Misuse of Drugs Act 2 Flashcards
Storage of CD is regulated by which act?
Safe custody regulations (1973)
Regulations for a CD cabinet (4)
Contraction: sheet steel/wheedled mesh
Close fitting door plus dead bolt and 5 level lock
Rigidly attached to floor or wall
No indications on exterior as to contents
You can use an alternative to a CD cabinet if you…
Get the police to certificate it.
Eg. Vault, gun cabinet, money safe.
In hospitals/prisons CD might be kept in a certified room (additional regulations due to large quantities)
Pharmacies should haven a politics saying who has access to CDs. (Separate to dispensing SOP). For example:
Identifies everyone who has access to the CDs in the pharmacy and for when/how long.
Eg. Electronic access to CD safe or audit train for holder of keys.
Normal practice is to keep the keys in the PHARMACISTS POCKET.
Which CDs do you keep in a CD safe? Schedule 1?
Schedule 1: Sativex should be kept in a lockable fridge or a fridge in a secure location.
Fridges must be out of public view
Schedule 2 kept in the CD cabinet?
Schedule 2: Keep all except quinalabarbitone and some liquids in cabinet.
Liquids due size.
Must keep injections in the cabinet.
Which schedule 3 should be kept in the CD cabinet?
ARE required to keep temazepam, buprenorphine, flunitrazepam and diethylpropion in cabinet.
There are many exceptions eg. phenobarbital, mazindol, meprobamate, midazolam, pentazocine, phentermine.
LEARN THE EXAMPLES :’(
Which schedule 4 & 5 are kept in the CD cabinet?
NONE
Safe custody does not apply when CDs are
Under the constant, direct supervision of a pharmacist. I.e. being dispenced.
Can CDs be dispenced/given out in the pharmacists absence?
You can dispense them but not give them out.
You may chose to hold into the keys when you leave the dispensary to ensure neither occurs.
Can you keep anything else in the CD cabinet?
Not other things such as money
You can keep other medicine in there if you have particular concern, eg. If you suspect it is being used for date rape.
Safe custody applies to what three types of stock?
Pharmacy stock
Out of date stock
Returned medicines from patients.
You must spare ate them in the cabinet to ensure not dispensing errors!
What is the difference between a Rx and a Rqn?
Prescription – order from practitioner to supply an individual patient
Requisition – a request for supply for use in the course of the requester’s professional role. May therefore be supplied/administered to several patients (i.e. stock supply)
Which CDs do not require a script?
Schedule 5 P meds.
What is a private script CD written on?
For what schedules?
FP10PCD
Schedules 2&3
When can you use normal paper to dispense a private CD?
In a hospital if dispensed in the hospital dispensary.
Can you have a private CD and nonCD on the same script?
No. One should be sent to audit
What do you do with the FP10PCD after it is dispenced?
Take a photocopy then send off for audit.
FP10PCD must contain
private prescriber IDENTIFICATION NUMBER – this is issued by a relevant NHS agency. Use to checked someone is a prescriber.
Not the same as registration number.
How long to you keep a vet Rx for?
5 years
Vet CD Rx do not require:
DO NOT NEED:
Prescriber identification number
Standardised form - may be on any paper
Don’t need to be submitted for audit.
NHS CDs Rx is written on…
FP10 - green
FP10D - yellow
FP10HP - hospital outpatient
Plus different coloured forms for drug dependancy (late lectures)
When dispensing a dental of nurses NHS CD Rx you should
Check the formulary to see if they can prescribe it
On a CD script the date should be
28 days from ‘appropriate date’ given on the prescription (either signature date or not be supplied before date)
If the signature date and supply date are not the same, then the 28 day validity runs from the later one.
Any owing balances must be supplied within 28 days.
Does the date need to be hand written?
No,
There can only be …. days between the supply date and the signature date
28
Does the Rx need to be in the prescribers own handwriting?
No. Receptionist could write but prescriber must sign
Can the prescriber signing be different from the one written in the form?
Yes. As long as they have the same practice address.
Prescribers address must be….
Within the UK
Patients address should be… But can’t be…
Must be stated.
Can put NFA (no fixed abode) but cannot use a PO box
As a pharmacist you must be familiar with the signature or
Check that it is genuine
How many days supply can be on a CD Rx
30.
This is not a legal requirement but a department of health recommendation. To exceed use your professional judgement.
Five fingers of things required for CD drug on the Rx?
- Name - not legal requirement
- Form - even if only on exists
- Strength - unless only one avail
- Total quantity in words and figures (ml or dosage units. Not mg)
- Direction
For instalment dispensing you need the ..
With instalment dispensing, must state the amount to be supplied per instalment and the interval between instalments to be observed as well as the dose.
Does the dose need to be in words and figures?
No. Just the total quantity.
Dental CDs need…
‘For dental treatment only’ written on them.
Not often used but maybe for anxiety before operation.
You might need to check why it is required.
Once dispensed how do we endorse the CD Rx
Date of supply.
Also convention to stamp.
How is temazepam different?
Temazepam (Sch 3) is exempt from the usual sch 2 and 3 prescription requirements except for 28 day validity from appropriate date.
What schedules do all these Rx requirements apply to?
1,2,3
4&5 are mainly only regulated for import and export.
What errors can a pharmacist amend on a CD script? (3)
Typographical
Spelling
Where words or figures (but not both) has been omitted from the total quantity.
Must be convinced the Rx is legal and you understand the prescribers intentions.
When amends am Rx as a pharmacist you should write
Date
Name
GPhC reg no
Signature
For someone to collect a schedule 2…
Should find out who they are
ID if not known to you.
If no ID use professional judgement if to provide.
If collected by healthcare professional you also need the
Address
What schedules require box signed in the back of the script?
2&3. This is not a leagal requirement but good practice.
When does a pharmacy require a requisition to get CD stock?
When obtaining stock form another pharmacy.
Not required if ordering stick from a wholesaler
What schedules require a Rqn when being supplied from a pharmacy?
1,2&3
Schedule 1 Rqn should be from a home office license holder (unless Sativex)
In an emergency do you need a requisition?
No. For example if you doctor is on a house call and realises stock is out of date.
Requisition is needed to supply schedules 2&3 to whom? (9)
- Practitioner (e.g. for on call bag, surgery use) including vets
- Supplementary prescriber
- Person in charge of hospital/care home –must be signed by Dr or Dentist working there.
- SRN in charge of ward, theatre, dept of hospital or care home. Can obtain supplies from person responsible for dispensing at the hospital/care home by way of requisition s/he has signed, stating total quantity. S/he must keep copy, pharmacist must keep original and mark requisition as supplied.
- Midwife (via a Midwife Supply Order)
- Person in charge of laboratory based in a University, U-C, hospital or approved institution for scientific education or research (NB: also supply Sch 1 if hold license). More commonly obtain CDs from wholesaler.
- Master of a UK registered ship with no doctor
- Installation manager of an off shore rig (in UK waters)
- Manager of foreign ship in UK port (need statement from proper officer of port health authority that CD quantity is necessary for equipment of ship)
What are Rqn written on?
Standardised from from PCT. (encouraged but not legal requirement)
Midwife supply order form.
Vets just used headed paper.
Faxed or photocopied is NOT ACCEPTABLE.
Can someone else collect a Rqn in behalf of the prescriber?
Must have written permission, you must be satisfied it is genuine, keep letter for two years.
Rqn legal requiments (5)
Signed by recipient
State recipients name & address
State recipients profession or occupation
Total quantity of drug requested (NB. No ‘words & figures’ needed)
Specify purpose for which drug is required (replenish used stock/use in my professional practice)
NB. Date not legal requirement but good practice.
CDs that can be supplied to midwives?
Diamorphine, morphine, pethidine and pentazocine
Mid-wife supply order needs (5):
State name of midwife
State occupation of midwife
State the purpose for which the CD is needed
Include total quantity of the drug needed
Be signed by ‘appropriate medical officer’ – person who supervises midwives in local area, appointed by supervising authority (PCT)
After supplying Rqn pharmacist should: (3)
Mark as spent with name and address (date is good practice)
Copy Rqn and keep for 2 years
Send original requisition to the NHS BSA
(Midwife supply order does not need to be sent - keep original)
Can you emergency supply CDs?
Only phenobarbital.
No others. This includes at request of prescriber and of patient.
Note - can emergency supply for practitioner’s use in practice. Must furnish Rqn within 24h.
Which invoices do we keep for CDs?
How long?
All is good practice.
2 years.
