emergency supply

Question 1

what is emergency supply

Answer 1

In an emergency, a pharmacist working in a registered pharmacy can supply POMs to a patient (humans not animals) without a prescription on the request of a ‘relevant prescriber’ or a patient.

Each request should be considered on a case-by-case basis, using professional judgement in the best interests of the patient

Question 2

what are the different types of emergency supply?

Answer 2

Request made by:

A prescriber: HMR 2012 Part 12 Chapter 3 Regulation 224

A patient: HMR 2012 Part 12 Chapter 3 Regulation 225

Question 3

how can a prescriber request an emergency supply?

Answer 3

Prescriber contacts pharmacy
by phone
personal visit
by fax/emailing prescription to the pharmacy?

Make sure the phone message is clear-
pharmacist should take the call
confirm what is required
ask for further details if necessary

Question 4

which prescribers can request emergency supply?

Answer 4

Prescriber must be registered in the UK or EEA/Switzerland

Pharmacists must be satisfied that the request is made by an appropriate prescriber- CHECK QUALIFICATIONS

Doctor
Dentist
Supplementary prescriber
Community practitioner nurse prescriber
Independent prescriber (nurse, pharmacist, optometrist, podiatrist, physiotherapist)
EEA or Swiss health professional
(EEA – European Economic Area - doctor, dentist, nurse, midwife, pharmacist defined within meaning of Council Directive 2005/36/EC)

Question 5

Emergency supply at Prescriber’s request - records

Answer 5

The record in the POM register (same day or next day) must state:

Date the medicine was sold or supplied
Name, form, strength, quantity of product
Name & address of prescriber 
Name & address of patient
Date on prescription
Date prescription received

Good practice:

Emergency supply-request of prescriber*
NHS paid/exemption, fee for private Rx*
Dosage of medication*
POM register reference number* (same number on dispensing label)

Question 6

how many days supply can the dr ask for?

Answer 6

however long .. not too long as it is emergency supply

Question 7

do the words emergency supply have to be on the prescription

Answer 7

no

Question 8

is fax or emailed prescription an emergency supply

Answer 8

-its not legally an emergency supply but it is still taken as seriously as one - and the prescriber will supply the prescription within 72 hours

Question 9

can you supply CD on emergency supply?

Answer 9

POM is NOT a CD Schedule 1, 2, or 3 except phenobarbital used in the treatment of epilepsy

schedule 4 and 5 is fine as long as the prescriber has the qualification to supply it

Question 10

summary of emergency supply at the request made by prescriber

Answer 10

1) take request by prescriber
2) ensure supply is legal and safe for the patient
3) if appropriate label and dispense the medication
4) document supply in POM register
5) patient or representative collects medication - take rx if necessary
5) receive rx and finish the pom register

Question 11

what are the requirements for emergency supply at the request of a patient

Answer 11

Pharmacist (Responsible Pharmacist) MUST interview the patient him/herself and be satisfied that:

Immediate need for the POM
Impracticable to obtain a prescription without undue delay
Treatment has previously been prescribed by a UK registered appropriate prescriber for the patient or EEA or Swiss health professional (this is usually interpreted as regular medication)
It is an appropriate dose for that patient in the circumstances

Question 12

how many day treatment should be supplied for emergency supply requested by patients and what are the exemptions

Answer 12

No greater than 30 days treatment should be supplied

except:
Ointments, creams or aerosol (e.g. inhaler) – supply smallest pack
Oral contraceptive – give full cycle
Antibiotics in liquid form –smallest quantity to complete the course
Insulin – smallest pack

Question 13

what are the standards for emergency supply in the request of a patient?

Answer 13

• no more than 30 days supply - unless the exempt
• Controlled Drugs (CDs) Schedule 2 and 3 CANNOT be supplied, except for phenobarbitone (phenobarbital) for epilepsy ONLY (Sch 3 CD)
• Phenobarbitone/phenobarbital or a Schedule 4 or 5 CD can be supplied for no more then 5 days treatment.
• A record in the POM register must be made on the day (or next day if impractical)

Patient of an EEA or Swiss health professional CANNOT obtain any Schedule 1, 2 or 3 CDs (even phenobarbital) or medicines without a UK Marketing Authorisation (MA)

There is also a list of substances that cannot be supplied to a patient as an emergency supply HMR 2012 (Schedule 18)

Question 14

what are the list of medicines which should nor be supplied at patient request?

Answer 14

Ammonium bromide                    
Hexobarbitone sodium
Prolintane hydrochloride
Calcium bromide
Hydrobromic acid
Sodium bromide
Calcium bromidolactobionate
Meclofenoxate hydrochloride
Strychnine hydrochloride

Methohexitone sodium
Tacrine hydrochloride
Fencamfamin hydrochloride
Pemoline
Thiopentone sodium
Fluanisone
Piracetam
Hexobarbitone
Potassium bromide
Embutramide

Question 15

what are the standards of emergency supply requested by patients during pandemic

Answer 15

Pharmacists:
Do not need to interview the patient
Need to be satisfied that the treatment has previously been prescribed by an appropriate practitioner and the dose is appropriate

Legislative change 29/04/2020:
CDs Schedule 2 and 3 can be supplied if:
Secretary of State makes a statement to allow it specifying:
Area covered (local area, region or country within UK)
Particular circumstances (e.g. a GP practice closure)
Timeframe for using this legislation

Question 16

Emergency Supply at Patient’s Request –POM Register Records

Answer 16

Record in the POM register must state:
Date the POM was sold or supplied
Name, form, strength, quantity of product
Name & address of patient requiring the POM
The nature of the emergency
Ref HMR 2012 (Schedule 23)

AND

good practice:

Emergency supply-request of patient*
GP name and address*
Dosage of medication*
Amount paid* …..or exemption/paid status if receiving a prescription retrospectively- ‘lending’ is common practice although not legally defined
POM register reference number (same number on dispensing label)

Question 17

Emergency Supply at Patient’s Request – Labelling Requirements

Answer 17

Container or packaging must be labelled as normal
PLUS the words “EMERGENCY SUPPLY”

Date of supply
Name, form, strength, quantity of product
Patient name
Name and address of the pharmacy
The words “Keep out of the sight and reach of children”
The words “EMERGENCY SUPPLY”

Question 18

summary for emergency supply requested by patient

Answer 18

Pharmacist must interview the patient him/herself except in a Pandemic
It must be an emergency
Must be previously prescribed by an appropriate prescriber
Must know appropriate dose
Not more than 5 days supply for CDs Sch 3 (phenobarbital), 4 and 5 .. 5 day maximum supply for other POMs except for 30 days
No CDs Sch 1, 2 and 3 except phenobarbital for epilepsy
For patients with an EEA/Swiss prescriber, CANNOT supply CDs Sch 1,2,3 at all and only supply medication with a UK MA
Must make records in POM register
Normal labelling requirements but in addition have the words “EMERGENCY SUPPLY” on label

1) Take request from patient – ask about prescriber, what medicines patient needs, previous use, length of supply needed etc
2) Assess validity and legality of request
3) Ensure supply is safe for the patient
4) If supply appropriate, label and dispense medication
5) Supply to patient and charge if necessary
6) Document supply in POM Register

Question 19

what is Community Pharmacist Consultation Service (CPCS)

Answer 19

Advanced Service
Service Design:
Emergency medicines supply requests from patients, received by NHS 111 call handlers or via NHS 111 online (111.nhs.uk), are referred to pharmacy (instead of NHS 111 doctors writing a prescription)
NHS 111 contacts the pharmacy (via CPCS IT system or NHS email account)
Patient phones pharmacy
Patient visits pharmacy and pharmacist completes emergency supply according to HMR 2012 Regulation 225 (pharmacist may not supply-depends whether it is appropriate)
Patient pays as if an NHS Rx (or exempt)
Pharmacist claims for service and drug costs
(Patients with minor ailments (low acuity conditions) are also referred from NHS 111 with CPCS)