MEP Flashcards
What are common themes in patient centred healthcare
Treating patients as people and equal partners in decision making
Putting them at the centre
Respect their preference
Compassion, dignity and empathy
Support for self care and independence
Patient choice control and influence
Good communication
What is medicines optimisation
Ensuring the patient gets the best possible outcome from their medicines.
Right patient right medicines right time
What can you help patients with in order to improve medicines optimisation
Take medicine correctly Improve adherence Abound taking unnecessary medicines Reduce wastage of medicines Improve medicine and patient safety
What are the 4 elements of medicines optimisation
Aim to understand the patients experience
Evidence based choice of medicines
Ensure medicines use is safe as possible
Make medicines optimisation part of routine practice
What’s the benefits of a comprehensive medication review for patients on poly pharmacy
A reduction in problematic poly pharmacy
Improved health
Patients more likely to take meds
Fewer wasted meds
What is professional judgement
Use of accumulated knowledge and experience as well as critical reasoning to make and informed professional decision
What does professional judgement take into account
The law Ethical considerations Relevant standards All other relevant factors Resonate the core values, attitudes and behavioural indicators of professionalism
How can you exercise professional judgement?
Identify the ethical dilemma or professional issue
Gather relevant info
Identify possible options
Weigh up the benefits and risk of each option
Choose an option
Record
What’s important about social media and being in a professional field
Should be responsible
Maintain boundaries
Respect confidentiality
Be aware of the potential audience and the circulation of things
What is professional indemnity
Insurance
Requirement to be covered if you’re registered with the GPhC before you start working in your role
The GPhC has adviced that the professional indemnity arrangement you have in place provides appropriate cover
What’s used as a consultation skill assessment
Medication related consultation framework (MRCF)
What is medicines reconciliation
Process of identifying an accurate list of a patients current medicine and comparing these with the medicines in use
What sources of information can be used when carrying out medicines reconciliation
Patient or patient representative Patients own meds Repeat prescriptions GP referral letter Patients GP surgery Hospital discharge summary Community patient medicine records Care home record Other healthcare clinics
What is a punitive culture
Based on assigning blame and punishment
How is patient care affected by a punitive culture
People fear being honest and the opportunity to learn is reduced
Disadvantage of a no blame culture
Can breed compliance or nonchalance which can impact patient safety
Why is a just culture needed in healthcare
Removes fear Increases sharing Reports concerns Being able to learn from mistakes and incidences Being able to share lessons
What are the culture principles for patient safety incidences
Patient safety is paramount
Deliberate harm to patient safety should not be tolerated
Patient safety is maintained by professionals raising concerns and learning from incidents
Individual accountability should be fair
What’s the purpose of reporting near miss errors
Prevent similar mistakes from happening in the future
What needs to be submitted annually from the second year of registration as a revalodation of pharmacy professionals
4 cpd record - two must be planned learning activities
A peer discussion
A reflective account
What’s the purpose of RPS faculty
Pharmacy professional recognition programmes provides you with a way of identifying what you need to know at different levels of practice, across all sectors
What are the steps of the research process
Identify topic
Critically review evidence
Clarify research question and aim
Select research design and method
Develop research protocol and proposal
Ethics and research governance approvals
Data collection and analysis
Interpretation of findings
Dissemination of findings (present)
Evaluate activity and outcomes
What are the 3 classification of medicines
Gsl
P
Pom
What does the term PO mean for classifying medications
A product that is licensed as a GSL medicine but for which the manufacture wishes to restrict sales or supplies through pharmacies
Eg: fybogel 30 pack
Can gsl be sold in pharmacist without the pharmacist ?
No there needs to be a RP but it can be sold if they’re physically absent for a short period of time while remaining responsible
What are P medicines
Medicinal product that can be sold from a registered pharmacy premises by a pharmacist or under supervision from one
What classification of medicines make up OTC
Gsl and p
What appropriate practitioners can prescribe poms
Doctor Dentist Supplementary prescriber Nurse independent prescriber Prescribing pharmacists Prescribing optometrists Podiatrist Physiotherapist
Whats the maximum p supply for pseudoephedrine and ephedrine
Pseudoephedrine 720mg (equivalent to 12x 60mg tabs) Ephedrine 180 mg
Can you supply pseudoephedrine and ephedrine together otc
No
How can pseudoephedrine and ephedrine be misused
Can be used to make methylamphetamine
From what age is emergency contraception licensed to be sold otc
16
Can pharmacist give an advanced supply of oral EHC
Yes but they should ensure patient is competent, clinically appropriate and aware on the correct way to take the medicine
Which ehc should you give for children under 16 (any age for women of child baring age)
Ulipristal
What ages is sexual activity still an offence but may be considered consensual
13-16
Maximum otc supply of paracetamol or aspirin
No more than 100 non effervescent tablets
No limit on effervescent tablets, sachet etc
What indication can codeine and dihydrocodeine be sold otc
Treatment of acute moderate pain not relived by paracetamol, ibuprofen or aspirin alone
All other previous indications like cold flu cough sore throat have been removed
What are the prescription requirements
Signature Address Date Particular (indicates appropriate practitioner) Name of the patient Address of the patient Age of the patient
Prescriptions must be written in indelible ink (carbon copies must be signed in ink)
Can you dispense a prescription in Welsh
Yes no law specifying language
Can you supply a CD if the prescription is in another language
As long as the prescribers address is in the UK
Can control drugs be sent as a batch prescription
Each batch needs a script
What’s the time limit on an owing medication
The validity period on the date of a prescription
Poms and cd sch 5- 6 months
P and gsl- 6 months
Sch 2,3 and 4- 28days
How long should prescription records be kept
POM for 2 years
CD schedule 2+3 records made in a cd register and retained for 2 years
What information should be recorded in a certain register
Supply date Prescription date Medicine details Prescriber details Patient details
What can you look out for to help detect fraudulent prescriptions
Is it for a large or excessive quantity
Is the prescriber known
Is the patient known
Has the title Dr been inserted before the signature
Is the behaviour of the patient indicative
Is the medication known to be commonly misused
What medications are not available on an EEA prescription
Schedule 1,2 and 3 CDs
Requirement for an emergency supply
If the request originates from an EEA prescriber
Prescription needs to be received in 72 hours
Cd sch 1, 2 and 3 cannot be given
Legally what should be included on medicinal labels
Name of patient Name and address of supplying pharmacy Date of dispensing Name of medicine Direction for use Precautions
What should packed down dispensed medication include
Name of the medicine Quantity of medicines in the container Quantitative particular of the medicines (ie the ingredients) Handling and storage instructions Expiry date Batch number
What is covert administration
When medicines are administered in a disguised format without the knowledge or consent of the person receiving them
What are the conditions for an emergency supply at the request of a prescriber
Relevant prescriber Emergency Prescription within 72 hours Directions as per the prescriber Not for CDs except phenobarbital Record kept in the POM register on day of supply or day after
What are the conditions for an emergency supply at the request of the patient
Interview the patient
There’s an immediate need
THEYVE had previous treatment
Dose is known
Not for CDs except phenobarbital
Length of treatment
(CD 5 days, Pom max 30 days, packs that can’t be split the smallest pack, contraceptives a full cycle)
Records kept in the POM register on day of supply or day after
Labelling ‘emergency supply’ should be added
Where can you refer a patient after refusing an emergency supply
Nhs walk in
A and e
111
Their gp
What changes have been made to emergency supply in a pandemic
Am interview would not need to take place
When can salbutamol be dispensed and stored by schools (since 2014)
If there’s a written order by the principal or head teacher
What information should be included in the signed order for sabutamol or adrenaline autoinjector pens for schools
The name of the school
The purpose of the product
The total quantity required
What records need to be kept for a supply of salbutamol inhalers or adrenaline autoinjector pens to schools
The signed order needs to be kept for 2 years
Good practice to record it including:
Date the Pom was supplied
Name, quantity, formulation and strength
Name and address of the person supplied to
The purpose of the supply
What else can be offered to schools when supplied salbutamol
Spacers
Counselling
Since when can adrenaline autoinjector pens be supplied to schools
October 2017
What else can be asked for the supply of adrenaline autoinjector pens for school storage
Instruction of administration
General info like storage, disposal, expiry
Importance of keeping a record
Strength varies with age and weight
Brands have different instructions
When was the supply of naloxone without a prescription on certain cases made acceptable
October 2015
Can emergency naloxone administration happen if the responsible pharmacist is not present
Yes
What should you be aware of when dispensing self prescribed prescription or prescriptions for close friend or family
Considered poor practice to self prescribe
Prescriber may be influenced or have poor judgement
Prescriber may be unable to conduct a proper clinical assessment
Professional bodies are told to avoid self prescribing
Abuse potential
CDs only prescribed in exceptional circumstances
Do the local guideline cover self prescribing
What is the pregnancy prevention programme
Education for the healthcare professionals and patients, therapy management and distribution control
To avoid patient getting pregnant while on treatment and a month after while on meds that are teratogenic
What’s biologic
Medicine made from a variety of natural sources that may be human, animal or microorganism
What’s a bio similar
Biological medicine that is similar to an already licensed biologic medicine in terms of quality safety and efficacy
How should biosimilars be prescribed
By brand names
What’s Pom-v
Prescription only medication that can only be prescribed by a vet surgeon and supplied by a vet surgeon or pharmacist with a prescription- records kept for 5 years
What’s poms vps
Prescription only medication that can be prescribed and supplied by a vet surgeon, pharmacist or suitable qualified person on an oral or written prescription
Written required if supplier is not a prescriber- records kept for 5 years
What’s nfa-vps
A catergory of medicines for non-food animals (eg: dogs) that can be supplied by a vet, pharmacist or suitable qualified person
What’s avm-gsl
An authorised vet medicine that is available on general sale
Which vet meds category require a prescription
Pom v
Pom vps
Medicines supplied under the veterinary cascade
For medicines prescribed under the vererinary cascade, Pom-v and Pom- vps
what must be present on the prescription
Name, address, phone number, qualification and signature of prescriber
Name and address of owner
Identification and species of the animal and its address
Date (6 month validity, cd 28 days)
Name quantity dose and administration instructions of the required medicine
Necessary warnings and withdrawal period
Statement showing the med is prescribed under the vet cascade
If CD drugs, state the item has been prescribed for an animal or herd under vet care
If prescription repeatable, number of repeats
When can human meds be given to animals
If it is supplied by veterinary surgeon and specifically states that it is for administration under the cascade
What is the veterinary cascade
Supply a licensed vet med
An existing licensed vet med for another species or different condition
A licensed human medicine or an EU licensed vet med
Extermporaneous or specially manufactured medicines
Can an animal owner purchase otc meds for the animal
No
It must follow the veterinary cascade
What must appear of a dispensed label for meds supplied under the veterinary cascade
Name of the prescribing vet surgeon
Name and address of the animal owner
Name and address of the pharmacy
Identification and species of the animal
Date of supply
Expiry date of product
Name and description of product
Dosage and administration instructions
Storage instructions
Warning
The words ‘for animal treatment only’
What must be recorded when supplying Pom v and pom vps
Name of medicine Date of the receipt or supply Batch number Name and address of the supplier Name and address of prescriber Record kept for atleast 5 years
Annual audit required
When was the CDs classified
2001
Name the cd classification
Sch1 CD lic POM Sch2 CD POM Sch3 CD no Pom register Sch4 CD benz Pom and CD anab Pom Sch5 CD inv P and CD inv P
When what gabapentin and pregabalin rescheduled and to what
1/4/2019
To schedule 3
Which cd schedules are valid for 28 days
1-4
Which CDs require a home office license
Schedule 1
Which CDs need a license when travelling or being imported or exported
1,2,3,4a
4b licence needed unless it’s for a patient self administering
What are the legal requirements for a controlled drug requisition
Signature of recipient Name of the recipient Address of the recipient Profession or occupation Total quantity of drug Purpose of the requisition
Prescription requirements for schedule 2 and 3 CD (some apply to 4)
Signature Date (valid for 28 days including owing) Prescribers address Dose (words and figures) Form Strength Quantity- in words and figures (recommended not to exceed 30 days) Name of patients Address of patient ‘For dental treatment’ if cd prescribed by a dentist Instalment directions
What technical errors can be amended by the pharmacist on a cd script
Spelling mistakes
Either words or figures (not both) of the total quantity is missing
What control drugs must be kept under safe custody
Schedule 1
Schedule 2 except liquid
Schedule 3 unless except
What control drugs need to be denatures before disposal
All CDs in schedule 2,3 and 4 (part 1)
For control drugs received what must be recorded
The date supply received
The name and address from whom received
Quantity received
For controlled drugs supplied what must be recorded
Date supplied Name and address of recipient Details of authority to possess Quantity supplied Details of person collecting Whether proof of identity was requested Whether proof was provided
Where does it need to be recorded if a patient has an adverse reaction
Yellow card scheme
Patients notes
First group driving offence drugs
Cannabis MDMA (ecstasy) Ketamine Methylamfetamine Cocaine LSD Heroin
Second group driving offensive drugs
Clonazepam Diazepam Lorazepam Oxazepam Temazepam Flunitrazepam Methadone Morphine Amfetamine
What does being the responsible pharmacist involve
Secure and effective running of the pharmacy
Display notice (name, gphc number)
Complete the pharmacy record
Establish, maintain and review pharmacy procedures
What must be recorded in terms of responsible pharmacist
RP name
RP gphc number
Date and time they were RP for
If RP was absent from the premises (date, time left and returned)
Records must be kept for 5 years
What’s the maximum length an RP can be absent
2 hours in a whole day
What arrangements should be made if the RP is absent
Ensure the pharmacy can continue to run safely
Remain contactable and able to return
If not contactable, arrange another contactable pharmacist
What’s the purpose of professional standards
To describe good practice, good system of care and good ways of working
What are the standards for pharmacy professionals
- Provide person-centred care
- Work in partnership with others
- Communicate effectively
- Maintain, develop and use their professional knowledge and skills
- Use professional judgement
- Behave in a professional manner
- Respect and maintain the Persons confidentiality and privacy
- Speak up when they have concerns or when things go wrong
- Demonstrate leadership
What are the standards/ principles for registered pharmacies
- The governance arrangements safeguard the health, safety and well-being of patients and the public
- Staff are empowered and competent to safeguard the health, safety and well-being of patients and the public
- The environment and condition of the premises from which pharmacy services are provided and any associated premises safeguard the health, safety and well-being of patients and the public
- The way in which pharmacy services, including the management of medicines and medical devices, are delivered safeguards and health, safety and well-being of patients and the public
- The equipment and facilities used in the provision of pharmacy services safeguard the health, safety and well-being of patients and the public
Under what circumstances may it be appropriate to disclose confidential information
Has consent from the person under their care
By law
Should do so in the public interest and /or must do so in the vital interest of the person receiving treatment or care
What are the two types of consent
Explicit- getting consent verbal or written
Implied consent- getting consent indirectly (eg: patient bringing their prescription to the pharmacy)
What makes consent valid
The patient having capacity
Must be acting voluntarily
Must have sufficient, balanced information to all an informed decision to be made
Be capable of using and weighing up information
Understand the consequence of not giving consent
whats considered a child and whats considered a young person
child: under 16
young person 16 and 17
are children presumed to have capacity
no, they must demonstrate they have capacity.
young people are presumed to have capacity.
who can give consent for a child or young person without capacity
the parent or court
can pharmacist give consent in urgent treatment
yes, if it is in the patients best interest
How can you minimise the risk of dispensing error
organised to keep distractions to a minimum
atmosphere should encourage good concentration
alert staff of any dangers
keep a segregated area of of the dispensary workbench for the dispensing process
segregate prescriptions on the work bench to avoid mixing people meds
what do you do in the event of a dispensing error
establish if the patient has taken any meds
ask to inspect the incorrect med
apologise
never try to minimise the seriousness
supply the correct meds
provide details on how to complain
establish how it happened
follow SOPs to report the error
record the error made to learn from it
inform the RP at that time
How many cpds must pharmacist record per year
4
EHC: If the patient vomits within how many hours of Levonelle/ Ella One should they take another dose?
2 hours of taking Levonorgesterel3 hours of taking Ella One (Ulipristal acetate)
What medication can Levonorgestrel increase the toxicity of?
What medication can Levonorgestrel increase the toxicity of?
Can EHC be used in breast feeding women?
Levonorgestrel appears in small amounts in breast milk- should not be harmful, but take tablet after a feed to allow maximal team until next feed.Ulipristal acetate is present in breast milk for 1 week after administration. Advise mother not to BF in this time but express and discard the milk to maintain lactation.
Is it okay to issue carbon copies of prescriptions to patients?
Yes as long as they’re signed in ink
What length of time to dispense requirements apply to EPS prescriptions?
Same things- must be dispensed 6 months from appropriate date, 28 days for CDs
Are Rx’s for Sch 2, 3, 4 and 5 CDs repeatable?Are private prescriptions repeatable?
Rx’s for Schedules 2 and 3 CDs are NOT repeatable.Rx’s for Schedule 4 and 5 are.
Private prescriptions can be repeated, indicated by prescriber, e.g. ‘Repeat x 3’ means the Rx can be dispensed 4 times in total.
If the number of repeats is not stated on an Rx- i.e. it just says ‘Repeat’, they can only be repeated once. What is the exception to this rule?
Prescriptions for an oral contraceptive. This can be dispensed 6 times if the number of repeats is not specified, within 6 months of appropriate date.
You have OWINGS on a Rx for P meds and GSL meds. How long do you have to dispense these owed items?
6 months6 months for POMS + Sch 5 CDs28 days for Sch 2,3,4 CDs
Prescriptions for What are exempt from having to be written in the POM register?
For oral contraceptives
For schedule 2 CDs- as these will be recorded in the CD register
Can you dispense against a Faxed prescription?
No- not legally validNot written in indelible inkRisk not receiving an original prescriptionDo it as an emergency supply instead- then it is on their back to get the original prescription to you
Emergency supplies cannot be made for CDs Schedule 1, 2, 3. With the exception of what?
Phenobarbital (also called phenobarbitone) for EPILEPSY by as UK-registered Doctor(NOT EEA)
Maximum quantity for an Emergency supply for CD’s (Phenobarbital, Schedule 4’s and 5’s) is?
What about for POMs?
CD’s: 5 daysSo things like Zopiclone can only be given for max 5 days. POMs: 30 days
How long are prescriptions for Isotretinoin valid for under the pregnancy prevention programme? What is the maximum quantity that can be supplied?
R valid for 7 days- I.e. have to dispense it within 7 days of date due to pregnancy test window. Rx’s presented after this 7 days are considered expired.Maximum of 30 days supply. If not under the Pregnancy prevention programme, more than 30 day
You are working a Lloyds pharmacy and realise you do not have any spiriva inhalers left. Mrs P is due to come in an hours time to pick up her prescription and you know she is going away tomorrow. Can you ring up Boots down the road and request a spiriva inhaler to meet this patients needs, do you need a Wholesalers Dealers License to do so?
Community + Hospital pharmacies can obtain small quantities of a medicine from other pharmacies to meet patients needs.A Wholesalers dealers license is not needed for this, as it is considered as ‘Provision of healthcare services’, not seen as commercial dealing.
Use by?
Expires?
Use by: End of previous month
Exipires: End of current month
A patient returns some unwanted medicines to your pharmacy. Some of it is blister strips in their outer packaging, some of it is bottles of liquids. How should these be disposed?
Blister strips can be removed from their outer packaging (but do not pop out tablets from blister) and ensure and patient info is confidentially disposed of. Liquids- do not empty the contents into the waste container- just put the whole bottle in- could be hazardous otherwise.
Whats the issue with using Adrenaline in patients on beta blockers?
Severe anaphylaxis in patients taking beta-blockers may not respond to adrenaline—consider bronchodilator therapy, e.g. IV salbutamol, adrenaline can cause severe hypertension and bradycardia in those taking non-cardioselective beta-blockers.
What are the symptoms of anaphylaxis?
Rapid development of airway and/or hypotension.Skin and mucosal changes may be present, e.g. urticaria (hives like rash) and angio-oedema of the face.
What 5 things relating to the Veterinary prescriber must be present on the prescription for it to be valid?
Name, Address, Telephone number, Qualification, Signature
If the Rx is for a Schedule 2 or 3 CD: Royal college of Veterinary Surgeons Qualification number is needed!!
How long are veterinary prescriptions valid for? What if its a CD?
6 monthsSchedule 2, 3, 4 CD Rx’s valid for 28 daysSchedule 5 CD Rx’s for 6 months(This is the same as human Rx’s)
Can veterinary prescribers use ‘As directed’ on their prescriptions?
No- not acceptable as an administration instruction, should state ‘with food’
When must the words ‘Prescribed under the cascade’ be used on veterinary prescriptions?
The cascade allows the supply of medicines not licensed in animals. It is ILLEGAL to supply a human medication for an animal if this wording is not present.E.g:-A medicine authorised in the UK for human use but being used in an animal -A vet medicine not authorised in the UK but in another European country for use in any animal species and in accordance with an import certificate issued by the VMD
When is ‘prescribed for an animal or herd under the care of the veterinarian’ required on a vet prescription?
For Schedule 2 or 3 CD’sNB: Usual CD prescription requirements apply here- words and figures for quantity,
How long should veterinary prescriptions be retained for? What about records (e.g. POM book entries) and documents for Vet supplies in general?
Keep all of them for 5 years They do not get submitted to an NHS agency
Are orignal private prescriptions for Schedule 2 and 3 CDs retained in the pharmacy? If so, for how long?
No- they must be sent of to the relevant NHS agency. NB: these Rx’s will be on standardised FP10PCD forms
If a vet prescribes a product and writes ‘prescribed under the cascade’ on the Rx, but there is an alternative licensed vet medicine that could be used, what happens?
The cascade requires the Licensed veterinary product to be supplied, not the medicine only licensed for human use, this is because licensed veterinary products should be given where available, even if it is for use in a different species.
What is the difference between POM-V and POM-VPS?
POM-V: Can only be prescribed by a VETERINARY SURGEON. The animal must be clinically assessed before these are prescribed. POM-VPS: Can be prescribed by a Registered qualified person- e.g. Veterinarian, Pharmacist. A clinical assessment of the animal is not needed in this situation, however sufficient info must be provided e.g. how the animal is kept. Minimum quantity should be prescribed.
What is a NFA-VPS Vet medicinal product?
Can be SUPPLIED by a Registered Qualified Person e.g. a Vet, a pharmacist, and DO NOT need a prescription- i.e. the vet can give this directly to the animal without needing to write and Rx for it. Minimum quantity should be supplied.
What is a AVM-GSL Vet medicinal product?
Products with no legal restrictions- same as OTC products.
How often must pharmacies supplying POM-V and POM-VPS medicines undertake an audit?
ANNUALLY
A woman comes to your counter with a pack of ranitidine tablets. You ask “are these for yourself?” and she says no “they’re actually for my dog”. Can you sell them?
It is unlawful to sell unlicensed veterinary medicines/ human medicines, including GSL and P medicines, unless this takes place under the cascade. This applies even if the Vet has told to owner to purchased an OTC human medicine. It is on your back.
How does a patient go about taking Controlled drugs abroad on holiday?
A personal license is NOT required if they are carrying less than a 3 month supply A covering letter from their prescriber is advised
Where a CD prescription is written by a dentist, what extra wording is required on the prescription?
“For dental treatment only”
Is temazepam exempt from Schedule 2 and 3 CD prescription requirements? (e.g. Quantity in words and figures etc)
No- not exempt from prescription requirements as of June 2015.It is a CD schedule 3, only thing its exempt from is CD register requirements.Must be kept in CD cupboard
The strength only needs to be written on a CD prescription if there is more than one strength available. True or False?
True
How should quantities of liquids be expressed on CD prescriptions?
In millilitres- and best to write this out in full.Words and figures
Is abbreviations like ‘tabs’ and ‘caps’ acceptable on a CD prescription?
Yes
How long are instalment prescriptions valid for? (i.e. Methadone prescriptions)
The first instalment has to be dispensed within 28 days of the appropriate date on the prescription, then the rest can be supplied any time afterInstalment prescriptions on need to be signed once by the collector (but not a legal requirement)
Most Schedule 3 (CD No Reg POMs) are exempted from being stored in the CD cabinet. Which two drugs are not exempt from this?
Temazepam
Buprenorphine
True or false: CD register entries must be entered on the day of supply?
False- can be entered the following day
A private prescription for buprenorphine tablets is presented to you. It is not on a standard FP10PCD form. The prescriber has included his General Medical Council number. You can dispense it. True or False?
False
ALL private CD Rx’s MUST be on the standard FP10PCD form, following the Shipman enquiry.Also the GMC number is NOT the correct number to include: must be the prescriber ID number issued by their relevant NHS agency!Only exception: Vet Rx’s. In hospitals if the private Rx was written by someone in that hospital. If it has come from outside the hospital: must be on FP10PCD.
You receive a prescription on an FP10PCD for Morphine sulphate tablets, Zopiclone and ibuprofen. Is there any issues here?
You are required to send FP10PCD forms off to the relevant NHS agency. This is so they can keep track of CD’s being prescribed. The Zopiclone (sch 4) and ibuprofen need to be entered into the POM book and the prescription for these kept for 2 years. Therefore this would not be possible in this case.Need a separate prescription for the zopiclone and ibuprofen!
Can a representative pick up for a drug misuser?
Yes if they have a letter from the drug misuser, a separate letter each time they pick up and ID and that the pharmacist sees the drug misuser at least once a week.
If the medication is supervised consumption- contact doctor- legally acceptable to confirm with Dr they are happy with this over the phone. This is because supervised consumption is not a legal requirement. If it was a police officer collecting as the person is in custody then don’t need to contact doctor- as consumption will be supervised by a HCP.
Getting the person collecting a CD schedule 2 or 3 to sign the back the Rx is a legal requirement, true or false?
False.It is good
Are there any schedule 2 CD’s that don’t have to be kept in the CD cupboard?
Quinalbarbitone (aka Secobarbital)Some liquid preparations
Is keeping a running balance in the CD register a legal requirement?
No- good practice Be sure to notify the owner, superintendent, GpHC inspector, accountable officer or Controlled Drug liaison officer of any discrepancies.
T or F:Pharmacist independent prescribers are able to prescribe and Controlled Drugs in Schedule 2 to 5.
TrueApart from diamorphine or cocaine for treatment of addiction (but can for pain/ organic disease)
How long must the RP log be retained?
5 years from last entry
In general, considering record keeping either involves 2 years or 5 years, what is the general rule (not just for vet stuff- for EVERYTHING)?
2 years for things to do with CDs and private Rx’s:
- CD register (from date of last entry) (legal)
- Requisitions (send off but keep copy) order records etc (legal)
- Invoices for schedule 3 and 5 CDs (legal)
- POM book- 2 yrs last entry, private prescriptions (legal)
- MUR/ NMS records (legal)
5 years for:
- Vet prescriptions- POM-V and POM-VPS (legal)
- Responsible Pharmacist record (from date of last entry) (legal)
- Extemporaneous dispensing records (legal- community, 13 yrs reference hospital)
What are the extra requirements on a Vet label when compared to a human label?
For animal treatment only
Pet details and Owner details
Expiry date if not on box
Warnings for owner re administration etc
How long are are vet prescriptions for CD’s 2 and 3’s valid for?
28 days
All the normal CD Rx requirements are followed as for humans e.g. total quantity in words and figures
How many days worth of treatment for Vet CD’s is considered good practice?
28 days max quantity
Unless ongoing treatment needed e.g. epilepsy in dog
(differs to human which is 30 days)
Human private prescriptions for schedule 2 and 3 CDs must be submitted to the relevant agency to track CD prescribing. Does this therefore apply to Vet private prescriptions for CD’s?
No
Just retain in pharmacy for 5 years
Which should be first line: Prescribing a licensed human medicine for an animal Prescribing a licensed Vet medicine for another species or in a different condition
1) Prescribing a licensed Vet medicine for another species or in a different condition (basically Off-label)
2) Prescribing a licensed human medicine for an animal
How many NHS prescription charges do warfarin 1 mg tablets and warfarin 5 mg tablets levy (assuming the patient is not exempt for NHS charges) for an NHS prescription written in England?
1 charge:Same drug with the same formulation but different strengths is classed as one prescription charge.
A midwife may use a midwife supply order to obtain what 3 controlled drugs?
- Diamorphine2. Morphine3. Pethidine
A Scottish lady asking for a emergency dutasteride for her husband who has taken his last tablet this morning. What should you do?
Need to speak to the patientEmergency supply at the request of a patient requires interviewing the patient
After a GPhC inspection, what is the time limit to respond to confirm accuracy of report?
5 days
Can you have an electronic CD register?
Yes
Can you issue faxed prescriptions for oral isotretinoin?
Can you issue repeat prescriptions of oral isotretinoin?
No
Do you need an authorised witness when destroying CD stock?
Yes if schedule 2
Good practice for schedule 3
Preferably a registered health care professional
Do you need to make a record when destroying CD stock?
Yes in the CD register for CD2 drugs
For a patient to have capacity and to be able to make an informed decision, what 4 things must they be able to do?
• Understand the information provided• Remember the information provided• Use and weigh up the information provided• Communicate their decision to the pharmacy professional (by any means).
For emergency supplies, what is the max quantity that can be supplied for:1. CD 4 and 5s2. Any other POMsWhat are the exceptions to this?
- 5 day supply max2. 30 day supply maxExceptions include insulin, creams, inhaler where a pack cannot be broken down. The smallest pack available should be given.
For MDA (methadone) scripts, what is the maximum number of days you can prescribe on one script?
14 day
How long after having a baby are female patients eligible for free prescription charges?
Up to 12 months after having the baby
How long are isotretinoin prescriptions under the pregnancy prevention programme valid for?
7 days
How long can the responsible pharmacist be absent for?
Max of 2 hours in 24 hour period
How long do you need to keep a record of an appliance use review?
12 months
How long do you need to keep a record of an MUR for?
2 years
How many CPD entries do you have to do a year to revalidate?
4
2 must be planned learning activities
How much of a liquid antibiotic should you give in an emergency supply?
If an antibiotic in liquid form, smallest quantity that will provide full course should be supplied
How much of an oral contraceptive should you give in an emergency supply?
If an oral contraceptive, a full treatment cycle should be provided
How often should SOPs be reviewed in community pharmacy?
Every 2 years
If a patient came into the pharmacy with a prescription for:Amoxicillin 500mg capsAmoxicillin 250/5mL solutionHow many charges would this be?
2 charges as different formulations
If a patient is homeless, what should you put in the address section on a prescription?
No fixed abode
If a repeat number is not stated on a repeat prescription, how many times can it be repeated?What is an exception to this rule?
Only once
so dispensed twice in total)Oral contraceptives can be repeated 5 times (dispensed 6 times in total
If a veterinary surgeon has told the animal owner to purchase a human medicine for their pet, would you be able to do sell this?
No- it has to be prescribed under the veterinary cascade
If the responsible pharmacist absence exceeds 2 hours, can the pharmacy still be open?
No- after the 2 hours in 24 hours, the pharmacy must close if the pharmacist needs to be absent
In addition to standard labelling requirements, what else needs to be included on the dispensing label in an emergency supply?
The words “Emergency supply”
In secure environments (prison) what is strongly recommended that is also on the label to identify the patient?
Prisoner number
On prescriptions, if it states “repeat x times”, when must the first dispensing be done?What about controlled drugs?
Within 6 months (following this no time limit) CD2 and 3 are not repeatable CD4 within 28 days (following this no time limit for the remaining repeat)
What schedule is tramadol?
CD3 - exempt from safe custody requirements
maximum supply of codeine containing products otc
32 pack size max
any greater is POM
what should codeine containing products have on the packaging when selling otc
can cause addiction, for 3 days use only
cough and cold remedies containing the ingredients that cant be sold to <6, can be sold for 6-12 for what duration
5 days
what are EEA/ swiss prescribers not allowed to prescribe in the UK
CD 1, 2, 3 or unlicensed medications
what needs to be done if a patient wishes to collect their repeat prescription from different pharmacies
an audit trail needs to be kept of the number of repeats dispensed
the pharmacy must stamp their name, address and date supplied each time it is dispensed
when giving an emergency supply at the request of the prescriber, what 3 dates need to be documented
date POM supplied
Date prescription received
and date on the prescription
as a general rule, how long are records kept in a pharmacy
vet and RP records kept for 5 years
everything else pretty much 2 years
why might batch number always be necessary when dispensing in part packs
you could get an MHRA batch number product recall
what is patient group direction (PGD)
a written direction to supply or administer specified medication to a well-defined group of patients required treatment for a specific condition (POM supply without a prescription)
what is patient specific directions (PSD)
written instructions for a medicine to be supplied or administered to a named patient after they are individually assessed
if there was a pandemic declared by the department of health, would the pharmacist need to interview the patient to give an emergency supply
no
when is a pharmacist except from requiring a wholesale dealers license
occasional basis
small quantity of medicines
profit is not made
not for onward wholesale distribution
a pharmacy with a whole sale dealers license also supplying CD 2-5 also needs what
a home office license too
what type of prescriptions do the legal requirements of vet prescriptions apply to
POM-V
POM-VPS
unlicensed pom under the vet cascade
when is ‘keep out of reach of children’ a legal requirement, vet med or human meds
vet meds
how often should pharmacies that supply vet med have an audit
annually
where should adverse drug reaction for animals be reported
adverse reaction scheme for veterinary medicines (yellow card scheme equivalent)
requirements for sch 1 CD lic pom
need home office license to possess, produce or supply
no therapeutic use
requirements for a sch 2 CD pom
record in CD register CD rx required 28 day validity safe custody (except quinalbarbitone) 30 day supply
requirements for a sch 3 CD pom no register
keep invoices
CD rx required
28 day validity
safe custody (except tramadol, phenobarbitone and midazolam)
which CD dont allow emergency supply
cd 2 and 3 (except phenobarbital)
which CD need invoices to be kept
sch 3 and 5
all CDs have a 28 day validity except which one and how long is it
sch 5
6 months
which CD does not need a license to import and export
sch 5 and sch 4 anab part 2 if it is for personal use as a medicine
where should private CD 2/3 scripts be submitted and when
to the NHS agency at the end of the month
why should POM and CD be prescribed seperately
because the POM needs to be kept for 2 years and the CD needs to be submitted at the end of the month
what happens if a patient misses their installment cd 2/3
carry on with the other days and skip that one
refer if miss >3 days
what CD thats not CD 1 or 2 needs to be added to a register
sativex CD 4 part 1
if you need to disclose information, what should you do
get consent unless valid reason to not
anonymise it if possible
only disclose necessary information
release the information promptly
make sure the person receiving the info knows and treats it confidentially
make a record (who requested, what you disclosed, if consent was and and obtained)
be prepared to justify your decisions and actions
what are the 6 principles for processing personal data under GDPR
Processed lawfully, fairly and in a transparent manner
collected for specific, explicit and legitimate purposes
adequate, relevant and limited to what is necessary
accurate and up to date
kept no longer that necessary
protected against unauthorised/ unlawful processing
how long have you got to report confidentiality breach
72 hours from when youre aware
records must be kept
according to the freedom of information act 2000, you can make a request for public information in writing and how long have they got as a legal obligation to respond
20 days
what is capacity
a patients ability to make a specific and informed decision
can you sell gsl meds if the pharmacist hasnt signed in
no
can you sell gsl meds if the pharmacist has signed in but is absent
yes
How many days should you supply for a CD emergency supply
5 days
How long should an invoice for a Sch 3 CD taking account tax requirements be retained for
6 years
How do you record residue CD liquids
You do not need to make a record of disposable irretrievable amounts of CD
What are the 11 GPHC standards in the MEP
Standards for pharmacy professionals
Standards for registered pharmacies
Guidance on confidentiality
Guidance on consent
Guidance on raising concerns
Guidance on maintaining sexual boundaries
Guidance on religion personal values and beliefs
Guidance on responding to complaints and concerns
Guidance for registered pharmacies preparing unlicensed meds
Guidance for registered pharmacies providing pharmacy services at a distance including on the internet
Guidance to ensure a safe and effective pharmacy team
What’s the minimum length of time CD decryption records should be kept
2 years
Patient returns 7 years
What do the 6 legal requirements for a CD requisition include
Recipients signature Name of recipient Address of recipient Profession/ occupation Total quantity of drug Purpose of requisition
What’s the time limit for repeat prescriptions (for cd and normal meds)
Normal meds the first repeat must be dispensed within 6 months then there is no legal limit must use clinical judgment
CD 4+ must first be dispensed within 28 days then clinical judgement after no legal limit
(Cd1-3 cannot be repeated)
