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115 Cards in this Set
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Name Laws and Regulations Relating to Dispensing |
Medicines Act 1968 Human Medicines Regulations 2012 Misuse of Drugs Act 1971 Misuse of Drugs Regulations Poisons Act 1972 Equality Act 2010 Data Protection Act 2018 and General Data Protection Regulations (GDPR) |
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What is the Medicines, Ethics and Practice (MEP)? |
The MEP is published annually as a practical guide to the legal restrictions on the sale or supply of medicines and poisons. It gives guidance on law and ethics in pharmacy, including legal requirements for prescriptions and record-keeping, as well as the GPhC standards for pharmacy professionals (it used to be called the code of ethics). Paper copies of the MEP are issued to members of the Royal Pharmaceutical Society (RPS) and they can also access it online. Note that only pharmacists are members so you should ask a workplace pharmacist if you may view theirs. Non-members may also purchase paper copies. |
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Give examples of people/organisations who may receive medicines supplied by wholesale. |
Healthcare Professionals (doctors, dentists, midwives, chiropodists, optometrists, pharmacists, paramedics) Owner/master of a ship Independent hospitals/clinics/medical agencies Royal National Lifeboat Institution & their certified first aiders First aid organisations e.g. The Red Cross Occupational health schemes Offshore installations Her Majesty's Armed Forces |
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Name the Prescription Information Checklist |
legal requirements information required on the prescription quantity of stock available prescription payments (if applicable) handling common problems with prescriptions |
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Explain the Electronic Prescriptions system. |
It is becoming more common for dispensaries to receive prescriptions electronically. You will not be facing the patients or their representatives when receiving the prescription, but you must remember to protect patient confidentiality. The generic term for this service is the Electronic Transfer of Prescriptions (ETP), with the NHS Electronic Prescription Service (EPS) being one of the main forms of ETP used. Electronic prescription systems are usually password-protected to only allow authorised individuals to access the system. It may require access by individual password-protected smartcards, such as the NHS Smartcard to access the NHS Electronic Prescription Service (EPS). This can also leave a record on the system to show who has accessed the system and the actions that were performed. This is known as an audit trail. Community pharmacies may receive prescriptions electronically from GP practices, for example, via the NHS EPS. Hospital pharmacies and dispensing practices may use internal electronic systems to send electronic prescriptions from the prescriber to the dispensary. The processes vary depending on your workplace. |
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Explain the prescription process for Hospital Inpatients and Discharges. |
In hospital pharmacies, you will receive prescriptions for inpatients, to-take-out (TTO) medicines for patients being discharged, as well as outpatient prescriptions. The outpatient pharmacies tend to have a similar process for receiving prescriptions as the walk-in and electronic prescription flowcharts in the previous sections. For inpatients and discharges, the processes will be different. Here is an example of how prescriptions may be received in these situations. 1. A medicine is prescribed on the ward for an inpatient or for a patient being discharged from the hospital electroncially/on a paper drug chart/on a discharge note 2. The pharmacist will check if it's valid and clinically screen it to authorise the supply 3. The prescription is sent to the dispensary to be downloaded (electronically) or a paper copy is taken 4. The prescription is printed/placed in the dispensary ready for dispensing |
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Who can prescribe medicines? |
Not only doctors can prescribe medicines. Other healthcare professionals with appropriate qualifications can prescribe them too. Certain qualified healthcare professionals can prescribe treatments for patients under their care. Some professionals may require further training after their initial qualification to be able to prescribe treatments. There may be restrictions on what can be prescribed depending on the type of prescriber, some may be restricted to a formulary. Doctors, dentists and veterinary surgeons do not need to undertake any further training to be independent prescribers. They can prescribe for any clinical condition but must only prescribe within their clinical and professional competence. |
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What is a formulary? |
A formulary is a list of items which are permitted to be prescribed in certain circumstances. Different professionals have different formularies; the medicines permitted to be prescribed vary from one formulary to another. The formularies for dentists, community nurses and nurse independent prescribers can be found in the Drug Tariffs and the BNF. These prescribers must adhere to the relevant formulary when prescribing on the NHS; any item prescribed and dispensed which is not permitted will be treated in the same way as an item on the Black List and the pharmacy will not be paid. The Drug Tariff for England and Wales also contains information on Pharmacist, Optometrist, Physiotherapist and Chiropodist/Podiatrist Independent prescribing. To confirm a prescriber's registration status, the appropriate regulatory body should be contacted, e.g. the General Medical Council (GMC) for doctors, the General Dental Council (GDC) for dentists and the Nursing and Midwifery Council (NMC) for nurses. Local prescribing guidelines and formularies are commonly used in hospitals and in GP practices. They provide information to prescribers on the most appropriate treatments to use for listed conditions and will also ensure the treatment is cost-effective. Formularies can facilitate effective stock management as most prescriptions will be for items listed within the formulary. Where a prescriber has chosen a treatment which is outside the formulary, there will be a policy in place to advise dispensary staff of the appropriate action to take. |
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What is a supplementary prescribed? |
Supplementary prescribers prescribe when there is an agreement between a doctor or a dentist (who acts as the independent prescriber) and the patient. There must also be a clinical management plan for that patient. The supplementary prescriber may prescribe any drug provided it is within this plan. The following registered healthcare professionals can become supplementary prescribers after further training: nurses midwives pharmacists optometrists chiropodists and podiatrists radiographers physiotherapists registered dietitians |
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Are prescriptions from International Prescribers valid in the UK? |
Prescriptions from doctors, dentists, prescribing pharmacists and prescribing nurses practising in the European Economic Area (EEA) and Switzerland are legally valid in the UK provided the prescription is neither for a controlled drug in Schedule 1, 2 or 3 nor for a medicine which does not have a UK Marketing Authorisation. You will learn more about controlled drugs later in this module. Prescriptions from countries outside the EEA and Switzerland, or from other prescribers in the EEA and/or Switzerland, are not legally valid. |
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Broadly, how many types of prescriptions are there? |
Broadly, there are two main types of prescriptions: National Health Service - These include NHS prescriptions dispensed in the community and those dispensed in hospitals, for example, for inpatients, outpatients, for patients to take home and for clinical trials. Private Prescriptions - These can be dispensed in the community or by a hospital and include those for humans and prescriptions for the treatment of animals. |
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Descrcibe the different coloured prescriptions in England. |
NHS prescriptions dispensed in the community come in a variety of colours. There is a code on each form which indicates the type of form it is and also gives information about the prescriber. |
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Describe the different types of private prescriptions. |
Private prescriptions are issued in a number of different circumstances. A patient may have seen a doctor at a private hospital or clinic, or they may have seen their GP and need something prescribing which the NHS will not pay for. In both situations, the patient will need to pay for the dispensing of the prescription as well as for the cost of the medicines. Prescriptions from vets for animals are also private prescriptions as the NHS will not pay for treatment for animals! We will look at veterinary prescriptions later in this module. Private prescriptions can vary in their appearance as there are no set forms to use other than for controlled drugs dispensed in community pharmacy for human use. However, private prescriptions must still meet all the legal requirements for prescriptions. |
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Describe repeatable private prescriptions in community pharmacy. |
These prescriptions can be dispensed more than once if this is what the prescriber has requested. Repeatable prescriptions will be private prescriptions. They are different to the NHS Repeat Dispensing Service, which you will learn about soon. Patients can take the repeatable prescription away with them (provided it has not been dispensed for the last time, in which case the pharmacy will keep it) and so it is extremely important to keep a record of the dispensing in the prescription-only register as well as within your patient medication records on the dispensary computer. The first dispensing must be within six months of the date on the prescription or four weeks for Schedule 4 controlled drugs. Prescriptions for controlled drugs in Schedules 2 and 3 cannot be repeated. The instruction to repeat the dispensing will be written within the main body of the prescription underneath the drug. If the instruction is "repeat" this means the items can be dispensed twice; once initially and one repeat dispensing.
If the prescriber has written "repeat four times" this means the prescription can be dispensed a total of five times, once initially and then on four other occasions.
If the medicine is an oral contraceptive, "repeat" means it can be repeated five times (so it can be dispensed six times in total). |
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Describe the different types of prescriptions used inside hospitals. |
There are a number of different systems in hospitals. Medicines are dispensed for named patients and clinical trials as well as being issued as stock for use on wards and in theatres and clinics. The forms used include inpatient drug charts, inpatient order cards, clinical trial prescriptions, outpatient prescriptions and those for take-home medication (often called discharge notes or TTOs). An inpatient drug chart is used on the ward to prescribe medicines and to record when these have been administered to an inpatient. Where electronic ordering is not available, pharmacy staff use an inpatient order card to order medicines by transcribing the information from the patient's drug chart, these medicines are then dispensed and sent to the ward. Whereas, an outpatient prescription form is used to prescribe medicines for patients who have attended an outpatient clinic appointment. |
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What kind of information is found on a prescription? |
Prescriptions contain lots of information including details about the patient, the prescriber and the medication and/or any appliances prescribed. When receiving a prescription, it is important to check it meets all of the legal requirements before being dispensed. For a prescription to be legal, it must be written in a certain way and contain specific information. As the information on a prescription is very important, it is vital that it is written in a way so as to be indelible, in other words, it cannot be removed. Most prescriptions are computer generated and those which are handwritten are acceptable so long as they are written in ink. Those generated using rubber stamps are also permitted so long as the ink is indelible. |
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What kind of information is found on a prescription? |
Prescriptions contain lots of information including details about the patient, the prescriber and the medication and/or any appliances prescribed. When receiving a prescription, it is important to check it meets all of the legal requirements before being dispensed. For a prescription to be legal, it must be written in a certain way and contain specific information. As the information on a prescription is very important, it is vital that it is written in a way so as to be indelible, in other words, it cannot be removed. Most prescriptions are computer generated and those which are handwritten are acceptable so long as they are written in ink. Those generated using rubber stamps are also permitted so long as the ink is indelible. |
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Describe electronic prescriptions used in community and hospital pharmacies. |
The increasing use of technology means that many prescriptions are now being written and sent electronically from the prescriber to the dispensary. The national NHS Electronic Prescription Service (EPS) now forms a core part of the day to day running of community pharmacies. Electronic prescribing systems are also being used in hospitals and dispensing practices. The EPS requires each authorised user to have a passcode-protected personal Smartcard to use the system. Speak to your pharmacist/practice to find out how you can get your personal Smartcard and the rules that you have to follow when using the EPS system. Many hospitals have now switched to using electronic prescribing systems. When a prescriber wants to prescribe a medicine for an in-patient, they input it onto the system and an electronic medicines prescription and administration chart (often called the ‘drug chart’) is generated. The pharmacist can access the system and authorise the supply. A member of the pharmacy team then generates an order which is sent electronically to the pharmacy for dispensing. This significantly increases the efficiency of the supply process, as the pharmacy receives the medicine requests more quickly. |
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Describe Repeat Dispensing Services in England and Wales. |
As part of the Pharmacy Contract in England and Wales, community pharmacies must take part in the Repeat Dispensing Service. Refresh your memory on the NHS Pharmacy Contract in Module 1. Under this NHS Scheme, patients who take regular medication for a condition that is stable can get their repeat medication from the pharmacy without a new prescription being printed each time. The scheme starts with the GP reviewing the patient's medication and if the patient agrees, they authorise a set number of prescriptions in advance, usually 6 or 12 months' worth. Repeat Dispensing used to be done on paper prescriptions, but as the Electronic Prescription Service (EPS) becomes increasingly common, the majority is now sent electronically using EPS Release 2, known as electronic Repeat Dispensing (eRD). After the GP decides how many times the prescription can be repeated and how often to repeat it (the interval, usually 28 days), the repeat prescription is sent to the nominated pharmacy via EPS at the specified intervals or it can be downloaded from the NHS Spine by the dispensary at those intervals. You can learn more about eRD on the PSNC website. |
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List the Legal Requirements for Prescriptions. |
For a prescription to meet the legal requirements detailed in the Human Medicines Regulations, it must contain the following: prescriber’s name and address information indicating the type of prescriber (doctor, dentist, pharmacist etc.) prescriber's signature (this must be in ink unless the prescription is sent electronically) the date of signing the name and address of the patient the age of the patient if they are under 12 years of age The date is important as prescriptions are typically only valid for six months from the date of signing. Rarely, the prescriber will write the prescription in advance in which case they will specify the start date. Prescriptions for controlled drugs in Schedules 2, 3 or 4 are only valid for four weeks (28 days). If the prescription is a repeatable prescription, it must be dispensed for the first time within six months of the date it was written (or the start date indicated by the prescriber) unless it is for a Schedule 4 controlled drug in which case it must be dispensed for the first time within four weeks of the date. Repeatable prescriptions are not permitted for Schedule 2 and 3 controlled drugs. Regulations are changing all the time. Since 2019, GP practices have been able to send prescriptions for controlled drugs electronically, whereas previously they had to be prescribed on paper prescriptions. |
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List the Information that should be listed on a prescription about Prescribed Items. |
In addition to providing information about the patient and the prescriber, prescriptions contain information about the medicines and/or appliances (for example, dressings) prescribed. This includes: drug or appliance name (this can be the brand or generic name) strength or size (the prescriber should take care to ensure the strength is unambiguous) form (capsules, tablets, cream, ointment, suspension etc.) quantity to supply directions for use When a prescription gives the generic name for a medicine, the dispensary can supply any brand they have in stock of that medicine or a generic product. If the prescription specifies the brand, only that brand may be dispensed. These days, the cost of supply is important and your workplace may have specific rules around which brands or generics are given for a generically written prescription. In addition, some prescribers are now prescribing so-called ‘branded generics’ to ensure they are keeping down their prescribing costs, as the NHS monitor their prescribing spend. Most NHS prescriptions will be written generically unless it is important for the patient's treatment that they have a specific brand. For example, some patients with epilepsy must have the same brand of medication all the time as they may experience seizures if the brand changes. The BNF states when the prescriber should specify the brand name on the prescription. When prescribing a drug, it is extremely important that the prescriber specifies the strength of the preparation if there is more than one strength available. The strength will often be given as the amount of drug per tablet or capsule. For example, paracetamol 500mg tablets or, for oral liquids, as the amount of drug per 5ml. It can be also stated as a percentage, as is the case for hydrocortisone 1% cream, or as a rate of drug administration, for example, nicotine patches are available as a "7mg" strength, this is actually the amount of nicotine delivered over a 24-hour period. |
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Why should the quantity be specified on the prescription. |
It is important that the prescriber specifies how much to dispense. Typically, they will simply state the number of tablets, the weight of a cream or the volume of a suspension. Some prescriptions will contain information relating to the daily dose and then state the number of days of treatment. Where this happens, the total quantity to be dispensed must be calculated by the dispensary staff. Calculating the total quantity required for the prescription also allows you to work out whether you have the full quantity in stock, and whether the patient needs to return for any owed items. This can help some patients decide if they want to wait for a prescription to be dispensed or come back for the whole prescription when the full quantity is available. |
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What should you do if you receive a forged prescription or a prescription with an error. |
Sometimes prescriptions will be handed in for dispensing that are lacking one or more pieces of information. For example, the prescriber may have forgotten to sign the prescription or have omitted the strength of the preparation, the quantity or the dose. If you think a prescription is incomplete or unclear, alert your supervisor or manager if you are not sure what to do, as they will need to confirm what the prescriber intended and make arrangements for the prescription to be amended or replaced. Most prescriptions are now computer-generated, including both paper and electronic prescriptions, so you may not come across too many handwritten prescriptions that are difficult to read. However, you should still be aware of how to react in this situation. Unfortunately, pharmacy staff do need to consider whether the prescription presented for dispensing could be fraudulent. It could be that the entire prescription has been written by someone who is not a prescriber, for example, when a blank prescription pad has been stolen, or a genuine prescription may have been amended to either add a medicine or to increase the quantity of medicine. Controlled drugs and medicines which are liable to misuse are much more likely to appear on fraudulent prescriptions. If you are at all suspicious, alert your pharmacist in a discreet manner and try to keep the prescription in the pharmacy. In England, Wales and Northern Ireland, there are schemes which reward pharmacies that have identified fraudulent prescriptions; the details can be found in the relevant Drug Tariff. In Scotland, pharmacy staff should contact the Counter Fraud Services team. Examples of medicines liable to misuse include: controlled drugs, for example, methadone hypnotics (sleeping tablets), for example, zopiclone steroids insulin laxatives, for example, senna decongestants, for example, pseudoephedrine |
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Describe prescription payments in community pharmacies and hospitals. |
Some prescriptions need to be paid for by the patient, whilst others are exempt from prescription charges. The factors affecting prescription charges include: the type of prescription regional differences in prescription charges the type of item prescribed the patient’s exemption status All patients receiving private prescriptions will have to pay for those prescriptions. The fees they pay will be calculated individually for each prescription The price will take into account the cost of the medicines supplied and also a dispensing fee Prescriptions from vets for animals will also incur Value Added Tax (VAT) at the current rate. The situation is not as straightforward when it comes to NHS prescriptions for a number of reasons: some patients are exempt from paying for their prescriptions some patients are given remission from paying for their prescriptions (this also means they do not pay) - this is usually due to their medical condition, for example, patients with certain thyroid disorders. The exemption can also be temporary, for example, pregnant women are exempt from prescription charges during their pregnancy and for one year after giving birth patients who pay for their prescriptions can have prescription prepayment certificates patients living in Scotland, Wales and Northern Ireland do not pay NHS prescription charges In hospitals, prescription charges for inpatients do not apply as long as the medicine is being administered in the hospital. However, the ward or department in which the patient is staying does have to pay for the price of the medicine. They are known as a cost centre. On the other hand, the regular NHS prescription charges and exemptions do apply for outpatient prescriptions from the hospital.
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Describe the different Prescription Charges. |
Where there are fees payable for NHS prescriptions, the patient or their representative will typically complete the declaration on the reverse of the prescription before it is dispensed and often any fees will be paid at that point. Fees for private and veterinary prescriptions are usually calculated at the point of dispensing, however patients may ask for a quote in advance. Patients taking regular medication who are not entitled to remission from prescription charges, nor are exempt from charges, can purchase a Prescription Prepayment Certificate. In England, these can be purchased online, over the phone or by completing a paper application form (FP95). There is no limit on the number of items a patient can have dispensed whilst their prepayment certificate is valid. Where patients pay for their prescriptions, it is extremely important that the total charge is calculated correctly. This figure is used not only to charge the patient but it is also recorded by the dispensary to ensure the pricing bureau correctly pay them. In most cases the number of items on the form will be the same as the number of charges. There are a few exceptions. Where the formulations differ, the patient will pay for each item, for example, two charges would be payable for a prescription for prednisolone 5mg tablets and prednisolone 5mg enteric coated (e/c) tablets. In some situations, the patient will not pay for an item (or items) on the prescription form: If a medicine is prescribed at multiple strengths with the same formulation on one prescription, the patient will only pay for one item. If a contraceptive device or medicine is prescribed, no charges are payable. In addition, if an item is prescribed which is not a contraceptive device or medicine but the prescriber has marked the prescription to make it clear that the item is being used for contraceptive purposes, no charges are payable in this situation either. One of the following three endorsements are typically used: “OC”, “CC” or “ ♀” From January 2020, a new prescriber endorsement “FS” has been introduced in England to indicate prescription items that are supplied free-of-charge for the treatment of a sexually transmitted infection (STI). In practice, this may include an antibacterial treatment for an STI. You can find more information on sexual health related treatment in Part XVI of the Drug Tariff. Only the prescriber is authorised to endorse the item with “FS”. If a patient is unsure about paying a prescription charge for an item that is not endorsed as “FS”, the patient should be referred to the prescriber. Sometimes it will appear that only one item has been prescribed but there will be more than one charge payable. Many preparations prescribed for Hormone Replacement Therapy (HRT) fall into this category because within the pack there are actually two or three different types of tablets and each will incur a charge. The charges section of the Drug Tariff gives examples of the common multiple charge items. You can also refer to the BNF as this will give information on the different items in a pack. Remember, there is one charge payable for each piece of hosiery supplied. There are TWO pieces of hosiery in ONE PAIR. |
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Describe the refund process for prescription payments. |
Official NHS receipts can be issued at the time of dispensing if the patient requests this. The FP57 is the form used in England. The receipts allow patients to claim a refund for the charges paid in certain circumstances, for example, if they intend to purchase a new or replacement prepayment certificate. There are some restrictions on claiming the refund: the start date on the certificate or new evidence of exemption must either be the same day as the date of dispensing, or a date prior to this date (prepayment certificates can be back dated up to month) the refund must be claimed within three months of payment (if it is later than this the patient must request their refund in writing) Once the patient has evidence of their entitlement to a refund, they can then take their FP57 to any community pharmacy for a refund. |
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What are the laws relating to controlled drugs? |
The primary purpose of the Misuse of Drugs Act 1971 is to prevent the misuse of controlled drugs (CDs). It does this by prohibiting the possession, supply, manufacture, import and export of controlled drugs except as allowed by the regulations or by licence from the Secretary of State. Some controlled drugs have important uses in medicine and special arrangements are made to permit their supply. The use of controlled drugs in medicine is permitted by the Misuse of Drugs Regulations 2001. Other regulations deal with the safe custody of controlled drugs and the supply of drugs for the treatment of misusers. Controlled drugs regulated by Misuse of Drugs Regulations are categorised into schedules 1 to 5 according to the different levels of control that are required. The BNF indicates the schedule by using the abbreviation CD followed by the schedule number, for example CD-1. |
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Describe Schedule 1 drugs (CD Lic POM) |
Schedule 1 includes drugs which have virtually no therapeutic use, for example, hallucinogenic drugs, ecstasy-type substances and cannabis. Production, supply or possession of these drugs is unlawful without a special licence from the Home Office. Strict records of the receipt and supply of Schedule 1 drugs must be kept. They must also be stored securely. Hospital pharmacists may have to deal with substances removed from patients on admission which could well be Schedule 1 controlled drugs. There are only two circumstances where the pharmacist can legally take possession of such drugs: if they take possession for the purpose of destruction if they take possession for the purpose of handing over to a police officer |
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Describe Schedule 2 drugs (CD POM) |
Schedule 2 includes the opiates, such as diamorphine, morphine and methadone, and the major stimulants, such as amphetamine and quinalbarbitone (also known as secobarbital). A pharmacist may supply Schedule 2 controlled drugs to a patient if they have a prescription that has been issued by a prescriber who is permitted to prescribe Schedule 2 drugs which also meets the additional prescription requirements. Strict records must be kept relating to the receipt and supply of these drugs and they must be stored securely. |
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Describe Schedule 2 drugs (CD POM) |
Schedule 2 includes the opiates, such as diamorphine, morphine and methadone, and the major stimulants, such as amphetamine and quinalbarbitone (also known as secobarbital). A pharmacist may supply Schedule 2 controlled drugs to a patient if they have a prescription that has been issued by a prescriber who is permitted to prescribe Schedule 2 drugs which also meets the additional prescription requirements. Strict records must be kept relating to the receipt and supply of these drugs and they must be stored securely. |
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Describe Schedule 3 drugs (CD No Register POM) |
Schedule 3 includes a small number of minor stimulant drugs and drugs such as buprenorphine, tramadol, midazolam, phenobarbitone and temazepam which are considered less likely to be misused and less harmful if misused when compared to those in Schedule 2. From 1 April 2019, gabapentin and pregabalin are reclassified from POM to Schedule 3 CDs. This means that prescription requirements for Schedule 3 CDs must be met for gabapentin and pregabalin. They are exempt from safe custody requirements. |
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Describe Schedule 2 drugs (CD POM) |
Schedule 2 includes the opiates, such as diamorphine, morphine and methadone, and the major stimulants, such as amphetamine and quinalbarbitone (also known as secobarbital). A pharmacist may supply Schedule 2 controlled drugs to a patient if they have a prescription that has been issued by a prescriber who is permitted to prescribe Schedule 2 drugs which also meets the additional prescription requirements. Strict records must be kept relating to the receipt and supply of these drugs and they must be stored securely. |
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Describe Schedule 3 drugs (CD No Register POM) |
Schedule 3 includes a small number of minor stimulant drugs and drugs such as buprenorphine, tramadol, midazolam, phenobarbitone and temazepam which are considered less likely to be misused and less harmful if misused when compared to those in Schedule 2. From 1 April 2019, gabapentin and pregabalin are reclassified from POM to Schedule 3 CDs. This means that prescription requirements for Schedule 3 CDs must be met for gabapentin and pregabalin. They are exempt from safe custody requirements. |
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Describe Schedule 4 drugs (CD Benz POM or CD Anab POM) |
Schedule 4 is split into two parts: Part I (CD Benz POM) contains most of the benzodiazepines plus zopiclone and Part II (CD Anab POM) contains most of the anabolic and androgenic steroids along with growth hormones. |
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Describe Schedule 5 drugs (CD Inv P or CD Inv POM) |
Schedule 5 contains preparations of certain controlled drugs which are exempt from full control when they are present in medicinal products of low strength. This means that, in certain circumstances, community pharmacies are able to sell medicines that contain Schedule 5 controlled drugs over the counter. This applies to products containing small amounts of codeine, morphine and pholcodine. This includes some cough medicines such as codeine linctus and pholcodine linctus, as well as Kaolin and Morphine mixture (a medicine for acute diarrhoea). |
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What do theregulations state about the strage of controlled drugs? |
The regulations state that controlled drugs in Schedules 1, 2 and 3, must be kept in safe custody. However, quinalbarbitone (in Schedule 2) is exempt from the safe custody requirements as are all but three of the drugs in Schedule 3. The following drugs in Schedule 3 must be kept in safe custody: temazepam buprenorphine diethylpropion |
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What do theregulations state about the strage of controlled drugs? |
The regulations state that controlled drugs in Schedules 1, 2 and 3, must be kept in safe custody. However, quinalbarbitone (in Schedule 2) is exempt from the safe custody requirements as are all but three of the drugs in Schedule 3. The following drugs in Schedule 3 must be kept in safe custody: temazepam buprenorphine diethylpropion |
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What does “Safe Custody” of CD’s mean? |
This typically means a locked and secured cupboard, commonly known as the "CD Cupboard" used solely for the purpose of storing controlled drugs. It should only be unlocked when absolutely necessary and access must be limited to those with specific authority. It is good practice to keep a log of who has accessed the CD Cupboard during the working day. There are detailed specifications which CD Cupboards must meet in order to satisfy the Misuse of Drugs (Safe Custody) Regulations 1973, as amended. When controlled drugs are not in the CD Cupboard, for example when they are being dispensed, they must be under the direct personal supervision of a pharmacist. Any controlled drugs received in a delivery should be promptly brought to the attention of the authorised person, checked, recorded in the CD register if appropriate, then placed in the CD cupboard if safe custody is required. Any prescriptions containing CDs that have been dispensed should be promptly placed in the CD cupboard if the patient is not waiting to collect them and any stock bottles or packets should also be returned to safe custody. In hospitals, all controlled drugs must be stored securely in a CD cupboard. Some hospitals have controlled drug rooms within the pharmacy department, which have a lockable door and contain a number of CD cupboards, they may also have closed-circuit television (CCTV) cameras inside the room for security purposes. The CD cupboards on hospital wards can only be accessed by a pharmacist, an authorised pharmacy technician working under the direct supervision of a pharmacist or an authorised nurse or midwife. Furthermore, CD cupboards kept in operating theatres can only be accessed by anaesthetists as well as the Lead Operating Department Practitioner (ODP). For doctors who visit patients in their homes, safe custody means a locked bag which they must carry with them. It is not acceptable for controlled drugs to be left in a locked car. Within dispensing practices there will be a local policy detailing the steps to take and extra checks to be completed when dispensing controlled drugs |
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What are Requisitions for Controlled Drugs? |
Requisitions are signed orders from professionals requesting the supply of certain items. A requisition in writing must be received by a supplier before they can deliver any Schedule 2 or 3 controlled drug. However, a doctor or dentist, who is urgently requesting these drugs but is unable to supply a requisition before delivery, may receive the drug provided they supply a requisition within the next 24 hours. If they do not, they will have committed an offence. The requisition must: be signed by the recipient state the recipient's name and address state the recipient's profession or occupation specify the total quantity of the drug specify the purpose for which it is required Since November 2015, it has been mandatory for all CD requisitions for Schedule 2 and 3 controlled drugs in the community to be made on the standardised CD Requisition form. Requisitions not made on this form cannot be accepted. This applies to products for both human and veterinary care in the community. A copy of the form (for England) can be found on the NHS Business Services Authority (BSA) website. In a hospital, a requisition is needed for CDs to be supplied to a ward or department. You will learn more about CDs in hospitals below. In dispensing practices, when a CD is ordered from the wholesaler, a requisition is created and signed. A copy is taken for the dispensary records and the original given to the wholesaler delivery driver at the point of delivery/receipt. |
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Who can generate a CD requisition? |
A requisition for controlled drugs may be generated by: a doctor or dentist a nurse or pharmacist independent prescriber any authorised nurse or midwife working in a hospital ward or theatre (they must provide a written requisition when obtaining CDs from the hospital pharmacy) the person in charge of a Care Home or Hospital (the requisition must be signed by a doctor/dentist employed there) an operating department practitioner the installation manager of an offshore installation a person in charge of a laboratory involved in scientific education the owner or master of a ship which does not carry a doctor the master of a foreign ship in port in Great Britain |
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How to Processing a CD Requisition? |
Upon receipt of a requisition for a controlled drug in Schedule 1, 2 or 3, a pharmacist working in a community pharmacy or the dispensary team from a dispensing doctor's practice with a wholesale licence must: mark the pharmacy/practice's name and address on the requisition in an indelible way (a stamp is acceptable) take a copy of the requisition and keep it for two years from the date of supply make appropriate records of the supply in the CD register and/or the Prescription-Only Register as required send the original requisition to the relevant National Health Service agency |
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Describe the legal requirements for controlled drug prescriptions. |
Prescriptions for controlled drugs in Schedules 2 and 3 have to meet not only the legal requirements set out in the Receiving and Interpreting Prescriptions chapter, which come under The Human Medicines Regulations 2012, but also the additional requirements specified in the Misuse of Drugs Regulations. It is unlawful for a prescriber to issue a prescription for a Schedule 2 or 3 controlled drug and for a pharmacist to dispense it if it does not meet all the requirements. Prescriptions for controlled drugs issued by dentists also need the wording "For dental treatment only" Temazepam is in Schedule 3 however, prescriptions for the drug require the total quantity to be written in both words and figures. As for other Schedule 2 and 3 CDs, prescriptions for temazepam are valid for 28 days and it must be stored securely in the CD cupboard Since 1 April 2019, gabapentin and pregabalin have been reclassified to Schedule 3 CDs, so their prescriptions need to fulfil these additional requirements Prescriptions for Schedule 5 CDs are valid for six months from the date on the prescription Prescriptions from doctors, dentists, prescribing pharmacists and prescribing nurses practising in the European Economic Area (EEA) and Switzerland for controlled drug in Schedule 1, 2 or 3 are not legally valid in the UK
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What to do is there is a technical err on Prescriptions for Controlled Drugs? |
Ideally every prescription presented for dispensing would contain all the information required, particularly those for controlled drugs where there are such strict regulations. If a prescription for a Schedule 2 or 3 controlled drug contains a minor typographical error, spelling mistake, or is lacking the total quantity in both words and figures but has one or the other, a pharmacist may still dispense the prescription provided they: believe the prescription to be genuine and that they are supplying the drug in accordance with the prescriber’s intention amend the prescription indelibly to correct the minor errors, spelling mistakes, or so that the prescription contains the total quantity in words and figures mark the prescription so that it is clear the amendment made is due to him/her |
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Describe Private Prescriptions for Controlled Drugs. Forms, record keeping etc. |
Private prescriptions for CDs in Schedules 2 and 3 dispensed in community pharmacies, including those for temazepam and midazolam, need to be on specific forms. It is a legal requirement that the prescription includes the private prescriber's identification number, this is different to their GMC number and can be issued to the prescriber by the local primary care organisation. No items other than controlled drugs may be prescribed on these forms. If a Schedule 2 controlled drug is prescribed privately, it is not essential for a record of the supply to be made in the Prescription-Only Register as there will be an entry in the controlled drugs register relating to the prescription. However, it is considered good practice to make this additional record. The original prescription forms must be sent to the relevant NHS Agency as is the case for the standardised controlled drug requisitions. Most pharmacies will usually take a copy of the private prescription as well as making the register entry. Veterinary prescriptions for controlled drugs do not need to be written on these forms nor sent to the NHS Agency. Instead the pharmacy must keep the prescription for at least five years. Hospital Pharmacy: The NHS controlled drug private prescription forms are not used in hospital inpatient pharmacies, but they are accepted in hospital outpatient pharmacies that dispense NHS prescriptions. |
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Are Repeat Prescriptions for Controlled Drugs allowed? |
Repeat prescriptions for Schedule 2 and 3 controlled drugs are not allowed. If a Schedule 4 drug, for example, diazepam, is prescribed on a repeat prescription, the first dispensing must be within 28 days of the date on the form. There is no time frame for the repeat dispensing(s) of private prescriptions for Schedule 4 drugs but if the repeatable prescription is part of the NHS Repeat Dispensing Scheme in England and Wales, then the batch prescriptions are valid for a maximum of 12 months. In either case, if a considerable amount of time has passed since the first time the prescription was dispensed, the pharmacist will make a professional judgement on whether the prescription is still appropriate for the patient as they would with any repeatable prescription. |
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Patient Group Directions and Controlled Drugs - are they allowed? |
Certain controlled drugs may be administered or supplied under a PGD but the list is limited. In addition, each PGD will specify the qualifications and training needed by the healthcare staff involved. https://www.gov.uk/government/organisations/medicines-and-healthcare-products-regulatory-agency |
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What are Controlled Drug Registers? |
Records of all Schedule 1 and 2 drugs obtained and supplied must be kept. These are recorded in the Controlled Drugs Register (CDR) which can be a bound book or an electronic register. CDRs must also be kept on every ward, theatre or department that stock controlled drugs and also in the bags of doctors if they carry controlled drugs when visiting patients outside their practice. The CDR must be shown to any authorised person who requests to see it, for example, a GPhC Inspector or Controlled Drugs Liaison Officer or the Accountable Officer. Every organisation in primary or secondary care will have an Accountable Officer. An Accountable Officer is responsible for the safe and secure management and use of controlled drugs within the organisation. There are set rules relating to the layout of CDRs and also how and when entries are made. |
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List some of the strict requirements for CD registers. |
Entries must be in chronological sequence so must be made in the order in which they are received/supplied A separate register or separate part of the register must be kept for each class of drugs A separate page must be used for each strength, form and brand of drug The class of the drug, its strength and form must be written at the head of the page Entries must be made on the day of the transaction or on the next day No cancellation, obliteration or alteration may be made; any errors should be marked neatly ,for example, with an asterisk* and amendments or corrections must be put in as a footnote and dated Entries must be in ink or otherwise indelible or shall be in computerised form Electronic registers need to identify the person making each entry and must prevent entries from being altered at a later date The running balance shows how much of that particular CD is currently in stock. This number is adjusted after receipt or supply of this CD in the next entry (to record the receipt or supply). You must take care to check the calculations are correct The CDR must be kept in the dispensary/department and if it is electronic it must be accessible in the dispensary/department it relates to Adequate back-ups must be made of computerised registers Registers must be kept for two years from the date of the last entry |
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How would you Record the Receipt of Controlled Drugs? |
When obtaining controlled drugs, the following must be recorded in the CDR: Date the supply was received Name and address from whom it was received Quantity received |
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What records should be made of the Supply and Collection of Controlled Drugs? |
A lot of information relating to the supply of controlled drugs must be recorded in the CDR including information about who has collected CDs ordered on a requisition or prescription. The details required as a minimum are: Date of supply Name and address of person or firm supplied Details of authority to possess, in other words, the prescriber or licence holder’s details Quantity supplied Person collecting the Schedule 2 CD (this could be the patient/patient’s representative /healthcare professional; if it is a healthcare professional, record their name and address) Whether proof of identity of person collecting was requested (yes or no) Whether proof of identity of person collecting was provided (yes or no) The regulations now allow additional related information to be recorded, e.g. Private Prescriber ID, the professional registration number of the prescriber, the type of identification provided etc. |
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What records should be made of the Supply and Collection of Controlled Drugs? |
A lot of information relating to the supply of controlled drugs must be recorded in the CDR including information about who has collected CDs ordered on a requisition or prescription. The details required as a minimum are: Date of supply Name and address of person or firm supplied Details of authority to possess, in other words, the prescriber or licence holder’s details Quantity supplied Person collecting the Schedule 2 CD (this could be the patient/patient’s representative /healthcare professional; if it is a healthcare professional, record their name and address) Whether proof of identity of person collecting was requested (yes or no) Whether proof of identity of person collecting was provided (yes or no) The regulations now allow additional related information to be recorded, e.g. Private Prescriber ID, the professional registration number of the prescriber, the type of identification provided etc. |
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Can a registered midwife possess CD’s? |
A registered midwife may possess the following controlled drugs for the practice of her profession: Diamorphine (Schedule 2 CD POM) Morphine (Schedule 2 CD POM) Pethidine (Schedule 2 CD POM) Supplies are obtained using a Midwife’s Supply Order (MSO) which needs to be signed by the “appropriate medical officer” or the person appointed by the local supervising authority to supervise the midwives in that area. Since July 2015, all MSOs have been required to be written specifically for a patient. Midwives can therefore supply or administer controlled drugs to specific patients only. The supply order must be in writing and state: The midwife’s name Occupation The purpose for which the controlled drug is required The total quantity obtained The signature of the “appropriate medical officer” or equivalent appointed person Name of specific patient or expecting mother |
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Is a midwife required to keep records of CD’s she has in her posession? |
A midwife is required to keep records of supplies of diamorphine, morphine and pethidine received and administered in a book used solely for that purpose. Surplus stock may not be destroyed by the midwife but must be given to the “appropriate medical officer”. A pharmacist must keep the Midwife’s Supply Order for two years. It is not necessary to send it to the local NHS Agency. Entries must be made in the CD register for the supply of diamorphine, morphine and pethidine as they are in Schedule 2. Although it is not legally required, pharmacists will typically also make a second entry in the Prescription-Only Register of the supplies of the Schedule 2 drugs. |
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Describe how instalement prescriptions work for drug misusers. |
A person is regarded as being addicted to a drug if, and only if, they have as a result of repeated administration become so dependent on a drug that they have an overpowering desire for the administration of it to be continued. Instalment prescriptions allow Schedule 2 and 3 controlled drugs to be issued over a period of time to drug misusers. The instalment prescription must state both the dose and instalment amount separately on the prescription. Home Office have issued approved wording for instalment prescribing. Depending on the patient’s needs, they will either come and collect their medication and take it away or in community pharmacies patients can be required to consume it under the pharmacist's supervision. In either case, robust procedures for both pharmacy staff and patients should be in place to ensure the service runs smoothly. In England, drug treatment centres and GPs use the FP10MDA prescription form. A maximum of 14 days' treatment is permitted of any drug in Schedule 2, diazepam, buprenorphine and the combination preparation Suboxone® which contains buprenorphine and naloxone. Cocaine and diamorphine can only be prescribed for the treatment of addiction by specially authorised doctors who hold a Home Office Licence. The Regulations state that instalment prescriptions for Schedule 2, 3 and 4 controlled drugs must be dispensed for the first time within 28 days of the date given on the prescription with the remainder of the instalments dispensed according to the prescriber's instructions. This can mean that some instalments are dispensed more than 28 days after the date on the prescription. However, in most cases this will not happen; instalment prescriptions are typically issued just prior to use. Approved Home Office wording for instalment prescriptions The Home Office approved wording for patients who have supervised consumption is: "Supervise consumption on collection days." In addition, if the pharmacy is due to be closed on a collection day the prescription should state: "Please dispense instalments due on pharmacy closed days on a prior suitable day." The prescription should also state: "Consult the prescriber if three or more consecutive days of a prescription have been missed." This is important because there is a risk that the patient may have lost tolerance to the drug after missing it for three days, so the usual dose may cause an overdose. If instalments are only being collected every few days rather than on a daily basis then this statement may be used to allow for a missed collection day. "If an instalment’s collection day has been missed, please still dispense the amount due for any remaining day(s) of that instalment." |
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Where should Records of Drugs Supplied in the Treatment of Addiction be made? |
A record should be made in the Controlled Drugs Register on the day of each supply for Schedule 2 controlled drugs e.g. methadone. |
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What is required of misuers upon collecting their CD’s? |
As mentioned previously, there is a space on the reverse of prescription forms for the person collecting a Schedule 2 or 3 CD to sign and it is good practice to obtain their signature. If a patient is collecting their prescription in instalments, they do not need to sign every time but it is considered good practice for them to sign at least once. Where a third party collects a CD for a patient being treated for addiction, it is good practice to get a letter of authorisation from the patient every time the representative collects the medicine. The letter should be retained in the pharmacy. |
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How are CD prescriptions endorsed? |
Prescriptions for CDs not intended for instalment dispensing can be endorsed in the same way as other prescriptions. Correctly endorsing CD prescriptions for methadone that demand instalment dispensing is particularly important as there will be numerous professional fees to claim. Every time an instalment prescription is dispensed, this must be recorded on the prescription. Many forms are double width for this purpose and have a particular space for this endorsement. Additional fees for a CD are also paid when a controlled drug in Schedule 2 or 3 is dispensed. However, it is no longer necessary to endorse these prescriptions with "CD" in England, Wales or Scotland to obtain this fee. |
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Are patients allowed to drive/travel after taking a CD? |
From 2 March 2015 it has become illegal to drive with certain CDs in the blood above specified limits. The list of drugs includes some licensed medicines including morphine, diamorphine, methadone, diazepam, oxazepam, temazepam and amfetamine. Since this date, anyone found to have any of these drugs in their blood above the specified limits will be guilty of an offence. However, a medical defence will be permitted for people who are taking drugs on the list for medical reasons if their driving ability is not affected. Affected patients should be advised: To continue to take their medicine To check the patient information leaflet that comes with it to find out whether and how their driving ability might be affected Not to drive until they know how the medicine affects them Not to drive if they feel sleepy, dizzy or unable to concentrate. Patients intending to carry CDs abroad may require a licence if they are travelling for more than three months, however it is advisable that all patients have a letter from their prescriber if travelling abroad with CDs.
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Name the act which establishes the standards that are applied to the way in which goods are measured and supplied. |
The Weights and Measures Act 1985 establishes the standards that are applied to the way in which goods are measured and supplied. This act covers equipment used for weighing and measuring, and is applicable to pharmacies where equipment is used to measure liquids or to prepare extemporaneous formulations. If the pharmacy scales are not automated, for example, Class B Balances, each weight and the balance must be passed as fit for use and stamps or stickers must be attached by Trading Standards Officers (previously known as Inspector of Weights and Measures) or an approved verifier acting on their behalf. Measures used for liquids must also be stamped with a Crown stamp, shown below, to confirm they are accurate and fit for use. All equipment must be regularly checked for accuracy and any found to be faulty should be promptly mended or replaced. |
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What is the British National Formulary (BNF)? |
The BNF is published every six months and is available online. In the printed version, there are 15 chapters related to a body system or an aspect of medical care. Each chapter is divided into sections and contains detailed information on individual medicines (known as a monograph). Both online and printed versions contain drug monographs and treatment summaries which are intended to help healthcare professionals decide on the most appropriate treatment. The appendices give additional information, for example, Appendix 1 gives information on interactions. The appendices can be found easily using the index of the printed BNF. The electronic BNF will provide you with links to the relevant sections of the appendices. The printed version contains copies of the yellow MHRA Suspected Adverse Drug Reaction Form (the Yellow Card Scheme). For each drug, its monograph (entry in the BNF) will have the following headings: Drug Name and Action Indications (details of uses) Dose (how to take the drug, how much to take and how often) Cautions (details of precautions and any monitoring required) and Interactions Contra-indications (when the drug usually cannot be used) Side effects, which details the rarity of the potential side effects Advice on use in pregnancy, breastfeeding, hepatic impairment and renal impairment Patient and carer advice Medicinal forms / Preparations available i.e. generic products, branded products and any cautionary labels required. |
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What is the British National Formulary for Children (BNFC)? |
It provides information on the use of medicines in children ranging from preterm neonates to adolescents. Doses are usually stated by age. |
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How many Drug tariffs are there in the UK? |
There are three Drug Tariffs available online: the Drug Tariff for England and Wales the Scottish Drug Tariff the Northern Ireland Drug Tariff |
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What is the drug tariff? |
The Drug Tariff is a reference source which provides information relating to the dispensing of NHS prescriptions by community contractors such as pharmacies, as well as dispensing practices and appliance contractors. This also applies to hospital outpatient pharmacies that dispense NHS prescriptions and sell medicines over the counter. It contains information on: the basic prices of drugs prescription charges and prepayment certificates (where applicable) professional and dispensing fees the appliances, dressings and chemical reagents which can be prescribed on the NHS prescriber formularies |
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What are the different professional fees that are paid to contractors for various aspects of dispensing? |
There is an agreed list of professional fees that are paid to contractors for various aspects of dispensing. These include: a basic fee for dispensing each prescription item fees for dispensing appliances such as elastic hosiery that need to be measured and fitted fees for the instalment dispensing of methadone fees for supplying consumables (other items that are supplied with medicines) such as 5ml spoons There is also an agreed scale of fees for other services linked to dispensing. In the tariff for England and Wales, for example, this includes fees that are paid to contractors who undertake Medicine Use Reviews and the New Medicines Service. |
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How are the basic prices of drugs worked out in the drug tariff? |
Each of the tariffs has a section that contains a list of generic drugs which have a pack size and basic price, i.e. a price which has been agreed will be reimbursed by the relevant government health department. In the tariff for England and Wales, this is Part VIIIA, and prices are determined by the Secretary of State (for England) and Welsh Ministers. The drugs in this section are categorised as A, C or M. |
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Describe category A, C & M medicines on the drug tariff. |
Category A Category A drugs are readily available. The price is based on an average of the list prices from four manufacturers and suppliers (AAH, Alliance Healthcare (Distribution) Ltd, Teva UK and Actavis). Category C Category C drugs are not readily available, so the price is based on a particular brand or manufacturer. Category M Category M drugs are readily available. The Secretary of State determines the price based on information submitted by manufacturers. Prices are set in advance every quarter based on figures from manufacturers and dispensing volumes from the Pricing Authority. |
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Describe how payments are made for Supplying Specials and Imported Unlicensed Medicines. |
In the English and Welsh tariff, these are outlined in part VIIIB. The agreed price is based on information submitted by manufacturers that hold Specials Manufacturers’ Licences issued by the MHRA. For each product listed, there is a minimum volume or weight that will be reimbursed and the price that will be paid for each ml or g supplied above the minimum. The price paid for dispensing prescriptions for specials that are not listed in this part will depend on how the special was sourced. If the special is made by the contractor (extemporaneously dispensed), then the contractor will be paid the costs of the ingredients used to manufacture it. The price that will be paid for dispensing prescriptions for imported unlicensed medicines that are not listed in this part will be the price endorsed on the prescription form, which should be the invoice price less any discount obtained. |
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In the drug tariff, name approved lists of items other than medicines. |
Only items listed in the Drug Tariff are allowed to be supplied on NHS prescription. The lists of items are normally divided into different categories, for example: Approved appliances, including dressings and bandages Incontinence appliances Stoma appliances Chemical reagents The sections on incontinence and stoma appliances are especially extensive. Only the pack sizes that are stated are allowed. |
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In the drug tariff, what is the blacklist? |
In the Drug Tariff for England and Wales, this is found in Part XVIIIA and is entitled "Drugs, Medicines and Other Substances not to be ordered under a General Medical Services Contract". When it comes to medicines, food and cosmetics, any product can be prescribed on the NHS and the pharmacy or dispensing practice will be reimbursed for dispensing it, provided it is not in the Black List and the prescriber is not limited to a set formulary. The products that cannot be prescribed include many cough and cold remedies, analgesics (pain-killers) for mild-moderate pain relief and multivitamin preparations. The Black List does not affect private or veterinary prescriptions, only those dispensed as part of the NHS. Example Diazepam 2mg tablets can be prescribed on the NHS as "diazepam 2mg tablets" because the generic drug is not in the Black List. NHS prescriptions written using the brand name "Valium® 2mg tablets" cannot be dispensed because this product is Black Listed.
Items are put on the Black List because they are expensive, not necessary or have little medicinal use. Certain brands of prescription-only medicines are on the Black List. |
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What to do if you receive an NHS prescription for a Black Listed item in a community pharmacy? |
If you receive an NHS prescription for a Black Listed item you should bring it to the attention of your pharmacist. The pharmacy will not be paid if a Black Listed item is dispensed and to do so would be a breach of their “Terms of Service”. For reference, the prescriber would also be classed as having breached their “Terms of Service” by issuing a prescription for a disallowed item. Depending on the item prescribed there are a number of options including: the patient may be able to purchase the item over the counter the prescriber could issue another prescription for an alternative the prescriber may be able to amend the prescription so that the drug is written generically the prescriber may be willing to issue a private prescription for the item that is Black Listed. A separate private prescription form would need to be issued because the NHS prescription form is the property of the Department of Health and Social Care |
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Why are prescribers encouraged to prescribe generic preparations? |
In general, prescribers are encouraged to prescribe generic preparations wherever possible as these are more cost-effective to the NHS. Many medicines that are Black Listed as branded products can be prescribed on the NHS if there is a generic version available. Example Calpol ® cannot be supplied on NHS prescription, but the generic version, which contains the same active ingredient, paracetamol, can be supplied on NHS prescription. Some preparations cannot be prescribed using either their brand or generic names. This is because the generic name is not an “approved” name. This often affects preparations with more than one active ingredient. Example Paramol ® tablets (dihydrocodeine 7.46mg and paracetamol 500mg) are Black Listed so cannot be prescribed on an NHS prescription. This combination of dihydrocodeine and paracetamol cannot be ordered generically on NHS prescription either, because there is no approved name for this combination of drugs at these strengths. Only co-dydramol 10/500 (dihydrocodeine 10mg and paracetamol 500mg) can be prescribed on the NHS as it has an approved name. Examples of combination preparations that have been given approved names and can be prescribed on the NHS include: co-careldopa 25mg/100mg tablets co-fluampicil 250mg/250mg capsules co-trimoxazole 80mg/400mg tablets |
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What is The Selected List Scheme (SLS)? |
Some drugs are only allowed to be prescribed on the NHS in certain circumstances. The full details can be found in the relevant part of the Drug Tariffs. When prescribing these drugs, the prescriber must endorse the prescription with "SLS" (or "S.11." in Northern Ireland). If this endorsement is missing the prescription must be returned to the prescriber, it cannot be added by the pharmacy. |
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What are borderline substances on prescription and how are they supposed to be endorsed by prescribers? |
Some foods, drinks and certain toiletries are available on prescription for patients with specific medical conditions. The Advisory Committee on Borderline Substances (ACBS) agrees which products can be prescribed for the treatment or management of an approved ACBS condition. The prescriber should endorse the prescription with "ACBS" to indicate that the item prescribed is for an approved condition. If the endorsement is missing the prescription can still be dispensed as the pharmacy or dispensing practice will still be paid for the item provided it is not on the Black List. Borderline Substances are not listed in the Scottish Drug Tariff but can be found within Appendix 2 of the British National Formulary (BNF). Within the Drug Tariffs for England and Wales and Northern Ireland they can be found as two lists: List A: is an alphabetical list of products with the ACBS approved conditions shown underneath each product. List B: is an alphabetical list of conditions and the products which the ACBS has approved for the management of those conditions. |
ACBS |
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Why is a prescription endorsed once dispensed? |
When a prescription is dispensed, it is endorsed. There are three reasons for this: it prevents it from being dispensed again (in error) should there be any problems, the prescription can be checked in community pharmacy and dispensing practices, the endorsement informs the pricing bureau what has been supplied so that the pharmacy or practice can be correctly paid |
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Why is a prescription endorsed once dispensed? |
When a prescription is dispensed, it is endorsed. There are three reasons for this: it prevents it from being dispensed again (in error) should there be any problems, the prescription can be checked in community pharmacy and dispensing practices, the endorsement informs the pricing bureau what has been supplied so that the pharmacy or practice can be correctly paid |
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List common Prescription Endorsements. |
Pack Size Commonly used generic drugs are listed in each Drug Tariff. The price paid for each preparation is listed next to the drug. The pack size supplied or used when dispensing should be written as an endorsement if there is more than one pack size listed in the Drug Tariff for that item. If the form is not endorsed and the quantity is different to any pack sizes listed, it will be assumed that the drugs were dispensed from the next largest pack size. Dispensary computer systems may suggest the generic product to dispense based on the price paid for that drug and the amount the pharmacy will be reimbursed. The recommended or preferred product will change, sometimes quite frequently, as pharmacies and dispensaries try to find the best prices from their suppliers. Brand Name For preparations prescribed generically and not listed in the Drug Tariff, the endorsement must include the brand name or, if this does not exist, the manufacturer/supplier. Broken Bulk Broken bulk is a claim which can be made when the pharmacy or dispensary has ordered the minimum quantity possible of a preparation but have some remaining stock after the prescription has been dispensed. If the prescription is endorsed "Broken Bulk" the organisation will be paid for the full amount they had to order rather than just the quantity on the prescription. Should any further prescriptions for the same item be dispensed in the following six months it will be assumed that the remaining stock has been used and the contractor will only be paid the container and professional dispensing fees for those prescriptions. After six months the contractor must indicate on subsequent prescription forms whether a claim for payment for the drug is being made as it could be that the same container is still being used, in which case the endorsement should clarify this so that double payment is not issued for the stock. There are some situations when broken bulk cannot be claimed. Out-of-Pocket Expenses Pharmacies and dispensing practices can claim reimbursement for out-of-pocket expenses they have incurred when obtaining certain drugs, appliances or reagents. Examples include postage costs or delivery charges. The specific circumstances and rules relating to when and how the claims can be made can be found in the Drug Tariff as these expenses cannot be claimed on all items. Evidence of the expenses paid is typically required. Drugs or Appliances Not Dispensed Occasionally a patient may request that an item on their prescription is not dispensed. The pharmacist, or prescriber in a dispensing practice, should be promptly made aware of this so that they can discuss the implications of not having the item with the patient. Any items which are not dispensed should be clearly marked with the endorsement N/D or "Not Dispensed". Bulk Prescriptions Usually prescriptions are for individuals. However, in England and Wales a doctor may prescribe a "Bulk" prescription if the following criteria are met: the prescription must be for two or more people the prescription must state the name of a school/institution where at least 20 people normally live the doctor is responsible for at least half of the residents the prescription is not for a POM or a dressing containing a POM The prescription is exempt from charge and should be endorsed with "Bulk Prescription". Bulk prescriptions are not allowed on GP10 forms in Scotland. Instead the GP10A form should be used. A number of otherwise non prescribable items can be ordered on GP10A forms; these are marked by an asterisk in the Drug Tariff and include sutures. Extemporaneously Dispensed If an item has been extemporaneously prepared from its ingredients, the prescription should be endorsed to reflect this. Full details of the ingredients should be given to ensure appropriate reimbursement. Broken bulk may be claimed on the ingredients used if applicable. No Cheaper Stock Obtainable: “NCSO” Recently there have been supply problems with various generic medicines, where contractors have problems obtaining those generic medicines at the Drug Tariff prices. The Department of Health and Social Care issues a list of price concessions on a monthly basis which reimburses the contractor by the set price rather than the Drug Tariff price. However, the list changes every month, and the price concessions are only valid for that particular month; the concessions do not automatically carry over to the following month. You can keep up to date with price concessions on the PSNC website. |
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How are the following processes sorted? Filing, Storing and Processing Prescriptions for Payment |
Usually at the end of each day, the prescriptions will be counted and the number of forms and items dispensed will be recorded. Often the person carrying out this task will also double check the reverse of the forms to ensure they have been correctly completed. The prescriptions are then filed by type and may also be filed by prescriber. This is done because the prescriptions must be sorted in a particular way prior to being submitted for payment. If a prescription has been received electronically via the Electronic Prescription Service, a dispense notification is sent informing the patient that their prescription is ready. After this an electronic claim for reimbursement can be submitted to NHS Prescription Services. This can be done in real time, at the end of each day, in batches or on a weekly basis. Dispensing or prescription tokens which have been signed by the patient or their representative should be separated from FP10s. They are then secured in separate bundles and sent to NHS Prescription Services. Tokens that have not been signed on the reverse should be destroyed in confidential waste; they do not need to be sent to NHS Prescription Services. Medicines supplied to patients on wards (inpatients) are written on a medicine prescription and administration chart (the ‘drug chart’) and this remains on the ward. Hospital out-patient prescriptions are usually filed in date order, they do not need to be sent for reimbursement, unless they are written on a hospital FP10HNC.
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How are the following processes sorted? Filing, Storing and Processing Prescriptions for Payment |
Usually at the end of each day, the prescriptions will be counted and the number of forms and items dispensed will be recorded. Often the person carrying out this task will also double check the reverse of the forms to ensure they have been correctly completed. The prescriptions are then filed by type and may also be filed by prescriber. This is done because the prescriptions must be sorted in a particular way prior to being submitted for payment. If a prescription has been received electronically via the Electronic Prescription Service, a dispense notification is sent informing the patient that their prescription is ready. After this an electronic claim for reimbursement can be submitted to NHS Prescription Services. This can be done in real time, at the end of each day, in batches or on a weekly basis. Dispensing or prescription tokens which have been signed by the patient or their representative should be separated from FP10s. They are then secured in separate bundles and sent to NHS Prescription Services. Tokens that have not been signed on the reverse should be destroyed in confidential waste; they do not need to be sent to NHS Prescription Services. Medicines supplied to patients on wards (inpatients) are written on a medicine prescription and administration chart (the ‘drug chart’) and this remains on the ward. Hospital out-patient prescriptions are usually filed in date order, they do not need to be sent for reimbursement, unless they are written on a hospital FP10HNC.
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How is Submission made of Prescriptions for Payment? |
Submission form - FP34C At the end of each calendar month in England and Wales and every two weeks in Scotland, prescriptions are organised and sent to the NHS prescription Services for payment. Any staples and paper clips must be removed and the forms must be in a specific order and packed according to the instructions given on the relevant submission form sent by the pricing bureau. The most obvious segregation in England is that the prescriptions which are not paid for are separated from those where the patients have paid. This is because the contractor keeps the money paid for prescriptions and then this amount is taken off the amount paid in reimbursements and fees.
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How are the following processes sorted? Filing, Storing and Processing Prescriptions for Payment |
Usually at the end of each day, the prescriptions will be counted and the number of forms and items dispensed will be recorded. Often the person carrying out this task will also double check the reverse of the forms to ensure they have been correctly completed. The prescriptions are then filed by type and may also be filed by prescriber. This is done because the prescriptions must be sorted in a particular way prior to being submitted for payment. If a prescription has been received electronically via the Electronic Prescription Service, a dispense notification is sent informing the patient that their prescription is ready. After this an electronic claim for reimbursement can be submitted to NHS Prescription Services. This can be done in real time, at the end of each day, in batches or on a weekly basis. Dispensing or prescription tokens which have been signed by the patient or their representative should be separated from FP10s. They are then secured in separate bundles and sent to NHS Prescription Services. Tokens that have not been signed on the reverse should be destroyed in confidential waste; they do not need to be sent to NHS Prescription Services. Medicines supplied to patients on wards (inpatients) are written on a medicine prescription and administration chart (the ‘drug chart’) and this remains on the ward. Hospital out-patient prescriptions are usually filed in date order, they do not need to be sent for reimbursement, unless they are written on a hospital FP10HNC.
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How is Submission made of Prescriptions for Payment? |
Submission form - FP34C At the end of each calendar month in England and Wales and every two weeks in Scotland, prescriptions are organised and sent to the NHS prescription Services for payment. Any staples and paper clips must be removed and the forms must be in a specific order and packed according to the instructions given on the relevant submission form sent by the pricing bureau. The most obvious segregation in England is that the prescriptions which are not paid for are separated from those where the patients have paid. This is because the contractor keeps the money paid for prescriptions and then this amount is taken off the amount paid in reimbursements and fees.
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What happens if prescriptions are returned from the NHS prescription service after being submitted? |
Unfortunately, prescriptions will sometimes be returned by NHS Prescription Services. This is not ideal as it delays payment. Common causes include: the endorsement gives insufficient information and so it is not clear what has been dispensed the pharmaceutical form is missing from the prescription and more than one is available a disallowed item has been dispensed; this could be an item from the Black List or a prescriber not adhering to their profession’s formulary (the prescription cannot be resubmitted in this instance) It is therefore extremely important to endorse prescriptions correctly in the first instance. |
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What is a ‘special container’? |
For most prescriptions the quantity ordered by the prescriber will be the quantity dispensed. However, products in special containers are exceptions. Certain drugs and chemical reagents are classed as having "Special Containers", this means the container cannot easily be split. If the amount prescribed does not match the quantity in an original pack, the amount nearest to that on the prescription must be dispensed using whole pack(s). If the prescribed quantity is exactly half way between two packs, the pharmacy will only be paid for supplying the lower number of packs. The quantity supplied should be endorsed on the prescription. In hospitals, medicines that come in special containers are dispensed in the original container or are packed down in to another container and a shorter expiry date is given to them. The drugs and chemical reagents supplied in special containers are those which are: sterile effervescent hygroscopic (attract water) liquid preparations for the addition to bath water coal tar preparations viscous external preparations packed in tubes, drop-bottles, aerosols, roll-ons, sachets, shakers, sprays or any container from which it is not practical to dispense an exact amount different to the quantity in the original pack |
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How is the concentration of a substance expressed? |
The concentration of substances can be expressed in many different ways, for example: grams per litre (g/l) milligrams per litre (mg/l) milligrams per millilitre (mg/ml) grams per millilitre (g/ml) moles per litre (mol/l) parts (e.g. 1 in 200) percentages (e.g. 1%) In general, the concentrations of drugs you will see in the dispensary are expressed as mg/l, mg/ml or as a percentage. The exception is concentrations of solutions for injections which are often expressed as mol/l. We will look at how to calculate these concentrations in this module. You should appreciate that you must carefully check the concentration of a product when dispensing to ensure it matches what is written on the prescription. |
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How to Convert Units of Mass and Volume? |
Mass is a measurement which tells us how much of a substance there is. A metric system is used for measuring mass, the base unit of which is a kilogram (kg). A kilogram is the largest unit and 1 kilogram is the same as 1000 grams (one thousand grams) or 1000000 milligrams (one million milligrams). Wherever a strength is less than 1, it should be written as full numbers rather than as decimals. |
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Example calculation - Convert 250micrograms into milligrams. |
From the units of mass table above we know there are 1000micrograms in 1mg (and therefore the answer is going to be less than 1mg as we do not have 1000micrograms). To work out the answer we must do the following calculation: 250/1000 = 0.25 The answer is that 250micrograms = 0.25mg |
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Example calculation - Convert 0.6g into milligrams |
From the units of mass table above we know that there are 1000milligrams in 1g (and therefore, as we have over half a gram, we know our answer must be over 500milligrams). To work out the answer we must do the following calculation: 0.6 x 1000 = 600 The answer is that 0.6g = 600mg |
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Example calculation - Convert 0.05g into micrograms |
First convert 0.05g into milligrams by multiplying by 1000: 0.05 × 1000 = 50 So 0.05g = 50mg Then convert 50mg into micrograms by multiplying by 1000: 50 × 1000 = 50000 The answer is that 0.05g = 50000micrograms Alternatively, this could have been completed in one step by multiplying 0.05 by 1000000 |
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Example calculation - Convert 0.76L into millilitres |
As we are going from litres to millilitres we need to multiply by 1000 0.76 × 1000 = 760 The answer is that 0.76L = 760mL |
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What is a percentage and how are they expressed? |
Often the strengths of topical preparations, such as creams and ointments, are expressed as a percentage and if you have to make a preparation extemporaneously (from the raw ingredients) you will need to know how to calculate how much of each ingredient is required. Percentage strength is the amount of drug in grams per 100g . This means that a 1% preparation contains 1g of the drug per 100g of the preparation. There are different ways to express percentage strengths depending on whether the solvent and solute are solid or liquid. Solids are measured by weight, whereas liquids are measured by volume. Click on the headings below to learn more. Dispensing labels should show what the percentage relationships are, namely w/w, v/v or w/v. Remember that: 1% w/v means 1g in 100ml 1% w/w means 1g in 100g 1% v/v means 1ml in 100ml |
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Explain w/w, v/v and w/v. |
w/w For weight in weight (w/w), both solvent and solute are solids, so they would need to be weighed in the required ratios. For example, 100g of 1% menthol in aqueous cream will contain 1g menthol and 99g of aqueous cream. Both ingredients should be weighed in grams. v/v For volume in volume (v/v), both solvent and solute are liquids, so each volume would be measured using the appropriate equipment, such as a measuring cylinder, pipette, or similar. Most measurements will be in millilitres. For example, 100ml of 40% ethanol solution would have 40% ethanol and 60ml water. w/v A 1% solution would have 1g of solid dissolved in a final volume of 100ml of solution (liquid). For example, 100ml of 2.5% solution of NaCl (sodium chloride, salt solution) would have 2.5g salt (solid) dissolved in a total volume of 100ml. Note that you add water to make up to 100ml, which is different to adding 100ml of water. 1% w/v means 1g in 100ml 1% w/w means 1g in 100g 1% v/v means 1ml in 100ml |
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Example calculation - How much hydrocortisone is there in a 30g tube of 1% hydrocortisone cream? |
This cream contains 1% hydrocortisone. Percent means "out of every hundred". In this example, our cream contains 1 part hydrocortisone cream in 100 parts or 1g of hydrocortisone in 100g. How much hydrocortisone is there in a 30g tube of 1% hydrocortisone cream? We know: 1% = 1g in 100g If we divide by 10 this tells us there is 0.1g of hydrocortisone (or 100mg) in 10g of the cream 1/10 = 0.1g In our case we have 30g so we need to multiply the amount in 10g by 3: 0.1 × 3 = 0.3g The answer is therefore that there is 0.3g hydrocortisone in 30g of cream Alternatively, this could be expressed in the following formula, where 1 is the percentage of hydrocortisone, 30 is the total amount of cream in grams and 0.3 is the number of grams of hydrocortisone in 30g: 1/100 × 30 = 0.3g |
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Example calculation - 100mg of drug X was mixed with Aqueous Cream BP until it was evenly dispersed. The cream was then made up to a total weight of 50g with more Aqueous Cream BP. What is the percentage strength? |
We know that percentage strength is the amount of drug in grams per 100g. We used 100mg of the drug. We can convert this figure to grams by dividing by 1000 100/1000 = 0.1g So we have: 0.1g of drug X in 50g To convert this to the amount in 100g we need to multiply by 2: 0.1 × 2 = 0.2g We have calculated that there is 0.2g of drug X in 100g so the percentage strength is 0.2% Or, using the same formula as before: ?/100 × 50 = 0.1 Where ? is the percentage of drug X that we want to calculate, 50 is the total number of grams of cream and 0.1 is the total amount of drug X in grams. This can be rearranged to give: (0.1×100)/50 = 0.2 |
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In pharmacy terms, what is the concentrated solution called? |
In pharmacy terms, the concentrated solution is called a stock solution. |
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What are ratios and dilutions? |
Ratios are a way of expressing the proportions of parts or ingredients. The most common examples we use in everyday life are food recipes. The same principle of ratios can be applied to dilutions of liquids. A common everyday example is diluting fruit squash drink with water. |
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There are 2 methods of calculating dilutions. Write them. |
Method 1: Dilution Factor To calculate the dilution factor, you must have the percentage strength of each solution to start with. There are two stages in this process: 1. Work out the dilution factor 2. Calculate the volume required using the dilution factor Dilution factor =Strength of concentrate / Strength of dilute solution Step 1 To work out the dilution factor: Dilution factor = 5/0.5 = 10 Step 2 Use the dilution factor and final volume to calculate the volume of concentrate required. Final volume / Dilution factor = Volume of concentrate required For this example, you will 10ml of the diluted solution. The dilution factor is 10. 10ml / 10 = 1ml So 1ml of 5% stock solution is required to make 10ml of 0.5% diluted solution. Method 2: Formula C1 × V1 = C2 × V2 C1 = strength of the concentrated solution (as a percentage) V1 = volume of concentrated solution (as ml) C2 = strength of the diluted solution (as a percentage) V2 = volume of the diluted solution you are making (as ml) This equation can be rearranged to work out either the concentration or volume required: To work out a concentration: C1 = C2 × V2 / V1 To work out a volume: V1 = C2 × V2 / C1 For the example below, to work out the volume: V1 = 0.5% × 10ml / 5% = 1ml (You are required to make 10ml of a 0.5% solution of sodium chloride and the stock (concentrated) solution is 5%. How much of the stock solution will be required for the dilution?) |
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How to Convert Units of Concentration? |
Think about how you can convert units of mass and volumes, for example, from grams into milligrams, and litres into millilitres, vice versa. The most common units of concentration you will see in medicines are mg/g, mg/ml (usually per 5ml for some oral liquid medicines, like paracetamol 250mg/5ml oral suspension), and percentages. Remember that: 1% w/v means 1g in 100ml 1% w/w means 1g in 100g 1% v/v means 1ml in 100ml You should start by converting the units of mass and volumes into grams and millilitres to make the units consistent and make your calculations easier. |
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Example calculation - g/l to percentage. A stock solution is 2g/0.2l. |
We should start by converting litres into millilitres. 2g / 0.2l = 2g / 200ml 0.2l × 1000ml /l = 200ml because there are 1000 millilitres per litre. You don’t need to convert 2g because it is already expressed in grams. Now we can follow the same steps to work out the percentage strength: 2g × 100 / 200ml = 1% Note that this is w/v because the solute is solid and solvent is liquid. |
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Example calculation - g/l to percentage. A stock solution is 2g/0.2l. |
We should start by converting litres into millilitres. 2g / 0.2l = 2g / 200ml 0.2l × 1000ml /l = 200ml because there are 1000 millilitres per litre. You don’t need to convert 2g because it is already expressed in grams. Now we can follow the same steps to work out the percentage strength: 2g × 100 / 200ml = 1% Note that this is w/v because the solute is solid and solvent is liquid. |
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Example calculation - mg/ml to percentage. The strength of a solution is 100mg/20ml. |
Start by converting mg into g: 100mg = 0.1g You don’t need to convert 20ml because it is already expressed in millilitres. Then use the same method to work out the percentage strength: 0.1g × 100 / 20ml = 0.5%w/v This is also the same as saying 0.1g in 20ml, so there will be 0.5g in 100ml, which means the strength is 0.5%w/v. The key is to remember that 1%w/v means 1g/100ml, and to convert to the correct units before starting the calculation. |
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What is Body Surface Area? |
The body surface area (BSA) is just what it sounds like – how big is the surface of your body? This would be the total area covered by all of your skin. The dosages of some medicines may be calculated by BSA for individual patients, particularly cytotoxic medicines used in chemotherapy. |
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Why are the risks of toxicity of medicines increased in babies? |
All children differ from adults in their response to medicines. Special care is needed for newly born babies, particularly in the neonatal (newborn) period or first 30 days of life.
The risks of toxicity of medicines are increased because of the following: enzymes required to metabolise (change, break down or get rid of) the medicine may be deficient the organs, particularly the kidneys and liver, are not sufficiently developed to deal with excretion and detoxifying procedures the weight of the baby is very small. In childhood, doses may be adjusted by the body surface area or age, depending on the medicine A more accurate approach which helps to avoid this issue is to use the patient's weight when calculating how much of a drug they need. The dose will be given per kilogram of body weight, e.g. 8mg/kg. When calculating the dose for these drugs, the dose per kilogram simply needs multiplying by the patient's weight. Sometimes a further calculation will then be needed to work out how much of our preparation contains the required amount of drug so we know how much the patient needs to take/be given. Using the patient's weight is not without problems. Doses calculated for older children based on their weight may suggest the child needs more of a drug than an adult would. Drugs which need extremely precise doses, such as those used in cancer treatment, are often prescribed using the patient's body surface area instead of their weight. Special charts are used to calculate this figure and the answer will be measured in square metres (m 2 ). The dosage for such drugs is given as the amount per m 2 , e.g. 2mg/m 2 . |
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Why must an adult dose of a drug be adjusted in adult patients, particularly in elderly patients and those with impaired kidney or liver function? |
Sometimes an adult dose of a drug must be adjusted in adult patients, particularly in elderly patients and those with impaired kidney or liver function. As our bodies get older, we start to deal with medicines differently or less efficiently. Some differences may be: drug levels in the blood are higher because we cannot get rid of it as quickly the effects of the drug are greater or last for longer (because we cannot get rid of it as quickly) we experience more side effects levels of medicine in the blood are lower because we do not absorb the medicines as effectively |
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What is a parallel import drug? |
These are medicines that are manufactured in Europe and imported into the United Kingdom. Parallel medicines are imported because they are sold for less in mainland Europe and as there is a fixed price paid for each drug dispensed using parallel imports can increase profitability. For a drug to be accepted as a parallel import it must: be manufactured to Good Manufacturing Practice (GMP) Standards have a special marketing authorisation from the Medicines and Healthcare Regulatory Agency (MHRA) known as a PL(PI) have the packaging and patient information leaflets in English (this may mean re-labelling or repackaging the product) The generic name of the drug must be the same as the generic name used in the UK. (The brand name can also be the same but, as most prescriptions are written generically, it is the generic name which is most often the more significant of the two). |
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What kind of checks need to be carried out during the dispensing process? |
professional check, also known as the clinical check in-process self-checks final accuracy check |
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What is Summary Care Records (SCR) ? |
The Summary Care Records (SCR) is an electronic summary of a patient's medical records held by their GP. Allowing other healthcare professionals to access the SCR can be beneficial to patients as it means the healthcare professional doesn't have to rely entirely on the patient to give them their medical history. However, in order to access the SCR, the patient must have given their consent. Only authorised healthcare professionals with personal NHS smartcards can access these records, and they should only be accessed when there is a clinical need. SCRs hold clinical information including medication history, allergies and adverse reactions, which can be helpful in emergency supplies of medicines where pharmacists can check to make sure the medicine is suitable for the patient. This means pharmacists can still find out clinical information about patients outside of GP surgeries’ working hours. This can improve patient safety. |
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List sundry items. |
Spoon Oral syringe Spacer devices Warning cards (steroid treatment card, Anticoagulant Alert Card, lithium alert card, methotrexate alert card) The NHS Insulin Passport Medical ID accessories |
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What's a Medicine Administration Record (MAR)? |
The Medicine Administration Record (MAR) chart is a legal record of the administration of medicines within care homes. The chart looks similar to the prescription and administration charts used in hospitals, but they are not used for prescribing purposes. The MAR is a record of what care workers administer to people who use care services, and it belongs to the care provider. For each care home resident, the chart provides a record of what is currently prescribed and what has been administered to a resident (including self-administered medicines). The carer or nurse signs each time a medicine or device is administered to a patient. Responsibility for providing MAR charts rests with the care provider; the pharmacist or dispensing GP are not responsible. However, in real life practice, MAR charts are easier to produce at the point of medication labelling and assembly.
Traditionally MAR charts have been produced in paper format, however electronic systems are emerging to replace paper MAR charts. |
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What is a Multi-Compartment Compliance Aids (MCAs)? |
Multi-Compartment Compliance Aids (MCAs) are also known as Monitored Dosage Systems (MDS). They are usually plastic trays with compartments divided into four different times of the day for each day of the week, where each dose of the medicines is put into the correct slot in the tray. The tray is prepared against a prescription (for dosette boxes) or Medicine Administration Record (MAR) chart (MCAs in care homes) by putting individual doses of medicines into each slot against the time and day the dose is due, each dose is called a unit dose . Effectively, the medicines are removed from their original packaging and repackaged into the MCAs according to the patient’s dosage regimen. The tray will go through the same legal, clinical and accuracy checks as normal prescriptions, then it will be sealed, usually with a self-adhesive sheet that has a space to pop out the unit dose (like popping out the chocolate each day on an Advent Calendar for Christmas). It will then be ready for the patient or carer to pop out the unit dose required at each time slot. Although MCAs are still widely used at the moment, they present potential problems and there has been growing evidence to move away from their use. This chapter aims to help you understand how to prepare and use MCAs safely. The decision to use MCAs is not always black and white. It is up to the organisation offering MCAs to carry out risk assessments and weigh up the potential benefits and risks. |
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The regulations specify the four classifications of veterinary medicinal products (VMP). What are they? |
When referring to POM-VPS products, the term "prescribing" can lead to confusion. A pharmacist "prescribing" these preparations will simply ask questions and provide advice in the same way they would when supplying a Pharmacy (P) medicine. This situation is not to be confused with pharmacists who are Independent or Supplementary Prescribers as mentioned in the Receiving and Interpreting Prescriptions section. You can use the Veterinary Medicines Directorate to confirm the classification of a VMP. https://www.vmd.defra.gov.uk/ProductInformationDatabase/Default.aspx |
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What are Veterinary Prescription Requirements?
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POM-V and POM-VPS products can only be prescribed against a valid prescription. Where the prescriber is the same person as the supplier e.g. if a veterinary surgeon sees the animal and then supplies the POM-V or POM-VPS then the prescription can be oral or written. If, however, the prescriber does not supply the product then a written prescription must be generated e.g. if a veterinary surgeon saw the animal and then a pharmacist supplied the POM-V or POM-VPS medication. Veterinary prescriptions also need to meet particular requirements. The extra information required in addition to the prescription requirements you have already learnt about are: name and address of owner/keeper identification (including species) of the animal or group of animals being treated the premises at which the animals are kept if different to the owner/keeper's address the dosage and administration instructions (the Veterinary Medicines Directorate advises that "as directed" is not acceptable) the withdrawal period if relevant if it is prescribed under the cascade a comment to indicate this Veterinary prescriptions for Schedules 2 and 3 controlled drugs must also meet these extra requirements in addition to the usual controlled drugs prescription requirements: the address of the prescriber must be in the UK and their RCVS number should be on the prescription there must be a declaration that the controlled drug is prescribed to treat an animal or herd under the veterinary surgeon or veterinary practitioner's care the name and address of the person to whom the controlled drug is to be delivered must be stated Prescriptions for controlled drugs in Schedules 1-4 are valid for 28 days from the date on the prescription. All other prescriptions are valid for a maximum of six months from the date on the prescription; the prescriber may shorten this period.
Repeatable prescriptions are permitted except for Schedule 2 and 3 controlled drugs. Repeatable prescriptions must state the number of repeats. |
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What does clinical governance mean? |
Clinical governance means taking care over your work and getting the right things to the right people at the right time. It is vital in protecting patient safety and it plays an important part in the work of pharmacy and dispensary teams. The following questions should be considered as part of a clinical governance strategy: what could go wrong? how do we prevent things going wrong? where and how would we document any incidents or near misses? how can we all learn from our mistakes? Error reduction is a key part of clinical governance. |
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What are the Classification of Errors? |
Violations A violation is a deliberate deviation from SOPs or working regulations. For example, where a dispenser does not get work checked even though this is stated in the SOP. The reason for the violation can vary. It may be due to lack of motivation, low self-esteem and/or poor organisational procedures. In some cases, staff may perceive that a shortcut is needed to enable then to complete a task. For example, a person producing labels on the dispensing software has noticed that an interaction has been flagged up between a new medicine and the patient’s regular medicine, but instead of alerting the pharmacist, they decide to ignore the warning because they wanted to finish dispensing the prescription quicky. For the member of staff involved, a violation may result in a disciplinary procedure. (For other types of error this would be unlikely). Skill-based Errors: Slips and Lapses Slips and lapses are skill-based errors. They occur when the action performed was not as planned. In general, skill-based errors are associated with familiar tasks which require little conscious attention. Slips are when the action was not completed as planned. In other words, the member of staff will know the correct action to take but still makes the error. For example, putting Eumovate® cream into the fridge when they meant to put the Timodine® cream that was lying next to it, into the fridge. Lapses are memory-based and are caused by a lack of attention or simply forgetting to do something. Typically, the outcome will be the same for a lapse as for a slip. For example, forgetting to mark a split pack after taking out one of the blister strips to fulfil a prescription then putting that unmarked split pack onto the shelf. Skill-based errors can occur when someone is experienced and confident in their role. They may be on auto-pilot as they perform familiar and routine tasks. They may not even realise that any changes may need addressing, which can lead to errors happening. Mistakes Mistakes are rule-based or knowledge-based. Rule-based mistakes relate to situations where a rule is ignored because it is perceived to be a poor rule, or the rule is applied incorrectly. For example, you misjudge how many fexofenadine tablets to reorder for the next day because you didn’t factor in the seasonal demand in the summer for hay fever. Knowledge-based mistakes are caused by the person having insufficient knowledge to consciously make the right decision. For example, the person did not know that Timodine® cream needs to be stored in the fridge (below 15°C). Never Events Never events are serious, largely preventable safety incidents that should not occur if the available preventative measures are implemented. (Care Quality Commission, 2018) Never events are serious patient safety incidents. They include the following types of incidents: wrong site surgery wrong implant/prosthesis misplaced nasogastric or orogastric tubes transfusion or transplantation of ABO incompatible blood components or organs Some never events are related to medication use. As for other patient safety incidents, never events are reported to a national agency, who analyse trends and, in some cases may issue a report or patient safety alert. |
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What is a Medication Safety Officers? |
Organisations providing healthcare are required to appoint a named Medication Safety Officer (MSO) to review medication incidents and oversee safety improvements within their organisation. MSOs work in all sectors of the NHS including hospitals, community pharmacies and Clinical Commissioning Groups (CCGs) |
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What kind of individual patient factors should be considered when supplying dispensed medication? |
In community pharmacies and hospital pharmacy departments, the pharmacists perform legal and clinical checks on each prescription. By doing this, they are looking to confirm that the prescription meets all the legal requirements and that the items prescribed are suitable for the patient. Refresh your memory on the legal requirements of prescriptions in the Receiving and Interpreting Prescriptions chapter. In this process, the pharmacist will consider many things including the patient's age, any long term (chronic) illnesses and/or additional needs they have, the medication they already take, any known allergies and whether the patient is pregnant or breastfeeding. This is because these factors may affect the treatment options available to the patient. |
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