Law And Ethics 1-5

Front 1

Why some medicines can be classified under more thanone category?

Back 1

depending upon formulation, quantity, strength, indication and marketing authorization

Hint 1

GLS/P/POM

Front 2

How many different types of “appropriateprescribers” of POM are there?

Back 2

13

-Doctor (GMC)

- Dentist (On the dental register – GDC)

- Supplementary prescriber

- Nurse independent prescriber

- Pharmacist independent prescriber

- EEA and Swiss doctors and dentists*

- EEA and Swiss prescribing pharmacists andnurses where they exist*

- Community practitioner nurse prescriber

- Optometrist independent prescribers**

Since August 2013

- Podiatrist independent prescribers*** - Physiotherapist independent prescribers***

Front 3

Is stating a total quantity of each drug legal requirement?

Back 3

NO

It is a good practice

Hint 3

for normal prescriptions i.e. not CD

Front 4

Is it possible to have multiple dispensing for one private prescription?

Back 4

Yes

Private prescriptions can be repeated as indicated by theprescriber (e.g. repeat x 3)

Front 5

Is NHS prescription repeatable?

Back 5

NO

Front 6

Is there any requirement for dispensing from a repeatable prescription?

Back 6

the first dispensingmust be made within six months of the appropriate date,following which there is no legal time limit for the remainingrepeats.

Hint 6

Can we dispense any time?

Front 7

What is the only exceptional drug that can be dispensed from a private prescription which is not stated as repeatable?

Back 7

oral contraceptive, which can be dispensed sixtimes (i.e. repeated five times) within six monthsof the appropriate date.

Front 8

What are the exceptional occasions for NOT making a POM record?

Back 8

(i) Supply is on NHS script

(ii) Any script for an Oral Contraceptive

(iii) A separate record is made in the Controlled Drugs Register ieschedule 2 controlled drugs

(iiii) Sale or supply is by wholesale dealing for a professionalperson and the signed order or invoice relating to the sale isretained for 2 years

Front 9

Is POM record a private record?

Back 9

yes

POM Book= POM Register = Private prescriptionbook

Front 10

How long does a private record need to be kept?

Back 10

2 years

Front 11

What do you need to add on a private prescription and labels when dispensing?

Back 11

The private record references;

BOOK / Page/ Column

Both on the prescription itself and the labels on the medicines

Front 12

A pharmacist working in a registered pharmacycan supply a POM to a patient under certainconditions, in an emergency when...?

Back 12

Under Patient’s request and prescriber’s request

Front 13

At the request of a prescriber, you can supply POMs in emergency but the prescriber needs to agree to furnish a written prescription within...?

Back 13

72 hours

Front 14

Under a request from UK prescriber,

does emergency supply cover Controlled Drugs?

Back 14

CD Schedule 1, 2 and 3 CANNOT be supplied except phenobarbital for epilepsy

Front 15

Under a request from EEA/Swiss doctors or dentists, does emergency supply cover all Controlled Drugs?

Back 15

NO,

CD schedule 1,2 and 3 cannot be supplied with NO exception

Front 16

Do you need to write a POM record for emergency supply?

Back 16

Yes, with in 24 hours after supplying

You need to add the date on prescription (can be added once prescription received) and the date on which prescription received (added once prescriptionreceived)

You need to add the nature of emergency (• Why patient needs POM immediately• Why a prescription cannot be obtained) for the request of a patient

Front 17

For the emergency supply,

what are the main differences between a request of a patient and a prescriber?

Back 17

At the request of a patient, a pharmacist need to

1. interview; a patient with RPS guidance (professional judgement)

2. dose; must be identified

3. labeling; add "Emergency Supply" on a dispensing label

Front 18

At a request of a patient, does the emergency supply cover all POM and CDs?

Back 18

POMs must be previously prescribed from appropriate prescribers.

CD schedule 1,2 and 3 are not allowed except phenobarbital for epilepsy

Front 19

For Emergency supply, what is the length of treatment for POM?

Back 19

@ POM = ≤ 30 days treatment

@ Insulin, ointment, cream, inhaler (i.e. Packs cannot bebroken) = give smallest pack available in the pharmacy

@ Oral contraceptive = give ONE full treatment cycle

@Antibiotic in oral liquid form = give smallest quantity thatprovides a full course of treatment

Front 20

For Emergency supply, what is the length of treatment for CDs?

Back 20

For CD schedule 4,5 and phenobarbital,

max 5 days of treatment

Front 21

Under your ethical and professional judgement, you may refuse to supply in emergency.

What do you advice to a patient?

Back 21

Advise patient on how to obtain a prescriptionfor the medicine or appropriate medical care

Referral to doctor

NHS walk-in centre

Family planning clinic

A&E department

Front 22

Under a request of a patient, you do not need to interview a patient at when?

Back 22

Legislation in place that relaxes emergency supplyrequirements in event of pandemic or imminentpandemic declared by DoH.

E.g. Swine flu (Tamiflu®)

Front 23

Emergency supply from a patient request:

Does interview to a patient HAVE TO be face to face?

Back 23

Preferably face to face, but also accept a telephone interview if not possible

Front 24

When making a POM record for emergency supply from a prescriber's request, is the date on the prescription when you receive it LEGALLY required?

Back 24

Yes

Front 25

Is the pharmacy's name and address LEGALLY required for the POM record under the emergency supply?

Back 25

NO

Front 26

Is stating "the nature of the emergency" LEGALLY required for POM record under emergency supply from a prescriber's request?

Back 26

NO.

Only required from a patient's request

Front 27

Is stating "the purpose of medicine" LEGALLY required for POM record under emergency supply?

Back 27

NO for both patient and prescriber's request

Front 28

Maintaining clear sexual boundaries is set by...?

Back 28

GPhC guidance

(General Pharmaceutical Council)

Front 29

What is schedule 1 CD?

What is it called?

Back 29

CD Lic POM

No real uses. Licence reqLSD, ecstasy, cannabis

Front 30

What is schedule 2 CD called?

what are the examples?

Are they dispensed commonly?

Back 30

CD POM

Yes it is common.

Morphine,methadone, diamorphine

Front 31

Does registration required for schedule 2 drugs?

Back 31

Yes, register required

Front 32

What are schedule 3 CD?

Back 32

Buprenorphine,temazepam, phenobarbital

Front 33

Does registration required for schedule 3 CD?

Back 33

No

Front 34

What are the sub sections for schedule 4 CDs?

Back 34

CD Benz POM and

CD Anab POM

Front 35

What are the examples of schedule 4 CD?

Back 35

BenzodiazepinesAnabolic and AndrogenicSteroids

Front 36

What are anabolic and androgenic steroids?

Back 36

They are synthetic substances related to the male sex hormones (androgens.) The anabolic effects of the drugs promote the growth of skeletal muscle, and the androgenic effects promote the development of male sexual characteristics.

Front 37

What are schedule 5 CDs?

Back 37

Codeine, Pholcodeine,morphine – low strengths

Front 38

What is special about schedule 5 CDs?

Back 38

some can be in P meds incombination

Front 39

Schedule 2 and 3 prescription:

What is the valid dates from appropriate date?

Back 39

28 days

Front 40

Schedule 2 and 3 prescription:

Can a patient with address which is out side UK get CDs?

Back 40

No

address must be in UK

Front 41

Schedule 2 and 3 prescription:

Is stating formulation for CD LEGALLY required?

Back 41

yes

Front 42

Schedule 2 and 3 prescription:

Is stating strength LEGALLY required for CDs?

Back 42

Only if there are more than ONE strength available

Front 43

Schedule 2 and 3 prescription:

What is the legal requirement for stating quantity for CDs?

Back 43

Written in BOTH figures and words

2 packs of 30 tabs – two packs of thirty tablets

Front 44

Schedule 2 and 3 prescription:

what is the maximum length of treatment?

Back 44

Guidance DoH supply not exceed 30 days treatment

Front 45

Can a dentist prescribe schedule 2 and 3 CDs?

Back 45

Yes,

prescription must be written

"for dental treatment only"

Front 46

What is the form of private prescription for schedule 2 and 3 CDs?

What colour is that?

Back 46

FP10PCD

pink

Front 47

What is the additional requirement for the prescriber in order to prescribe schedule 2 and 3?

Back 47

stating Prescriber identification number on script (not GMC number)

Front 48

Is repeating allowed for schedule 2 and 3 CDs?

Back 48

NO

Front 49

What is the role of pharmacy after collecting "dispensed FP10PCD"?

Back 49

Original scripts sent off with rest of NHS scripts at endof month to NHS BSA

Front 50

Is a pharmacist allowed to amend Minor spelling mistakes for CD prescription?

Back 50

Yes

Front 51

The CD prescription:

the quantity is written in figures but not with words.

Can a pharmacist amend it?

Back 51

Yes

but not BOTH

Front 52

What dose a pharmacist need to state in order to amend a CD prescription?

Back 52

Made in ink

Name of Pharmacist, date, signature and GPhCregistration number

Front 53

Can Pharmacists add the dose if missing?

Back 53

NO

Front 54

If a script for MST continus has 20 written for itsstrength can the Pharmacist add the “mg”?

Back 54

NO

Front 55

If a script says “Methadene” can the Pharmacistchange it?

Back 55

YES

Front 56

What are requirements for making Controlled Drug Records?

Back 56

Need to record both when CD is supplied and dispensed.

It must be

Entered chronologically Entered promptly within 24 hr

Ink or indelible

Unaltered

Front 57

What should you do if you make a mistakewhen writing a CD register entry?

Back 57

Note at foot of page or in the margin with * or ()

“Should read………”

Show who is responsible:

+Name of person making the amendments

+initials or signature

+ GPhC number

+ date of amend

Front 58

What are the 7 legal components that need to be stated on CD registers for "supply"?

Back 58

1.Date supplied

2. Name and address of person supplied

3. Details of authority to posses i.e. prescriber detail

4.Person collecting

5.Was ID asked for?

6. Was ID provided ? (what)

7. Quantity supplied– Update balance

Front 59

What are 4 legal components that need to be stated on CD register for "receipt"?

Back 59

1.Date supply received

2.Name and Address of “from whom received” (supplier info)

3.Quantity received

4.Update the running balance

Front 60

What does a pharmacist need to ask in order to hand in the medication to the patient or the representative?

Back 60

Sign the back of prescription to Confirm collection

Proof of ID (Schedule 2)

However, it is Pharmacist’s discretion whether to supply without it

Front 61

What is the form of prescription for treatment of addiction in UK?

Back 61

FP10MDA light blue, double sides

Front 62

FP10MDA

What is the maximum treatment period for installments?

Back 62

14 days

Front 63

What does a prescriber need to specify on the prescription FP10MDA?

Back 63

No of instalments

How much to dispense at each instalment

Interval between instalments

Front 64

1st instalment must be within ...days after the date of prescription

Back 64

28 days

Front 65

Can a pharmacist supply double the amount if a patient misses the dose?

Back 65

NO

Front 66

Can a pharmacist provide extra methadone doses while a pharmacy is closed? I.e. weekends and bank holidays

Back 66

You can only do that as indicated on prescription.

Call prescriber to add the information about installment.

Need to dispense daily doses in separate containers

Front 67

who can collect the CDs?

Back 67

• Patient• Patient’s representative• Healthcare professional acting on behalf of thepatient in their professional capacity

Front 68

what can you to confirm that the patient has already collected the CD prescription?

Back 68

- Ask the person to sing at the back of the prescription

- good practice to ask individual to sing to confirm that CD has been collected from pharmacy

- person can refuse, but a pharmacist must use discretion on whether or not to supply CDs

Front 69

When person comes to pharmacy to collect CD, what can you do to check their identity?

Back 69

It is legal requirement to find out who is collecting.

- if patient ask for ID (if the patient comes to collect many times from your pharmacy, you may use your judgement whether or not to ask for ID)

- patient's representative, then ask for ID
- Health care professional, must obtain the name and address and must ask for proof of ID unless already known to pharmacist

- pharmacist discretion whether to supply ID

IDs; driving license, card detail, passport...

Front 70

For schedule 2 CDs:pharmacists are LEGALLYREQUIRED to determinewhether the personcollecting is the patient, ortheir representative orhealthcare representative

Back 70

yes

Front 71

Pharmacists CANNOTgive out CDs to apatient’s healthcareprofessional collectingon their behalf if theyhave no ID available

Back 71

false

Front 72

What about collection of a CD by arepresentative of a drug misuse patient?

Back 72

• Pharmacists should obtain a letter from the patientauthorising and naming the representative

– Friend/relative, often if patient is unwell

– If in police custody, a letter of authorisation allowing thepolice custody officer to collect on their behalf

• Note: a separate letter should be presentedeverytime the representative collects

• The representative should bring ID with them

• Good practice: pharmacist insists on seeingpatient at least once a week

Front 73

What about collection of a CD by arepresentative of a drug misuse patient?

And when the patient is under the supervised dose?

Back 73

• If the medication is prescribed to be a supervised dose, the pharmacist should contact the prescriber before supplying to the representative (as supervision is not possible without patient there)

• Pharmacists should make records of such conversations.

• It is legally acceptable to verbally confirm thisarrangement with the prescriber as supervisionis not a legal requirement under the 2001regulations.

Front 74

CD collection:

If the prescription is installment prescription, how many times is it needed to be signed?

Back 74

 Instalment prescriptions only need to be signedONCE

Front 75

CD collection:

If the CD is sent to the patient by delivery, how do you confirm successful delivery?

Back 75

A representative, including a delivery driver, cansign on behalf of the patient.

a robustaudit trail should be available, confirmingsuccessful delivery of the CD to the patient (e.g.implementing an SOP which requires the patientto sign a form on receipt of the CD)

Front 76

what are the minimum standards for safe custody for CD?

Back 76

It is derived from safe custody regulations that Requires that pharmacies, private hospitals, andcare homes keep relevant CDs in a ‘locked safe,cabinet or room which is constructed as to preventunauthorised access to the drugs’

Front 77

what kinds of CD must be kept under safe custody?

Back 77

– Schedule 1 drugs

– Schedule 2 drugs except quinalbarbitone (secobarbital)

– Schedule 3 drugs unless exempted under the Misuse ofDrugs (Safe Custody) Regulations 1973 as amended *Common exemptions inc. phenobarbital and pentazocine

* Common Schedule 3 CDs requiring safe custody inc. temazepam and buprenorphine

Front 78

What do you need to do when CDs requiring safe custody are not in the CD cupboard?

Back 78

When CDs requiring safe custody are not in theCD cupboard (e.g. during the dispensing process)they must be under ‘direct personal supervision’ ofthe pharmacist

Front 79

What do you need to do in order to handle a CD key?

Back 79

Access to CDs, including the handling of CD keys,should be restricted and documented. Incommunity pharmacy it is common for thepharmacist to keep the CD keys on their personat all times

• A key log should be used to keep an audit trail ofwho has had access to keys; including overnightstorage in the pharmacy, transfer of keys from onepharmacist at the end of shift to another, etc.

Front 80

Safe custody: what about patient-returned,out-of-date, and obsolete CDs?

Back 80

- safe custody still applies to these drugs until they can be destroyed

- To minimise the risk of accidentally supplyingthese CDs to patients, this stock should besegregated from pharmacy stock and clearlymarked (e.g. in a bag labelled ‘patient returnsawaiting destruction’ or ‘expired CDs awaitingdestruction’)

Front 81

what is the drug driving legislation updated march 2015?

Back 81

- it is now offence to be caught driving with certain drugs in excess of specified levels

- Patient’s who have been prescribed orare taking specified drugs for legitimatemedical reasons should keep somesuitable evidence with them (E.g. repeat prescription slip for aprescribed medicine or the patientinformation leaflet for a P or GSLmedicine.)

Front 82

what are the two groups of specified drugs that are concerned under driving?

Back 82

1st group: commonly abused drugs

2nd group: licensed medicines that are likely to be abused

Front 83

Give examples of 2nd group of specified drugs

Back 83

- clonazepam

- methadone

- morphine

- temazepam

- diazepam

- lorazepam

- flunitrazepam

- oxazepam

- amphetamine

Front 84

Is dihydrocodein considered as 2nd group?

Back 84

not sure

depends on the concentration (if too high that causes driving impaired, then offensive)

Front 85

Is codeine considered as 2nd group?

Back 85

not sure

depends on the concentration (if too high that causes driving impaired, then offensive)

Front 86

What can you advice to patient if he/she is taking 2nd group drugs?

Back 86

• Pharmacist must counsel affected patientseffectively

• C and A label 2

• Greater awareness that it could affected drivingability or slow thinking or sight problems etc

• Find out how it affects you first

• Issues with interactions to be raised

• Avoidance of alcohol concurrent with medicines

• Not taking your medicines could also affect drivingability

• Pharmacist must counsel on importance ofcarrying evidence that you are taking medicinesas prescribed or supplied

• Patients made aware of the general issue

• Evidence e.g. repeat prescription slip, PIL etc.

• If they feel impaired … don’t drive !