3.3 Professional And Legal Issues: POM

Question 1

General Prescription requirements [7]

Answer 1

1. Patient Name
2. Patient Address
3. Age if under 12 (DOB not legal req)
4. Prescriber signature
5. Prescriber address
6. Date (valid 6 months, if CD 28 days)
7. Particular - that indicate the type of appropriate practitioner

Question 2

Discuss repeatable prescriptions [4]

Answer 2

• Repeated IF indicated by the prescriber
• Number is not stated - can only be repeated once (dispensed twice)
• UNLESS prescription is for an oral contraceptive - can be repeated five times (dispensed six times in total)
• CD 2 and 3 are not repeatable

Question 3

What is NHS repeat dispensing service

Answer 3

A specified number of ‘batch’ issues that may be dispensed at specified intervals from a pharmacy (England and Wales only).

Question 4

Private Prescriptions POM Entry requirements

Answer 4

1. Supply date
2. Prescription date
3. Drug name, strength, formulation and quantity
4. Prescriber name and address
5. Patient name and address

Question 5

Private POM Prescriptions Record Keeping

Answer 5

• Retain private POM for 2 years from date of supply (last supply of repeat)
• Retain POM register 2 years from last date

Question 6

Why is a faxed prescription NOT ‘legal’ [1]

Answer 6

Because it’s not written in indelible ink

Question 7

What are the risk of supply medicine against fax [7]

Answer 7

1. Uncertain supply made in accordance of a legally valid prescription
2. Risk of poor reproduction
3. Risks of non-receipt, inability to demonstrate a supply was made in accordance of prescription
4. Risks that the original prescription is subsequently amended by the prescriber
5. Risk it’s sent to multiple pharmacies/duplicate made
6. Risk it’s not genuine
7. Risk of faxing is not secure - GDPR

The supply of Schedule 2 and 3 CDs without possession of a lawful prescription could be prosecuted as a criminal offence.

Question 8

What questions help detect

Forged prescriptions [6]

Answer 8

1. Large or excess quantity for the condition?
2. Known prescriber?
3. Is the patient known?
4. Title ‘DR’ before the signature?
5. Patients behaviour - nervous, agitated, aggressive etc
6. Is the medicine commonly used

Question 9

Further investigations for a forged prescription [3]

Answer 9

1 Scrutinise the signature carefully –
possibly checking against a known genuine prescription from the same prescriber

2 Confirm details with the prescriber
(e.g. whether or not a prescription has been issued, the original intention of the prescriber and whether or not there has been an alteration)

3 Use contact details for the prescriber that are obtained from a source other than the suspicious prescription (e.g. directory enquiries)

Question 10

Approved EEA Countries and Switzerland

Answer 10

Austria, Belgium, Bulgaria, Croatia, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Republic
of Ireland, Italy, Latvia, Liechtenstein, Lithuania, Luxembourg, Malta, The Netherlands, Norway, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden, Switzerland.

Question 11

APPROVED HEALTH PROFESSIONAL

Answer 11

Doctors and Dentist
Other professions with prescribing rights i.e. chiropodists or podiatrists, nurses (including community nurses), optometrists, paramedics, pharmacists, physiotherapists and therapeutic radiographers

Question 12

PRESCRIPTIONS FROM THE EEA OR SWITZERLAND

Answer 12

• legally recognised by the UK
• Prescription
• Repeatable prescriptions
• Emergency supply

Question 13

What do if prescription isn’t by an approved EEA country/ Switzerland or an approved health professional

Answer 13

Refer them to local GP, walk-in, 111

Question 14

PRESCRIPTIONS REQUIREMENTS FROM THE EEA OR SWITZERLAND

Answer 14

• Patient full first name(s), surname, DOB
• Prescriber’s full first name(s), surname, professional qualifications, direct contact details including, email address and telephone or fax number (with international prefix), work address (including the country they work in)
• Name of the medicine (brand name where appropriate), pharmaceutical form, quantity, strength and dosage details
• Prescriber signature
• Prescriber signature
• Date of issue - Valid 6 months 28 days if Sch 4

Question 15

CHECKING THE REGISTRATION STATUS OF APPROVED HEALTH PROFESSIONALS

Answer 15

1. Doctors - General Medical Council (GMC) www.gmc-uk.org
2. Dentists - General Dental Council (GDC) www.gdc-uk.org
3. Search for ‘List of EEA competent authorities regulated professions and competent authorities - on the European Commission website (ec.europa.eu/info/index_en).

Question 16

Medicine not allowed on eea / Switzerland prescriptions

Answer 16

• CD Sch 1, 2, 3

Question 17

Legal requirement of a label

Answer 17

• Name of the patient
• Name and address of the supplying pharmacy • Date of dispensing
• Name of the medicine
• Directions for use
• Precautions relating to the use of the medicine.
• The RPS recommends the following also appears on the dispensing label•

‘Keep out of the reach and sight of children’
‘Use this medicine only on your skin’ where applicable.

Question 18

DEFINE COVERT ADMINISTRATION OF MEDICINE

Answer 18

• Medicine are administered in a disguised/without the knowledge /consent of the person receiving them, for example, in food or in a drink.
• People who actively refuse their medication and who are considered to lack mental capacity
• NEWT guidelines

Question 19

ADRENALINE IN AN EMERGENCY

Answer 19

• CHILD 5 OR UNDER: 100-150mcg
• CHILD 6-11: 300mcg
• 12+: 500mcg
  
  • 300 micrograms (0.3 mL) if child is small or prepubertal
  • Anterolateral area of mid thigh - injection site
  • If no improvement repeat dose after 5 mins

Question 20

Brands of adrenaline intramuscular injections in your pharmacy

Answer 20

Epipen®, Emerade® and Jext®

Question 21

Who is exempt to the restrictions on the sale, supply and administration of medicines IN HOSPITALS AND OTHER SETTINGS

Answer 21

patient specific directions (PSDs).

Question 22

EXEMPTIONS: SALE AND SUPPLY WITHOUT A PRESCRIPTION

Answer 22

• Patient group directions (PGDs)
• Patient specific directions (PSDs)
• Emergency supplies
• Optometrist or podiatrist signed patient orders
• Supply of salbutamol inhalers to schools
• Supply of adrenaline autoinjectors to schools
• Supply of naloxone by individuals providing recognised drug treatment services

Question 23

Label of PGD

Answer 23

Same as a normal label
Must state
‘supplied under a PGD’

Question 24

EMERGENCY SUPPLY AT THE REQUEST OF A PRESCRIBER

Answer 24

1. Must be a relevant prescriber
2. EMERGENCY i.e. Pt can collect prescriptions, prescriber unable to drop off prescriptions
3. Follow up prescriptions must be given with 72hrs
4. Directions
5. NO CD’s
6. Record keeping: date supplied; name, strength, formulation and quantity supplied; name and address of prescriber; date on prescription (added when received); date prescription was received

Question 25

EMERGENCY SUPPLY AT THE REQUEST OF A PATIENT

Answer 25

1. Interview the pt 2. Immediately needed - not of surgery is open 3. Must have used in previous (recent-ish) treatment 4. Dose 5. No CD’s 6. CD Exception = 5 days max. Others = no more than 30 days. Give full course of COC. Antibiotics = smallest quantity to fulfil scripts 7. Record keeping - include why pt needs it and why script can’t be obtained 8. Label must include Emergency supply

Question 26

Refuse the supply of an emergency supply

Answer 26

``` Advised pt on how to obtain a prescription E.g. -a doctor, NHS 111, NHS walk-in centre Accident and Emergency department. ``` A record could be made of why request was refused for audit purposes.

Question 27

OPTOMETRIST OR PODIATRIST SIGNED PATIENT ORDERS

Answer 27

Optometrists and podiatrists can authorise supplies of POMs IF they are additionally qualified as independent or supplementary prescribers

Question 28

Supplying medicine to schools

Answer 28

* Adrenaline auto- injectors (AAIs) | * and/or Salbutamol inhalers

Question 29

What does a school signed order require

Answer 29

* Name of the school * Product details (including spacer if relevant) * Strength (if relevant) * Purpose for which the product is required * Total quantity required * Signature of the principal or head teacher Ideally, appropriately headed paper should be used; however, this is not a legislative requirement. Gov.uk

Question 30

What is the maximum amount schools can order

Answer 30

Quantity not specified Pharmacist to use professional judgement Factors: * School size and number of sites it is comprised of * Number of children known to be affected * Past experiences e.g. of children not having access to an AAI or inhaler

Question 31

School signed order: record keeping

Answer 31

* Retain for 2 years | * from supply or POM entry

Question 32

Addition advice for a school signed order

Answer 32

* How to use and store correctly * Advise on appropriate spacer device for the different age groups and how to use them correctly * Advise on correct storage, care and disposal * Advise importance of record keeping, regular date checking and when to replace

Question 33

Supply of Naloxone: law amendments

Answer 33

Human Medicines (Amendment) (No.3) Regulations 2015 allow staff engaged or employed in “lawful drug treatment services” A pharmacy may be commissioned to participate in a local take home naloxone scheme - can continue in the absence of a pharmacist

Question 34

Define ‘staff engaged or employed in “lawful drug treatment services” ‘

Answer 34

(a) an NHS body (b) a local authority (c) Public Health England, or (d) Public Health Agency extends to commissioned services providing needle and syringe programmes AND substance dependence services

Question 35

Administration of Naloxone

Answer 35

* Anyone can administer it * anyone = people likely to witness an overdose and includes family members, peers and staff in regular contact with drug users

Question 36

PPP - PREGNANCY PREVENTION PROGRAMME

Answer 36

• Protects females of childbearing potential by minimising the risk of becoming pregnant while taking these medicines

Question 37

What medicine require PPP

Answer 37

``` • Oral retinoids, • Valproate, • Thalidomide, • Lenalidomide and Pomalidomide ``` carry a high risk of causing foetal malformations and terminating pregnancy

Question 38

VALPROATE PPP

Question 39

ORAL RETINOIDS PPP

Answer 39

DRUG USED TO TREAT SEVERE SKIN CONDITIONS E.g. acitretin, alitretinoin and isotretinoin Programme: education, pregnancy test and distribution control Prescription: check pt compliance, understanding and acknowledgement of PPP Patient: monthly follow up and pregnancy test