POM EXEMPTIONS: SALE AND SUPPLY WITHOUT RX - EMERGENCY SUPPLY

Question 1

In which two cases can a pharmacist supply a medicine without a prescription?

Answer 1

1. Prescriber’s request (Rx cannot be provided straight away)
2. Patient’s request

(and pandemic diseases)

Question 2

What are the conditions for emergency supply at the request of a prescriber (5)?

Answer 2

1. Sale/supply requested by appropriate prescribe
2. Emergency, Rx can’t be provided immediately
3. Rx-er provides Rx within 72 hours
4. POM sold/supplied in accordance w directions of Rx-er requesting it
5. POM isn’t a CD schedule 1, 2, or 3*
   
   • phenobarbital/Na allowed for treatment of epilepsy, at request of appropriate Rx-ers
   • EEA/swiss Rx-er can’t prescribe CD 1, 2 or 3 including phenobarbital

Question 3

When must the record for emergency supply at request of Rx-er be made?

Answer 3

On day of supply or the day following if impractical in the POM register

Question 4

What’s the max supply for an emergency supply at the request of a Rx-er?

Answer 4

No maximum

Rx-er will decide the appropriate amount because you’ll get the Rx later

Question 5

What needs to be recorded in the POM register for an emergency supply at request of Rx-er? (6)

Answer 5

3 names, 2 addresses, 3 dates

1. The name, strength, form and quantity of medicine
2. Name and address of practitioner
3. Name and address of patient who needs the POM
4. The date on the Rx (can be added when Rx is received by pharmacy)
5. The date when the Rx is received
6. The date the POM was supplied

Question 6

What are the conditions for an emergency supply of POM at request of patient? (5)

Answer 6

• Pharmacist MUST interview patient (HMR Regulation 225)
• There’s an immediate need
• Medicine has to have been prescribed previously (prescribed by a UK, EEA or Swiss prescriber)
• Dose is appropriate for patient
• No 1,2,3 CDs except phenobarbital

Question 7

How would an appropriate dose be determined for an emergency supply at request of patient? (3)

Answer 7

• PMR
• Electronic health record
• Summary care record

Question 8

What emergency supplies are not allowed at request of a patient?

Answer 8

• Controlled drugs sch 1, 2 or 3 (only ex. is phenobarbital for epilepsy)
• CD’s containing: Bromide salts, Hexobarbitone/Na, Methohexitone Na, Thiopentone Na, Strychnine HCl
  
  • They have a narrow therapeutic index

Question 9

What’s the maximum supply for an emergency supply of POM at the request of a patient?

Answer 9

• CD Sch 4 and 5 or phenobarbital = 5 days
• For other POMs = 30 days (but use professional judgement)

Question 10

What are exceptions to the maximum quantity that is allowed to be sold/supplied for an emergency supply at request of patient? (3)

Answer 10

• If insulin, an ointment, cream, or an inhaler (i.e. packs cannot be broken), the smallest available pack should be supplied
• Oral contraceptive - full treatment cycle should be supplied
• Antibiotic in liq form - smallest quantity that will provide full course

Question 11

The emergency supply records at request of patient must include? (5)

Answer 11

1. Name and address of patient
2. Date of supply
3. Details of medicine supplied# (including strength and form) and quantity of medicine supplied
4. Nature of emergency
5. Price as good practice – private Rx

Question 12

What is a summary care record? (4)

Answer 12

• Electronic summary of key clinical info
• Used by authorised healthcare professionals
• Requires patient consent (called permission to view) on each occasion
• If patient and doctor wish to add info to patient’s SCR, patient must consent

Question 13

What information is available from a NHS summary care record (CORE clinical information)? (3)

Answer 13

• Medicines: all current repeats, acute (12 months history) and discontinued repeats (6 months history)
• Allergies
• Adverse reactions about a patient

Question 14

What are the conditions for accessing a patients SCR? (4)

Answer 14

• Must complete training and CPPE assessment
• Access is via NHS smart card
• Only accessible with patient consent unless emergency access (permission to view)
• Only can be used if you’re involved in patient’s care at that time

Question 15

Three reasons why a pharmacist might access a patient’s SCR?

Answer 15

1. Emergency supply
2. Minor ailments
3. Adverse reactions

Question 16

What additional details can be added by a patient’s GP on their SCR? (7)

Answer 16

• Significant diagnoses
• Care plan information (e.g. end of life, long term conditions)
• Any other information that is considered relevant by patient and GP, such as patient preferences
• Details of fertility treatment
• Sexually transmitted infections and treatments
• Terminations
• Gender reassignment

PHARMACIST CANNOT ADD ANYTHING

Question 17

What should be done if the medication is not supplied?

Answer 17

Refer the patient to somewhere they can get a prescription and supply against this e.g. doctor, walk in centre or A&E

Question 18

What are the conditions for an emergency supply during a pandemic?

Answer 18

• Pandemic must be declared by the Department of Health
• The requested medication has been prescribed before
• The dose must be appropriate
• The pharmacist doesn’t need to interview patient or be present