MEP Flashcards
A profession can be described as an occupation that:
Is recognised by the public as a profession
Has a recognised representative professional
body
Benefits from professional standards and codes of conduct
Is regulated to ensure the maintenance of standards and codes of conduct
A professional can be described as:
- A member of a profession
- A member of a professional body
- An individual who:
– Behaves and acts professionally
– Exercises professionalism and professional
judgement
– Undertakes continuing professional development
– Has professional values, attitudes and behaviours.
Pharmacy professionalism can be defined as:
a set of values, behaviours and relationships that underpin the trust the public has in pharmacists.
Exercising professional judgement
- IDENTIFY THE ETHICAL DILEMMA OR PROFESSIONAL ISSUE
- GATHER ALL THE RELEVANT INFORMATION AND RESEARCH THE PROBLEM
- IDENTIFY ALL THE POSSIBLE SOLUTIONS
- WEIGH UP THE BENEFITS AND RISKS OF EACH OPTION
- CHOOSE AN OPTION - ENSURING YOU CAN JUSTIFY THE DECISION
- RECORD THE DECISION-MAKING PROCESS
It is important to point out that professional judgement is not a blanket defence or a blanket reason to take the most convenient choice.
Professional empowerment
is about enabling professionalism and professional judgement through through guidance, standards, news and alerts; through webinars and our mentoring programme; through our Leadership Development Framework; through influencing policy and embedding and nurturing the right culture.
Standards and Guidance (Appendix 1 - 6)
Regulation=>Professional Standards=>Best Practice Guidance=>Local Policy and Procedure=>Patient and Public Outcomes and Experiences
CONFLICTS OF INTEREST
INTERFACE BETWEEN PERSONAL AND PROFESSIONAL LIVES
Patient Or Person-Centred Healthcare
PROFESSIONAL INDEMNITY
The GPhC has advised
“that the professional indemnity arrangement you have in place provides appropriate cover. This means that the cover needs to be appropriate to the nature and extent of the risks involved in your practice.”
Revalidation
- Four continuing professional development (CPD) records (at least two planned)
- A peer discussion
- A reflective account.
An independent prescriber (IP)
is a practitioner, who is responsible and accountable for the assessment of patients with undiagnosed or diagnosed conditions and can make prescribing decisions to manage the clinical condition of the patient.
A supplementary prescriber (SP)
is a practitioner who prescribes within an agreed patient specific written clinical management plan (CMP), agreed in partnership with a doctor or dentist.
PHARMACISTS IN RESEARCH
research is often a multidisciplinary team activity
will require ethical approval by a Research Ethics Committee (REC); a group
of experts who hold the responsibility of ensuring research conforms to accepted standards. Professional bodies, such as the Health Research Authority, use these committees to help govern and regulate research in the UK.
BEING CULTURALLY INFORMED
- Age
- Gender
- Ethnicity
- Sexual orientation
- Nationality
- Religion
- Social class
- Profession
just culture
a culture based upon fairness and is achieved when attitudes, behaviours and practices are fair.
right culture=>open culture/reporting culture/learning culture=>safety and quality culture: balance accountability and learning=>for work environment, improved patient experience, improved patient safety and quality of care
punitive culture
based upon assigning blame and punishment. It contributes to creating a
culture of fear. People and organisations see what happens to others and if what they see is perceived to be draconian or unjust, this leads to fear, stifling reporting and stifling the raising of concerns. We lose the opportunity to learn, and patient safety is affected.
punishment=>stifles reporting and learning=>reduction in patient safety and quality of care
no-blame culture
It can breed complacency or nonchalance which can also impact upon patient safety. At its worst it can appear unacceptable
to society overall due to the immunity from accountability which can also be abused.
blanket immunity=>lack of accountabilty=>not acceptable to society, unfair
HANDLING DISPENSING ERRORS
1 Take steps to let the patient know promptly
2 Make things right (this may involve contacting
the prescriber)
3 Offer an apology
4 Let colleagues involved in the error know.
RSLAR : Report, Share, Learn, Act, Review
The Pharmacy (Preparation
and Dispensing Errors – Registered Pharmacies) Order 2018
a legal defence to prevent the automatic criminalisation of inadvertent dispensing errors
The legal defence against criminal prosecution can be used when the error has been:
1 Dispensed in a registered pharmacy, and
2 Dispensed by or under the supervision of a
registered pharmacist, and
3 Supplied against a prescription, PGD or direction
from a prescriber, and
4 Promptly notified to the patient once the pharmacy team are aware of the error.
SAFEGUARDING: PROTECTING CHILDREN AND YOUNG PEOPLE/Adults (18+, suffers from mental or physical disability, has learning difficulties is frail or elderly, is in an abusive relationship, is a substance misuser)
Emergency=>999
Otherwise=>local social services
Physical abuse (Unusual/unexplained injuries, injuries in inaccessible places, bite marks, scalds, fingertip bruising, fractures, repeated injuries, age of injuries inconsistent with account given by adult, injuries blamed on siblings)
Neglect (Poor growth and weight. Poor hygiene, dirty and messy. Inappropriate food or drink)
Emotional abuse (Evidence of self-harm/self mutilation, behavioural problems, inappropriate verbal abuse, fear of adults or a certain adult)
Sexual abuse (Indication of sexually transmitted disease, evidence of sexual activity or relationship that is inappropriate to the child’s age or competence), under the age of 13 are too young to consent to sexual activity
Additional signs (Parent/carer delays seeking medical treatment or advice and/or reluctant to allow treatment, detachment from the child, lacks concern at
the severity or extent of injury, reluctant to give information, aggressive towards child or children)
*Adults: Financial abuse (sudden changes to their finances, e.g. getting into debt. Inappropriate, exploitative or excessive control over the finances of the vulnerable adult)
**if unsure if an adult pt has capacity, seek advice from GP
You can provide contraception (e.g. on prescription or under PGD) or sexual health advice to a child or young person under 16 as long as, in England and Wales, the Fraser criteria are met, i.e. that:
- They have sufficient maturity and intelligence to understand the nature and implications of the proposed treatment
- They cannot be persuaded to tell her parents or to allow the practitioner to tell them
- They are very likely to begin or continue having sexual intercourse with or without contraceptive treatment
- Their physical or mental health is likely to suffer unless they receive the advice or treatment
- The advice or treatment is in the young person’s best interests.
PHARMACEUTICAL CARE
the pharmacist’s contribution in the care of individuals in order to optimise medicines and improve health outcomes
MEDICINES OPTIMISATION
It may involve stopping some medicines as well as starting others and considers opportunities for lifestyle changes and non-medical therapies to reduce
the need for medicines
PRINCIPLE 1: AIM TO UNDERSTAND THE PATIENT’S EXPERIENCE
PRINCIPLE 2: EVIDENCE-BASED CHOICE OF MEDICINES
PRINCIPLE 3: ENSURE MEDICINES USE IS AS SAFE AS POSSIBLE
PRINCIPLE 4: MAKE MEDICINES OPTIMISATION PART OF ROUTINE PRACTICE
MEDICINES RECONCILIATION
the process of identifying an accurate list of a patient’s current medicines (including over-the-counter and complementary medicines) and carrying out a comparison of these with the current list in use, recognising any discrepancies, and documenting any changes. It also takes into account the current health of the patient and any active or long- standing issues. The result is a complete list of medicines that is then accurately communicated. remember to ask about other medicines that may not be listed: over-the-counter (OTC) medicines, herbal products, vitamins, dietary supplements, recreational drugs (e.g. alcohol and tobacco) and remedies purchased over the internet
should take place whenever patients are transferred from one
care setting to another, when they are admitted to hospital, transferred between wards and on discharge. The way that the process is carried out will vary between care settings.
Sources of information:
Patient or patient’s representative Patient’s medicines
Repeat prescriptions
GP referral letters
The patient’s GP surgery
Hospital discharge summaries or outpatient appointment notes
Community pharmacy patient medication records
Care home records
Drug treatment centre records
Other healthcare professionals and specialist clinics
Patient medical records where available (e.g. in prisons or the Emergency Care Summary (Scotland), Summary Care Record (England), or Welsh GP Record (see also section 2.6.5).
POLYPHARMACY
- A reduction in problematic polypharmacy
- Improved health
- Patients more likely to take their medicines
- Fewer wasted medicines.
Human Medicines Regulations 2012 (GSL: General Sales List, P: Pharmacy Only, POM: Rx Only)
legislation regulating
the authorisation, sale and supply of medicinal products for human use, made under the Medicines Act 1968
GSL (self-selection, other retail outlets) and RP
GSL medicines can only be
sold when a pharmacist has assumed the role of responsible pharmacist; however, the pharmacist may be physically absent for a limited period of time while remaining responsible, thus permitting sales of general sale medicines during this absence
Pharmacy (P) Medicines (otherwise known as OTC, non-prescription medicines)
a medicinal product
that can be sold from a registered pharmacy premises by a pharmacist or a person acting under the supervision of a pharmacist. Pharmacy medicines must not be accessible to the public by self-selection.
PRESCRIPTION-ONLY MEDICINES (POM)
escription written by an appropriate practitioner.
PSEUDOEPHEDRINE AND EPHEDRINE
ue to their potential for misuse in the illicit production of methylamphetamine (crystal meth), there are legal restrictions on the quantities that can be sold or supplied
It is unlawful to supply a product or combination of products that contain more than 720mg of pseudoephedrine OR 180mg of ephedrine at any one time, without a prescription
It is unlawful to sell or supply any pseudoephedrine product at the same time as an ephedrine product without a prescription
ORAL EMERGENCY CONTRACEPTIVES
Levonorgestrel 1500 microgram tablet and ulipristal acetate 30mg tablet are licensed as pharmacy medicines for emergency hormonal contraception (EHC). Levonorgestrel is licensed for women aged
16 years or over for emergency contraception within 72 hours of unprotected sexual intercourse or failure of a contraceptive method. Ulipristal acetate is licensed for emergency contraception within 120 hours (five days) of unprotected sexual intercourse or failure of a contraceptive method.
PARACETAMOL AND ASPIRIN
Paracetamol
Not more than 100 non effervescent* tablets or capsules can be sold to a person at any one time. Since most OTC pack sizes are for 16 or 32 dose units, this means that, in practice, 96 is the maximum number that can be sold.
There are no legal limits on the quantity
of over-the-counter effervescent* tablets, powders, granules or liquids that can be sold to a person at any one time. Use professional judgement to decide the appropriate quantity to supply and what limits to impose.
Aspirin
Not more than 100 non-effervescent* tablets or capsules can be sold to a person at any one time. Since most OTC pack sizes are for 16 or 32 dose units, this means that, in practice, 96 is the maximum number that can be sold.
There are no legal limits on the quantities
of over-the-counter effervescent* tablets
or powders that can be sold to a person at any one time. Use professional judgement
to decide the appropriate quantity to supply and what limits to impose.
CODEINE AND DIHYDROCODEINE
restricted to the short-term treatment of acute, moderate pain that is not relieved by paracetamol, ibuprofen or aspirin alone. All other previous indications, including cold, flu, cough, sore throats and minor pain have been removed.
Any pack containing more than 32 dose units (including effervescent formulations) is a POM.
The warning ‘Can cause addiction. For three days use only’ must be positioned in a prominent clear position on the front of the pack. In addition, both the PIL and packaging must state the indication and that the medicine can cause addiction or headache if used continuously for more than three days. The
PIL must also contain information about the warning signs of addiction.
Prescription requirements
Name of the patient
Address of the patient
Age (if under 12)
Signature of the prescriber
Date
Particulars of Prescriber
Address of Prescriber
**indelible ink
**valid 6 months, CD 28 days
repeatable prescriptions
are done by private rx (If a number is not stated, they can only be repeated once (dispensed twice) unless the prescription is for an oral contraceptive in which case it can be repeated five times (dispensed six times in total), Sch 2 and 3 cannot be repeated, 1st dispensing must be made within 6 months (Sch, 2, 3, 4, within 28 days)
The patient can choose to have repeats dispensed from different pharmacies and can retain the prescription. To maintain an audit trail mark on the prescription the name and address of the pharmacy from where supply has been made and the date of supply.
RECORD KEEPING
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. 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
* Prescription date
* Medicine details
* Prescriber details
* Patient details
The record should be made on the day the sale or supply takes place or if that is not practical, on the next day following.
PRESCRIPTIONS FROM THE EEA OR SWITZERLAND
Approved countries comprise EEA countries and Switzerland:
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.
PRESCRIPTION REQUIREMENTS
The following details are required on a prescription from an approved health professional from an approved country:
* 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.
Even if the prescription requirements have been written in a foreign language the prescription is still legally acceptable. However, you will need to have enough information to enable the safe supply of medicines considering patient care and wellbeing.
EMERGENCY SUPPLY
EMERGENCY SUPPLY AT THE REQUEST OF A PRESCRIBER
EMERGENCY SUPPLY AT THE REQUEST OF A PATIENT
Emergency supplies at the request of a patient, or at the request of an approved health professional, are legally possible
Schedule 1, 2 and 3 CDs (including phenobarbital) or unlicensed products cannot be supplied in
an emergency to a patient of an approved health professional.
Relevant prescriber
Satisfied with Emergency Reason
Prescription within 72 hours
Directions
Not for CDs, except phenobarbital
Schedule 1, 2 or 3 CDs cannot be supplied in an emergency whether requested by UK, EEA or Swiss health professionals. Phenobarbital (also known as phenobarbitone or phenobarbitone sodium) is the exception and can be authorised by UK doctor, dentist, nurse or pharmacist independent prescriber or supplementary prescriber in an emergency for the treatment
of epilepsy.
Record kept (Rx info such as date of rx and date rx is received should be documented)
Interview
Immediate need
Must have had previous treatment with medicine
Dose
Not for CDs, except phenobarbital for epilepsy
Length of treatment: Sch 4/5 CD-5 days, POM-30 days, smallest pack sizes available, contraceptive: full cycle, antibiotic: smallest quantity to complete course
Record Kept (why emergency was needed)
‘Emergency supply’ need to be added to the dispensing label.
LABELLING OF DISPENSED MEDICINAL PRODUCTS
It is a legal requirement for the following
to appear on dispensed medicinal products:
* 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.
**the actual container (e.g. inhaler or tube of cream) should
be labelled rather than the outer container.
Patient specific directions (PSDs)
PATIENT GROUP DIRECTIONS (PGDS)
a written instruction from a doctor, dentist or non-medical prescriber for a medicine
to be supplied or administered to a named patient after the prescriber has assessed that patient
on an individual basis.
a written direction that allows the supply and/or administration of a specified medicine
or medicines, by named authorised health professionals, to a well-defined group of patients requiring treatment for a specific condition
SUPPLY OF MEDICINES TO SCHOOLS
The signed order should contain:
* 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.
The signed order needs to be retained for two years from the date of supply or an entry made into the POM register.
Even when the signed order is retained, it is good practice to make a record in POM register for audit purposes.
Who can purchase Naloxone?
Pregnancy Prevention Programmes (PPP)
rotect females of childbearing potential by minimising the risk of becoming pregnant while taking these medicines: e.g. oral retinoids, valproate, thalidomide, lenalidomide and pomalidomide
Oral retinoids (including acitretin, alitretinoin and isotretinoin) are used for severe skin conditions.
1 Prescription Validity
Under the PPP, prescriptions are valid only
for seven days and ideally should be
dispensed on the date the prescription is written. Prescriptions which are presented
after seven days should be considered expired and the patient should be referred back to the prescriber for a new prescription. Pregnancy status may need to be reconfirmed by a further negative pregnancy test.
2 Quantity
Check that the quantity is for a maximum of 30 days’ supply. A quantity for more than 30 days can only be dispensed if the patient is confirmed by the prescriber as not being under the PPP.
SIGNED ORDERS AND RECORD KEEPING
When a POM is supplied from a registered pharmacy to healthcare professionals or organisations, an entry needs to be made in the POM register or the signed order/invoice needs to be retained for two years from the date of supply. Even where the signed order/invoice is retained, it is good practice to make a record in the POM register for audit purposes.
