ms 2 Flashcards
What are the POM Rx requirements?
These apply to private AND NHS
- Signature
- In original ink!
- an advanced electronic signature can be used to authorise an electronic Rx - Prescriber’s Address
- Date
Either:
- Date signed (by the signature)
- Or date indicated by prescriber (e.g. post dated)
What date is the appropriate date for private POM Rx’s?
the date signed
What isn’t a POM Rx legal requirement?
. The medicine detail
- but they wouldn’t give you a blank Rx
- If there is something missing e.g. dose, quantity or strength, then:
- contact prescriber and write it yourself on Rx (endorsing as PC with name & date)
OR
- If you use your judgement and are confident on whats missing then write it and (endorse as PNC with name and date)
What if the medicine quantity is missing?
- If surgery open
- contact prescriber and confirm quantity and PC as endorsement - If surgery closed
- 5 days of treatment should be supplied
- PNC should be endorsement (as you haven’t contacted the prescriber)
How long is a Rx valid?
6 months from the appropriate date (INCLUDING OWINGS)
- within 28 days from the appropriate date for schedule 2 and 3 drugs
When is there an exemption to the validity of a Rx?
f the Rx is repeatable
- this where prescriber has added a direction on the Rx to be repeated
- These are commonly found on private Rx!
(NHS not so common) - The direction could say “Repeat x 5”
- For the first time, the Rx HAS to be dispensed within 6 months.
- But for times after the first dispensing, there is no legal timeframe to dispense them (but always use professional judgement on whether further dispensing is appropriate)
Are NHS prescriptions repeatable? As in it can say “repeat 2x”?
no
If a Rx says “Repeat x 5”, how many times in total will you dispense that Rx?
6 time.
So first time you dispense, then repeat a further 5 times
What happens if the Rx just says “Repeat” without specifying how many times?
This means you’ll ONLY repeat one more time
- So in total, you would have dispensed it TWICE
- However, there is an exemption..
What is the exemption with regards to “Repeat” on rx that doesn’t specify how long?
RAL CONTRACEPTIVES! ONLY!
- If it say’s repeat, then that means you can repeat for a further 5 times
- So you would in total dispensed it 6 times (for 6 months treatment)
Can you write “Repeat” on Control drugs Rx’s?
chedule 2 = No
Schedule 3 = No
Schedule 4 = Yes
- Remember, Rx’s are valid for 28 days, so the first dispensing MUST occur within then
- there is NO TIME LIMIT for further repeats to be dispensed
- e.g. Diazepam
- But remember, use professional judgement
Can patients with “Repeat” on Rx go to different pharmacies?
They can go to different pharmacies
- To maintain an audit trail, the pharmacist should mark the name and the address of the pharmacy from where the supply has been and the date.
Which type’s of prescriptions require you to make a record? And how long are they retained for?
Private Rx’s
Rx is retained for 2 years since since the date of supply (or for repeatable, the last authorised supply)
Records are made in a POM register (written or electronic)
What are the exemptions to record keeping?
A private Rx for Oral contraceptives
- YOU DO NOT NEED TO MAKE A RECORD
- But you retain the script for 2 years
- Schedule 2 CD’s
- they’re made on a separate register - sale is via wholesale dealing
- no record is made
- BUT order/invoice is made for 2 year
How long are the records in the POM register retained for?
E.g. if book finished, then it’s two years since the last entry (on the last page perhaps)
What must the POM record entail?
- Patient’s name and address
- Medicine detail
- e.g. medicine, strength, formulation and quantity provided - Prescriber’s name and address
- Date on Rx
- Date dispensed
When should a record be made?
on the day of the supply
Or if this is not possible
- the next following day
Is a faxed prescription legally valid?
No
- its not signed indelibly (by ink)
If a patient brings you a prescription for Amlodipine 10mg from Italy, can you dispense it?
Yes
- Prescriptions and repeatable prescriptions issued by a doctor, dentist, prescribing pharmacist or prescribing nurse Registered in an EEA country OR Switzerland are legally recognised in the UK
Which countries are part of the EEA? (DONT NEED TO REMEMBER THIS, JUST BE AWARE)
. Austria
- Belgium
- Bulgaria
- Croatia
- Cyprus
- Czech rebuplic
- Denmark
- Estonia
- Finland
- France
- Germany
- Greece
- Hungary
- Iceland
- Ireland
- Italy
- Latvia
- Liechtenstein
- Lithuania
- Luxemberg
- Malta
- Netherlands
- Norway
- Poland
- Portugal
- Romania
- Slovakia
- Slovenia
- Spain
30 Sweden
State some European countries that may not be part of EEA?
Russia
- Ukraine
- Belarus
- Serbia
- Moldova
- Bosnia
>
- Montenegro
- Macedonia
- Albania
- Andorra
What are the legal Rx requirements for EEA/Switzerland prescriptions?
- Patient details
- Full first names(s)
- Surname/>- D.O.B. (Note: not a legal requirement if on normal NHS prescription) - Prescriber details
- First full names
- Surname
- Professional qualification
- Direct contact details e.g. Email address and telephone/fax number (with international prefix)
- Work address (including the country they work in) - Prescribed medicine details
- Name of medicine (brand where appropriate)
- Form
- Quantity<br></br>- Strength
- Dose - Prescriber signature
- Date of issue
Which isn’t a legal requirement for EEA prescriptions?
Patients address
Can the medicine be a brand that is available only in the EEA country?
No!
The prescribed medicine HAS to be available in the UK
You wouldn’t import it
Can EEA/Switzerland prescribers prescribe when they are in the UK? E.g. the prescriber writes a prescription in front of you and tells you to dispense it!
No!
They can only write the prescription if they were in their country (so issued in the EEA/Switzerland state except UK)
They CANNOT prescribe in the UK unless they are registered with the GMC
How long are Rx’s from EEA/Switzerland valid for?
POM & CD5: 6 months from the appropriate date
- Schedule 4: 28 days from appropriate date
Can Rx’ers from EEA/Switzerland prescribe for CD1, 2 and 3?
NO
Can you do an emergency supply at the request of an EEA/Switzerland prescriber?
Yes you can!
- BUT NOT FOR CD1, 2 and 3 (INCLUDING Phenobarbital Note: in UK, you can give phenobarbital emergency, ONLY exeption)
- For CD 4 & 5 you can!
- This is provided you receive the Rx within 72 hours
What happens if the Rx is in a foreign language?
As long as you have enough information
And
- the rx is legal
Then it is valid and you can still make supply (same with welsh)
What happens if your unable to confirm registration status of an EEA/Switzerland prescriber?
it may be possible to still make a safe & legal supply to patient
- as long as you took the necessary steps and used your judgement and recorded the steps you made
Are you obliged to make a supply for EEA/Switzerland prescriptions, even if its valid?
No
- If pharmacist not satisfied, then they can refer them to a UK prescribe
What are the legal requirements of a label?
Name of the patient
- Name and address of supplying pharmacy
- Date of dispensing
- Name of medicine
- Directions for use
- Precautions related to use of medicine
- Keep out of the reach and sign of children!
- IF EMERGENCY SUPPLY: the words “Emergency Supply” MUST be added to dispensing label
Medicines dispensing from bulk containers
ou are allowed to dispense the medicines from a bulk container for prescriptions or in anticipation of prescription
If for anticipation of Rx, then you must label the container:
1. Name of medicine
- Quantity in the container
- The ingredients
- Expiry date
- Batch Number or LOT number
Is it okay to supply medicines against a prescription that has been self-prescribed?
ts not against the law
- but pharmacists should use judgement when dealing with these
How do you deal with Isotretinoin prescriptions and PPP?
Prescriptions are ONLY valid for 7 days under PPP
- If it has been longer, then women need to take it back do a pregnancy test again and get the prescription re-authorised
- if prescription is NOT under PPP, then its usual (6 months)?? (Confirm with prescriber)
- Max quantity is 30 days
- If the patient is not under PPP (confirmed by prescriber), then they may be prescribed more - Only to be prescribed by a consultant dermatologist
How do you deal with valproate prescriptions for girls and women?
. Talk to the patients and find out whether:
- they had a review with doctor recently
- aware of risks on pregnancy
- and are on a pregnancy prevention programme (PPP)
- If patient is telling you they want to get pregnant, then they should have an appointment with doctor
- If patient gets pregnant, advise them to NOT stop treatment and see doctor asap
- Report any suspected side-effects via yellow cards scheme
List the types of prescribers?
Doctors
- Dentists
- Pharmacists Independent prescribers
- Physiotherapist independent prescriber
- Podiatrist IP
- Nurse IP
- Community practitioner Nurse
- Optometrist IP
- Therapeutic radiographer IP<br></br>
- Supplementary prescribers (SP)
- Veterinary prescribers
Doctors
- Controlled drugs
- CD1: They need a license from home office to prescribe cocaine, dipipanone or diamorphine for treating addiction
- Can prescribe all other CD’s - Unlicensed
- Yes - Consideration
- Must prescribe within their clinical expertise - Can they they authorise emergency sale
- Yes
- but not CD1, 2 or 3 (Except Phenobarbital for epilepsy)
- Dentists
Controlled drugs
- CD1: They CANT prescribe cocaine, dipipanone or diamorphine for treating addiction
- Can prescribe all other CD’s
- Unlicensed
- Yes - Consideration
- They should restrict prescribing to treatment of dental conditions, but legally they can prescribe anything - Can they they authorise emergency sale
- Yes
- but not CD1, 2 or 3 (Except Phenobarbital for epilepsy)
- Pharmacist IP
Controlled drugs
- CD1: They need a license from home office to prescribe cocaine, dipipanone or diamorphine for treating addiction
- Can prescribe all other CD’s
- Unlicensed
- Yes - Consideration
- Medicines within their competence - Can they they authorise emergency sale
- Yes
- but not CD1, 2 or 3 (Except Phenobarbital for epilepsy)
- Physiotherapist IP
. Controlled drugs
- ONLY: Diazepam, Lorazepam, Temazepam
- Morphine, Oxycodone and Fentanyl
- Dihydrocodeine
- any others is not acceptable
- Unlicensed
- ONLY “Off-label” - Consideration
- Medicines for any medical condition within their competence - Can they they authorise emergency sale
- Yes
- but not CD1, 2 or 3 (INCLUDING Phenobarbital for epilepsy)
- so they can’t issue emergency for phenobarbital
- Podiatrist IP
Controlled drugs
- ONLY: Diazepam, Lorazepam, Temazepam
- Dihydrocodeine
- any others is not acceptable
- Unlicensed
- ONLY “Off-label” - Consideration
- Medicines for any medical condition within their competence - Can they they authorise emergency sale
- Yes
- but not CD1, 2 or 3 (INCLUDING Phenobarbital for epilepsy)
- so they can’t issue emergency for phenobarbital
- Nurse IP
ontrolled drugs
- CD1: They CANT prescribe cocaine, dipipanone or diamorphine for treating addiction
- Can prescribe all other CD’s
- Unlicensed
- Not allowed in Scotland. Not sure about England? - Consideration
- Medicines for any medical condition within their competence - Can they they authorise emergency sale
- Yes
- but not CD1, 2 or 3 (Except Phenobarbital for epilepsy)
- Community practitioner Nurse
ontrolled drugs
- NO
- Unlicensed
- NO - Consideration
- Restricted to dressings, appliances and licensed medicines which are listed in Nurse Prescribers formulary - Can they they authorise emergency sale
- Yes
- but not CDs
- Optometrist IP
Controlled drugs
- NO
- Unlicensed
- Only “off-label” - Consideration
- For ocular conditions affecting the eye and surrounding tissue ONLY - Can they they authorise emergency sale
- Yes
- but not CDs
- Therapeutic Radiographer
Controlled drugs
- I think so?
- Unlicensed
- “Off-label” - Consideration
- Medicines for any medical condition within their competence - Can they they authorise emergency sale/>- Yes
- but not CD1, 2 or 3 (INCLUDING Phenobarbital for epilepsy)
- so they can’t issue emergency for phenobarbital
- Supplementary prescribers (SP)
Controlled drugs
- CD1: They CANT prescribe cocaine, dipipanone or diamorphine for treating addiction
- Can prescribe all other CD’s
- Unlicensed
- Yes - Consideration
- They should restrict prescribing medicines within the clinical management plan agreed between Doctor (or dentist) and patient - Can they they authorise emergency sale
- Yes
- but not CD1, 2 or 3 (Except Phenobarbital for epilepsy)
- They can request emergency for phenobarbital, provided its in the clinical management plan agreed
Who can be supplementary prescribers?
harmacist
- Midwife
- Nurse/>
- Chiropodist
- Dietician
- Podiatrist
- Physiotherapist
- Radiographer
- Optometrist
11. Veterinary prescribers
1. Controlled drugs - Yes for the treatment of Animals
- Unlicensed
- Yes for treatment of animals (subject to the veterinary cascade) - Consideration
- For the treatment of animals only - Can they they authorise emergency sale
- Not applicable (since that applies to humans only)
Overall, which prescribers can authorise an emergency for phenobarbital?
Doctors
- Dentists
- Pharmacist IP
- Nurse IP
- Supplementary Prescribers
- provided it is included in the agreed clinical management plan for that patient
