5) Prescription only medicines (POMs): professional and legal issues Flashcards
General Prescription Requirement?
- Signature: signed in ink by prescriber. An advanced electronic signature can
be used. - Address of prescribed
- Date: Prescription valid for up to 6 months from the appropriate date if POM. See
special requirements for CDs schedule 2, 3 or 4.
For private prescriptions the appropriate date is the date the prescription was
signed. For NHS prescription the date is the later of either the date the
prescription was signed or another date as indicated by the prescriber - Particulars that indicate the type of appropriate practitioner
- Name of the patient
- Address of the patient
- Age of the patient if under 12
• Medicinal products are not a legal requirement…but are important for
supply and renumeration.
- ‘As directed’ : check with patient they understand how to use the medicine
Indelible: indelible ink, computer generated or typed
- Carbon copies: allowed as long as signed in ink
- Electronic prescriptions: must still meet general requirements.
- Language is not specified but the pharmacist must be able to understand the
prescription and put safety first.
diff types of prescription
http://psnc.org.uk/dispensing-supply/receiving-a-prescription/is-this-prescription-form-valid/
Owings?
• If the pharmacy does not have stock or has only part of the medicines prescribed, the pharmacy can issue what they do have and provide an owing slip to collect the remainder at a later date. • Any owed medicines should be supplied within a timeframe depending on the medication classification • POM and CD Sch 5: – 6 months from appropriate date • P and GSL – 6 months from appropriate date • Sch 2, 3 and 4 CDs: – 28 days after appropriate date
Pharmacists and pharmacies can also supply against a private prescription
• Same requirements as NHS prescriptions
• Can be repeated
– ‘repeatable prescriptions’ are private prescriptions that can be dispensed more than once e.g., ‘repeat x 5’ so you can dispense six times so first then a further five
– If not stated only repeated once I.e., twice in total
Timeframes
• POM: First dispensing within 6 months of the appropriate date, but then no legal time limit.
• Sch 4 - first dispensing within 28 days but then no legal time limit but use professional judgement
• Sch 2 & 3 prescriptions are not repeatable.
• Patient can choose to retain prescription and have repeats dispensed from different pharmacies or the pharmacy can retain the prescription
• Annotate the prescription with name and address of pharmacy where the supply was made and the date
Records
If you are dispensing from a private prescription for a pom, must make a record for pom register
Private prescriptions for a POM must be retained for two years from the date of the sale or supply or for repeatable prescriptions from the date of the last sale or supply.
• Private prescriptions for Schedule 2 and 3 CDs must be submitted to the relevant NHS agency, bc for auditing processes, so its a pink pcd prescription
• Records must be made in the POM register (written or electronically), which should be retained for two years from the date of the last entry in the register.
• The record must include:
– Supply date: The date on which the medicine was sold or supplied
– Prescription date: The date on the prescription
– Medicine details: The name, quantity, formulation and strength of medicine supplied (where not apparent from the name)
– Prescriber details: The name and address of the practitioner
– Patient details The name and address of the patient.
• Record keeping should be made on day of supply or sale or next day following
• For Sch 2 and 3 medicines a separate register record should be made in the CD register
Electronic Repeat Dispensing Service, so for standard NHS repeat process
So might want a patient on repeat prescription for taking a med for long term condition and is stable and well maintained with that, rather than reordering every month, prescriber can issue a batch of prescriptions for 12 months Service for greater efficiency
- GP decides to issue prescription which can be repeated X times
- EPS R2 repeat dispensing used to prescribe
- X repeat Rx for the medication added to the spine
- Spine sends Rx to patient’s nominated pharmacy, or is pulled from spine by pharmacist
- pharmacy dispenses repeat Rx
- Patient collects repeat Rx from pharmacy
Electronic repeat dispensing service
• Prescriber authorises a batch of prescriptions for up to 12 months with one signature.
• Prescriptions available for dispensing at specified intervals
• On the repeat prescription, prescriber must add
– Intended time interval
– How many times the repeatable prescription can be issued
• Once prescription generated on the system it is sent to the NHS Spine where it can be downloaded by a nominated dispenser
– Requirement to have nominated dispenser (although this may change in the future)
• Must ensure staff trained to monitor patient in absence of GP review and review for any other changes that may affect suitability of prescription (e.g, new medicines, recent new diagnoses, other drug interactions etc.)
• Repeat authorization token
– Master copy of the prescription
– As well as usual information on all tokens such as patient/ prescriber, it will also include:
• items; number of issues; interval; and end date.
– This is usually held by either the patient or the dispenser
Paper repeat dispensing service?
- Largely superseded but might see in occasionally
- Paper process of slide before- largely superseded but may still see
• Batch of paper prescriptions
– Repeat Authorisation (RA), which indicated number of repeats that can be made.
– When the RA is electronically issued it will not and does not need to be signed and is not used as a prescription
– Repeat Dispensing (RD) form, has a digital signature. These are prescriptions which are dispensed against.
– First dispensing must be within 6 months of the batch being issues
– If RA is not- issued electronically, the prescriber will sign the RA and the batch of RDs do not need to be signed
• Before each supply, confirm patient:
– Is taking and using the medicine and that the actual appliance/ formulation is appropriate
– Is not experiencing any side effects and check whether a review is needed
– Has not had any change to the therapy
– Has not experienced any other changed in their health that should be reviewed
More information: http://archive.psnc.org.uk/data/files/PharmacyContractandServices/RepeatDispensing/service20spec20es22020repeat20dispensing20v1201020oct2004.pdf
Dental prescription?
- yellow
- Dentist can legally can write
prescriptions for any POM
• But General Dental Council
advises dentists restrict
prescribing to competency
and used in dentistry
• If prescribing on an NHS
prescription must prescribe
from the Dental Prescribers
Formulary (see list in BNF
Prescriptions from EEA or Switzerland?
- legally can dispense from a prescription or a repeatable prescription thats been issued from EEA or Switzerland
Prescriptions and repeatable prescriptions issued by an approved health professional in an approved country are legally recognised in the UK.
• Emergency supplies for patients of these healthcare professionals are also permitted.
• See MEP for list of approved health professionals and approved countries
• Can’t supply SCh 2 and 3 CDs there, only UK
EEA and Switzerland prescription requirements?
Prescription requirements:
– Patient details Patient’s full first name(s), surname and date of birth
– Prescriber details Prescriber’s full first name(s), surname, professional qualifications, direct contact details including email address and telephone or fax number (with international prefix), work address (including the country they work in)
– Prescribed medicine details Name of the medicine (brand name where appropriate), pharmaceutical form, quantity, strength and dosage details
– Prescriber signature
– Date of issue Prescriptions are valid for up to six months from the appropriate date (prescriptions for Schedule 4 CDs 28 days). For prescriptions from these countries the appropriate date is the date on which the prescription was signed.
– May need to exercise professional judgement to confirm prescriber and registration status. Should put patient safety at key priority and always aim to support them as much as possible.
Labelling of dispensed product?
• Legal requirement to have the following:
– 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 including:
• ‘Keep out of the reach and sight of children’
‘Use this medicine only on your skin’
where applicable.
• Lawful to label out container but may need to use judgement about what is the most appropriate place for
a label e.g., inhaler rather than box that is likely to be disposed of.
Labelling from broken down supply
• If breaking down the original quantity to
supply a smaller amount to satisfy a
prescription (e.g., 7 tablets from a box of
28) the label must also contain:
• Name of the medicine
• Quantity of the medicine in the container
• Quantitative particulars of the medicine
(i.e. the ingredients)
• Handling and storage requirements
where appropriate
• Expiry date
• Batch reference number (e.g. LOT
number or BN)
Restrictions relating administrations?
• See MEP 2021,
section 3.3
- In healthcare settings organisational policies define who can administer medicines, or the appropriate delegation of the administration of medicines, within that setting.
- Registered healthcare professionals who administer medicines are accountable for their own actions, non-actions and omissions, and exercise professionalism and professional judgement at all times. They would be expected to meet their own professional and regulatory standards and guidance.
- Non registered healthcare professionals are appropriately trained, assessed as competent and meet relevant organisational guidance on medicines administration.
- Before administration, the person administering the medicine must have an overall understanding of the medicine being administered and seeks advice if necessary from a prescriber or a pharmacy professional.
- Wherever possible, the actions of prescribing, dispensing/supply and administration are performed by separate healthcare professionals.
