Military Prescriptions
A
- Some military medical centres have outsourced the dispensing process to designated community pharmacies under a Ministry of Defence (MOD) contract
- Community pharmacies not covered by the contract will not routinely handle military prescriptions
- Military prescriptions are written on a military form FMed 296
- Pharmacies with a dispensing contract with the MOD will usually invoice the MOD directly
- For a non-contracted pharmacy, the prescription should be treated as a private prescription
- Therefore, charge the patient the appropriate fee
9
Q
Optometrist and Podiatrist Signed
Orders
A
- Certain POMs can be given directly to patients in accordance with a signed patient order from any registered optometrist or podiatrist.
- Must be medicine which can be legally sold or supplied by the practitioner
- Rather than one which they can only administer.
- Additional Supply Optometrists can issue signed patient orders for an extended range of medicines.
- The practitioner must provide sufficient advice to enable the patient to use the medicine safely and effectively.
- Pharmacists should ensure that the medicine is labelled accordingly as a dispensed medicinal product
- Appropriate record must be made in the POM register.
- Any additional counselling
10
Q
Patient Group Directions (PGDs)
A
- Written direction that allows the supply and/or administration of a specified medicine or medicines, by named authorised health professionals, to a well-defined group of patients requiring treatment for a specific condition.
- Advantage for patient care, without compromising patient safety?
- Only developed after careful consideration of all options
-including prescribing, by medical or nonmedical prescribers. - Prescription-only medicines supplied under a PGD should be labelled in the same way as if supplied against a prescription.
11
Q
Patient Specific Directions
What information is required?
A
- Not defined in legislation
- Traditional written instruction, signed by a prescriber
- To be supplied and/or administered to a named patient after assessment.
- The information required in a PSD at a minimum should include:
- Name of patient and/or other individual patient identifiers including age if a child
- Name, form and strength of medicine (generic or brand name where appropriate)
- Route of administration
- Dose
- Frequency
- Date of treatment/number of doses/frequency/date treatment ends as applicable.
- Signature of prescriber and date PSD written.
- There should, wherever possible, be separation of prescribing and supply/administration roles
12
Q
Supply of Medicines to Schools
A
- Schools can obtain supplies of adrenaline autoinjectors (AAIs) and/or salbutamol inhalers from a pharmacy on a signed order. These can then be administered in an emergency, by persons trained to administer them, to
pupils previously prescribed such medication and where parental consent has been received. - The number that can be obtained by individual schools is not specified in legislation.
- The signed order needs to be retained for two years from the date of supply or an entry made into the POM register.
13
Q
What are the School supply requirements? (6)
A
- Name of the school
- Product details (including spacer if relevant)
- Strength (if relevant)
- Purpose for which the product is required
- Total quantity required
- Signature of the principal or headteacher
- Ideally, appropriately headed paper should be used; however, this is not a legislative requirement
14
Q
Supply of Naloxone
A
- Supply of naloxone by individuals employed or engaged in the provision of recognised drug treatment services
- Human Medicines (Amendment) (No.3) Regulations 2015
- Under arrangements made by
- an NHS body
- a local authority
- Public Health England
- Public Health Agency
- Groups of people include:
- family members
- peers
- staff in regular contact with drug user
- This is a service that can continue to be provided by appropriately trained staff in the absence of the RP
15
Q
Wholesaling
Who is responsible for the overseeing of this?
A
The Medicines and Healthcare products Regulatory Authority (MHRA)
is the regulatory body with the responsibility for oversight and enforcement of the wholesale distribution of medicines.
16
Q
What are the Wholesaler Licence Requirements? (4)
A
- Anyone trading medicines, other than to a patient, is required to:
- Hold a wholesaler licence – wholesale distribution authorisation (WDA)
- Comply with the Good Distribution Practice (GDP) standards
- Responsible Person
- For example, trade to wholesalers, pharmacies, or other authorised or entitled to supply medicine
17
Q
WDA Exemptions
A
Pharmacies supplying stock to another pharmacy within the same
legal entity are not required to have a WDA.
* Where however, a legal entity does hold a WDA, the pharmacy
supplying the medicines for the purposes of wholesaling must be
named on the WDA.
* Medicines Act 1968
18
Q
Who can be supplied?
A
- Doctors
- Dentists
- Registered pharmacies
- Hospitals, clinics and independent medical agencies
- Midwives
- Chiropodists/Podiatrists
- Optometrists and Additional Supply Optometrists
- Paramedics
- Owner or Master of Ship
- Orthoptists
- First aid organisations
- Certified first aiders
- Working for National Lifeboat Institution
- Occupational health schemes
- Drug treatment services
- NHS Trusts
19
Q
Wholesaling and Medicine Shortages
A
- Measures are in place to minimise medicines shortages
- Limiting those medicines which can be traded or exported.
- Legal and ethical issues
20
Q
What are Serious Shortage Protocols?
A
- Serious Shortage Protocols (SSPs) in England, Wales and Northern Ireland enable pharmacists to make amendments to prescriptions and
supply alternative medicine to those in short supply. SSPs are specific to each home country
21
Q
Written requisitions
A
- Medicinal product required for use during the course of practice or business.
- This may not be for a named patient.
- For example, where a GP requests something for use during home visits or an optician requests a medicinal item for use during eye
examinations. - Sometimes known as a ‘signed order”
- somewhat misleading because, although most written requisitions are signed, they do not actually need to be signed to meet legal requirement
NOT considered wholesale distribution, as long as:
* The transaction takes place on an occasional basis
* The quantity of medicines supplied is small
* The supply is made on a not for profit basis
* The supply is not for onward wholesale distribution
22
Q
What are the requirements of Written requisitions? (5)
A
- No legally defined details as to the content required
- Local standard operating procedures (e.g. local NHS Trust policies or company SOPs) may require templates to be used.
- Recommended details include:
- Date
- Name, quantity and, where it is not apparent, formulation and strength
- Name and address, trade, business or profession of the person
- Purpose for which it was sold or supplied.
- Signature of prescribe
23
Q
Written requisitions supply
What are the requirements? (3)
A
- Only complete packs (including PILs) can be supplied
- No need to label the medication
- Good practice to make an entry in the POM register at the time of supply
- Requisition is retained within the pharmacy for 2 years from the date of supply
24
Q
Optometrist and Podiatrist Signed
Orders:
A
- Certain POMs can be given directly to patients in accordance with a signed patient order from any registered optometrist or podiatrist.
- Must be medicine which can be legally sold or supplied by the practitioner
- Rather than one which they can only administer.
- Additional Supply Optometrists can issue signed patient orders for an extended range of medicines.
- The practitioner must provide sufficient advice to enable the patient to use the medicine safely and effectively.
- Pharmacist should ensure that the medicine is labelled accordingly as a dispensed medicinal product
- Appropriate record must be made in the POM register.
- Any additional counselling
25
What is an Emergency Supply?
Who can request it?
In an emergency, a pharmacist working in a registered pharmacy can supply POMs to a patient without a prescription on the request of:
* a 'relevant prescriber’
* a patient
e.g. Not ordered meds in time and GP practice is closed
Gone on holiday and left presciption at home
26
Emergency Supply at the Request of a
Prescriber
What needs to be known/done? (6)
* Relevant prescriber (why cant they supply/prescribe?)
* Emergency (reasoning)
* Prescription must arrive within 72 hours (longer than this is breach of emergency supply)
* Directions
* Record kept (for audit trail)
* Correctly labelled
27
Emergency Supply at the Request of a
Patient:
What must be done?
* MUST interview the patient
* Immediate need AND not practical for the patient to obtain a prescription
* Previous treatment prescribed by a UK, EEA or Swiss health professional
* The pharmacist must be satisfied of knowing the dose that the patient needs to take
= Refer to the PMR, electronic health record, prescription repeat slip, labelled medicine box, etc.
* May supply of up to 30 days' treatment, with these exceptions:
=Insulin, an ointment, a cream or an asthma inhaler – only the smallest pack size
=The contraceptive pill – only enough for a full treatment cycle
=Liquid oral antibiotics – only the
smallest quantity to provide a full course of treatment
28
Records for Emergency supply:
* Records must include information on the nature of the emergency, such as why the patient needs the POM and why a prescription cannot be obtained, etc.
* In addition to standard labelling requirements, the words ‘Emergency supply’ need to be added to the dispensing label.
29
Whatc can be viewed on 'Choose Pharmacy?' (4)
* The EMS module enables you to access relevant medicines information from the Welsh GP Record.
* The following information can be viewed:
* Allergies
* Repeat medication prescribed
* Acute medication prescribed
* Medication that has been discontinued
30
Faxed Prescriptions
* 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.
* 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
31
Prescribing & Dispensing to the Same
Person
* Should remain separate functions
* Patient safety is improved by a second healthcare professional check
* If it is in the interests of the patient, good practice to:
-Ensure processes are in place to limit errors
i.e. taking a break or implementing additional checks
* Maintain an audit trail
* Document reasons
32
Dispensing self-prescribed prescriptions and prescriptions for close friends and family:
Two options in supplying?
* A prescription may fulfil the usual legal requirements
1. Exceptional circumstances
-Life saving (no other option)
2. Refusing to supply
-clearly and calmly explain that in your professional judgement it would not be appropriate to supply the medicine
33
Recording supplies:
Dispensing of which medications should be recorded and where?
* Records of medication supply are made in the prescription-only medicine (POM) register in the following instances:
-medication supply via a non-NHS (private) prescription
-supply of medication via a written requisition
-emergency supply of medication at the request of a practitioner
-emergency supply of POM at the request of a patient.
* Prescriptions for oral contraceptives are exempt from record keeping
34
POM Register
What must this record include? (7)
* Records must be made in the POM register (written or electronically), which should be retained at the premises to which it relates for two years from the date of the last entry in the register.
* The record must include:
* Supply date
* Prescription date
* Name, quantity, formulation and strength of medicine supplied
* Prescriber details (name & address)
* Patient details (name & address)
* Additional details (e.g., reason for supply)
* 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
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