PM4B Law and Ethics Update Flashcards
1
Q
The community pharmacy contractual framework 2019/20 to 2023/4
A
- a new NHS community pharmacist consultation service
- a new pharmacy quality scheme
- change in status of MURs
- Change in Established Payments
- Essential requirement for community pharmacy contractors to be level 1 HLP
2
Q
CPCF
A
- Local
- Advanced
- Essential
3
Q
Advanced Services
A
1) NMS
2) BP service
3) Appliance use review
4) Stroma Appliance Customisation
5) Flu Vaccination Service
6) Community Pharmacist Consultation Service (CPCS)
7) Hep C testing
8) Smoking Cessation Service
4
Q
Locally Commissioned Services
A
- Minor ailments service
- Care home service
- Needle and Syringe exchange
- Monitored dosage systems
- Supervised consumption
- Sexual Health Screening
- Alcohol screening and brief interventions
- Weight management
- Falls Reduction
- Independent and supplementary prescribing
5
Q
Hep C Testing
A
- Community pharmacy hepatitis C antibody testing service
- Focused on provision of point of care testing for hep C antibodies to persons who inject drugs (PWID)
6
Q
Who is eligible for Hep C testing?
A
- PWID
- > 18
- Not engaged in community drug and alcohol treatment service
7
Q
Pre-test discussion with PWID
A
- Before test, pharmacist or technician have pre-test discussion with PWID
- After discussion, PWID must give consent; can be gained verbally
8
Q
What happens if an individual tests positive for Hep C
A
- Where people test positive, will be sent for a confirmatory test and treatment
9
Q
Community pharmacy consultation service
A
- Where patients are referred into community pharmacy. Pharmacies will take referrals from NHS 111 telephone or online service, general practice for minor illness and urgent med supply
10
Q
what happens if there is no referral on CPCS IT system and you are contacted by the patient?
A
- Check patient is at correct pharmacy
- Check NHS email
- Contact NHS 111 providers health professionals number or GP.
- Confirm patients NHS number and GP with NHS 111 call handler or GP surgery and ask for them to re-send the referral
11
Q
Can consultations be done by telephone?
A
Yes, pharmacists can provide consultation over phone unless there is a clinical need to see the patient
12
Q
Advanced services: Changes to consent
A
- no longer contractual requirement that written consent is given for flu vaccination, NMS, and AUR
- instead verbal consent can be made with written record of service
13
Q
Further changes in CPCF
A
- new NMR Service to ensure changes in med made in secondary care are implemented when patients discharged back into the community = discharge med service
- considering expansion of NMS
- new service to improve palliative care meds
14
Q
Serious Shortage protocol (SSP)
A
- In event of serious shortage
- Legislation which enables protocols to allow community pharmacies to dispense against specific protocol instead of an Rx without going back to prescriber first
- Pharmacist must conduct SSP with their professional judgement, and suggest an alternative that is reasonable and appropriate for patient
- May supply alternative only specified in SSP, provided that pt agrees with alternative SSP supply
- Dispensed SSP must have label that show that supply has been made in accordance with SSP and identify SSP
- SSP protocol endorsed on Rx
15
Q
Types of SSP
A
- An alternative quantity
- An alternative formulation
- Alternative strength
- Generic equivalent
- Therapeutic equivalent
IN LINE WITH PROTOCOL GUIDELINES
16
Q
SSP appropriateness
A
- Pharmacy owners don’t have to use SSP, if they believe that not reasonable or inappropriate, and is in a good time scale, they can supply normal product
- Pharmacy can refuse supply under SSP, must refer back to prescriber
17
Q
SSP Endorsements
A
- NCSO: to indicate the supply was made in accordance with SSP
- Details of product supplied in accordance w SSP (drug name, strength, quantity, formulation, supplier name or brand)
- Quantity supplied
- Pack Size
- Invoice Price: only if NHSBSA has no list price available
18
Q
PPP
A
Protects females of childbearing potential, by minimising the risk of becoming pregnant:
- Pregnancy testing before, during and after treatment
- Contraception requirements
- Distribution control
- Education for healthcare professionals and people
19
Q
Valproate Rx presented for a female 12-49 years
A
- For patients under 55 years currently receiving valproate, 2 specialists should independently consider and document that there is no other effective or tolerated treatment or the risks do not apply
Need to have a convo with pt to check they:
- Understand the risks of valproate use in pregnancy
- Adhere to PPP with one high effective or 2 effective contraceptive methods in place
- Have had specialist review where risks have been discussed in past year
20
Q
If PPP is not in place on valproate
A
- If there is NOT a chance patient is pregnant: make valproate supply and refer to prescriber
- If there is a chance patient is pregnancy: make the valproate supply AND URGENTLY refer to the prescriber.
21
Q
What to do when dispensing valproate?
A
- Provide a valproate patient card every time you dispense a valproate med to all female patients
- Ask if they have received an updated valproate patient guide and provide a copy if they have not received this
- Dispense valproate in original package with outer warning and avoid repacking. in situation where this cannot be avoided, always provide a copy of PIL, and add a warning sticker to outside of box
- Ensure important info is well known throughout staff
22
Q
Valproate under the age of 55
A
- No patients (male or female) under 55 should be initiated on valproate unless 2 specialists independently consider and document that there is no other effective or tolerated treatment
23
Q
Oral retinoids
A
- Must not be used in pregnancy
- Women and girls must be on PPP
- Negative pregnancy test, issuing an rx and dispensing isotretinoin should ideally occur on the same day
- Should be ideally limited to 30 days supply at a time
- Rx should be collected from pharmacy within 7 days of it being signed by doctor
24
Q
In the event of suspected pregnancy and isotretinoin
A
- Stop iso and see GP urgently
25
When can you get pregnant after oral retinoids
Not get pregnant for one month after use and don't donate blood
26
Hypertension case-finding Service (BP Check)
2 stages
1. identifying people at risk of hypertension and offering them blood pressure monitoring (a ‘clinic check’).
2. Offering 24 hour ambulatory blood pressure monitoring (ABPM) where clinically indicated.
The blood pressure test results will then be shared with the patient’s GP to inform a potential diagnosis of hypertension
27
Pharmacist requirements when carrying out a BP check
- Recommended training on how to use the blood pressure monitoring equipment
- Consultation room that will be used for the provision of the service
28
Stop Smoking Advanced Service
- This service enables NHS trusts to refer patients discharged from hospital to a community pharmacy for smoking cessation
29
To provide SCS, pharmacist must have:
- Read and understood operational processes to provide the SCS
- National Centre for Smoking Cessation and Training (NCSCT) courses and satisfactorily passed the assessments
30
What are the assessments that a pharmacist needs to pass to offer SCS
- Stop Smoking Practitioner training and certification;
- Mental health and smoking cessation course;
- Pregnancy and smoking cessation course
- E-cigarettes: a guide for healthcare professionals course.
31
Botulinum toxin and cosmetic fillers Act 2021
1. It is a criminal offence to administer botulinum toxin, or a filler by way of injection for a cosmetic purpose, to a person under 18 in England
2. It is an offence to make arrangements for, or book an appointment to provide these treatments to any person under 18 in England
32
Failure to comply with the Botulinum toxin and cosmetic fillers Act 2021
- Failure to comply could result in a criminal prosecution and an unlimited fine
- The law applies even if the person has the permission of someone over 18
33
What if the treatments are needed to meet a clinical need?
- Under the new law, the treatments can still be approved for use on persons under 18 by a registered medical practitioner (doctor) for a CLINICAL need.
- Where approved by, and under the directions of a doctor, only a pharmacist, nurse or dentist may administer the treatments to under-18s only
34
FIt notes
Form of medical evidence that can enable an individual to access health-related benefits or evidence eligibility for statutory sick pay (SSP)
35
Who else can provide a fit note?
- Nurses, occupational therapists, pharmacists (only in hospital and community) and physiotherapists.
36
Training to be able to provide fit note
- Should complete the e-learning for health training modules on fit note certification and have a period of mentorship and support
37
Are fit notes part of the NHS service?
- Fit notes are not part of the NHS services which community pharmacies provide and community pharmacists will not/do not have access to the ‘Med 3’
