POM’s 1 Flashcards
Define POM. (1)
Prescription Only Medicines:
- Medicines that can only be supplied from a written direction of the prescriber i.e. a Rx.
Give e.g. of exemptions of obtaining an Rx to supply a POM. (3)
PGD
Emergency supplies
PSD in hospitals.
Give e.g. of products that are always POMs. (5)
Parenteral products
CDs unless MA of product is P or GSL.
Cyanogenics unless for external use.
Medicinal produces that upon administration emit radiation.
New chemical entities.
Give e.g. of products that can also be pharmacy medicines. (5)
Hydrocortisone 1% cream (strength, form, route of administration and pack size)
Naproxen 250mg (primary dysmenorrhea in women 15-50yrs)
Codeine, dihydrocodeine + morphine (low strengths)
What are the legal requirements for POMs Rx? (10)
Issued by an appropriate practitioner +
A) Be signed in ink by appropriate Rxer giving it.
B) Written in ink or otherwise indelible.
C) Particulars:
- Address of appropriate practitioner.
- Appropriate date
- Indication of kind of appropriate practitioner giving it.
- Name and address of person (px)
- IF person is < 12 yrs, person’s age.
D) Validity 6 months from appropriate date.
E) Practitioner must be registered in the UK or be an approved health practitioner in approved country.
How should repeatable Rx be dispensed? (1)
Dispensed for the first time within 6 months from the appropriate date + in accordance with directions of the Rx.
What is an owing? (1)
If the full quantity can’t be dispensed upon patient collection they are given an owing slip stating the remainder of the medication still needed for a full treatment supply. The full quantity is dispensed within the validity period of the R
What is an owing? (1)
If the full quantity can’t be dispensed upon patient collection they are given an owing slip stating the remainder of the medication still needed for a full treatment supply. The full quantity is dispensed within the validity period of the Rx.
What are the main features of a private Rx? (5)
Written on anything.
Written by any appropriate practitioner.
Signed date.
No drug restrictions.
Can be repeated.
What are the main features of repeatable Rx? (5)
Rx that can be dispensed more than once.
No legal limit on number of times a Rxer may request to be requested.
No expiry date as long as it’s dispensed for the first time ( 6 months).
Patient can retain Rx between repeats - pharmacy who dispenses the Rx for the final time must keep the Rx.
(5)
Repeatable Rx should have the name and address of pharmacy and dispensing date to maintain an audit trail .
What are the main features of of dental prescribing? (5)
FP10D Rx (yellow) written by dentist validity only if medicinal products is ordered in DPF.
It’s against a dentists Terms of service not to follow this.
It’s against the pharmacist’s terms of service to dispense these Rx.
DPF only includes generic names but can Rx brand names.
A private Rx written by a dentist can legally be for any POM, P or GSL medicines but dentists are required by their registration body GDC to restrict their prescribing to their area of competency i.e. dentistry.
What are the main features of community practitioner nurse prescribers? (4)
This includes community nurses (District nurses and Health visitors).
Community nurses prescribers can Rx limited range of medicines on NHS prescription (FP10P = Lilac)
Medicines listed in NPF only.
Rx generically but can Rx by brand.
What is the working definition of ‘due diligence’? (1)
If any of the particulars are missing but not incorrect can be subjected to due diligence.
What particulars can be subjected to due diligence? (5)
Practitioner’s address
Appropriate date
Indication on type of prescriber.
Name and address of px.
Px’s age if < 12 yrs.
What are the practical considerations when dispensing Rx? (2)
If medicine is prescribed by brand, only the specific brand on the Rx can be dispensed no alternative can be given.
You must supply exactly what the prescriber has requested. Can supply a different quantity in specific situations e.g. OPD.
An owing slip is given if the full quantity can’t be dispensed and the remainder should be given within the validity of the Rx.
What is OPD? (6)
Original Pack Dispensing:
- The quantity of the drug dispensed must be within 10% above or below of the quantity on the Rx.
- Only applies to EPS NHS + Private Rx.
- N/A to SSP, non-Rx supplies, CD (Sch. 2-4) and specials.
- Pharmacist must believe that giving a different quantity to that Rx is reasonable and appropriate and will not cause the patient to fail to follow the medication regimen as intended by the prescriber.
- Ends blister cutting and repacking and saves time for pharmacy team.
Explain the implications of dispensing valproate-containing medicines. (5)
E.g. sodium valproate, valproic acid + valproate semisodium.
Risks of congenital malformations and neurodevelopmental disorder.
Only dispense full packs of valproate-containing medicines. Not re-packed or split packs.
Give PIL and patient card.
Label not covering patient safety warnings.
What are the main features of electronic Rx? (4)
Electronic Rx must be signed with an advanced electronic signature.
Electronic signature must be:
- Uniquely linked to the signatory
- Related data where any changes can be detected.
All drugs including CDs schedule 2 and 3 = can be electronically Rx.
What does advanced electronic signature mean? (4)
Uniquely linked to person giving the Rx.
Capable of identifying the signatory.
Created using means that the signatory can maintain under their control.
Linked to the data to which it relates to where any changes to the data is detected.
How are NHS electronic Rx sent to the pharmacy? (1)
Via NHS Spine and prints out as a dispensing token.
What happens to the undispensed tokens or tokens containing errors? (1)
They’re sent back to the NHS Spine for GP cancellation.
What is a non-UK prescriptions? (1)
Rx issued by appropriate health professional in an approved country e.g. EEA and Switzerland.
What are the legal requirements of non-UK prescriptions? (15)
Patient’s full first name(s), surname and DOB
Prescriber’s full first name(s), surname, professional qualifications, direct contact details including email address, tel or fax no. (With international prefix), work address (including country they work in.) Signature.
Medicine name, (brand name where appropriate), form, quantity, strength, dose.
Issue date. (Signed date)
CD (Sch. 1-3) and products without a UK MA = X Rx)
What are the implications of non-UK prescriptions? (5)
Rx likely to be written in a foreign language.
Check registration status of prescriber.
A legal defence is applied if unable to confirm the registration status.
Check if clinically and legally appropriate.
If you are unable to dispense the medicine, consider how you can help the patient to obtain the medication they need.
What are the implications of faxed Rx? (3)
Not a legal Rx.
If dispensed, pharmacist must keep the original Rx for a short time.
Dispensing a CD Rx (Sch. 2-3) = CRIME! As there’s no Rx present in the pharmacist.
What are the risks associated with faxed Rx? (7)
Uncertain that a supply is made with a legally valid Rx.
Risks of poor reproduction.
Risk of non-receipt of original Rx.
Original Rx may have been amended and a supply was made prior to change.
Risks of Rx copy and sent to multiple pharmacies.
Rx not genuine
Risks that system of sending and receiving of fax/digital copy of Rx is not secure or from a reputable source.
What are the implications of photos, scans or emails of Rx? (3)
Not legally valid Rx.
Similar principles to fax Rx.
Printed document is not the original but a copy of the Rx.
What should be checked on a Rx to ensure it’s not forged? (2)
Signature of prescriber - check against a known genuine prescription.
Contact the prescriber to verify what has been prescribed - don’t use the contact number on the Rx but from directory enquiries or website.
Which professionals should you inform an incident of a forged Rx? (3)
NHS Counter Fraud Service for NHS Rx.
Police
Prescriber to be informed of any alterations to the issued Rx.
What factors may indicate a prescription is forgery? (6)
- Is a large or excessive quantity prescribed and is this appropriate for the medicine and condition being treated?
- Is the prescriber known?
- Is the patient known?
- Has the title Dr been inserted before the signature?
- Is the behaviour of hte patient indicative? (E.g. nervous, agitated, aggressive etc.)
- Is the medicine known to be commonly misused?
When should a record be made? (6)
Made on every POM supply unless:
- On a health Rx or Rx for an oral contraceptive.
- A separate record is made in the CD register
- Wholesaling and order or invoice or a copy of it and retained for 2 yrs.
Good practice to make a record if exempt from legal requirement but not on all NHS Rx.
Hospital pharmacies only need to make record if registered under the GPhC.
What should be considered when making prescriptions records? (3)
Entry made on the day as the sale/supply or if not practical, the next following day.
Records kept for 2 years, so POM register must be kept for 2 yrs from date of last entry in the book.
Rx must be kept for 2 years from the date of last supplysale.
What particulars is recorded in the POM register? (7)
Supply date.
Medicine name, quantity, form, strength.
Rx date.
Practitioner’s name and address.
Patient’s name and address.
Reference number (on Rx, dispensing label)
For second and subsequent repeats, record supply date and original reference number of first supply
What is the fate of a NHS prescription once dispensed? (1)
Send to the NHS Business Service Authority (NHSBSA), Prescription Services Division at the end of the month.
What is the fate of a private prescription (non-repeatable) once dispensed? (1)
Keep at the pharmacy for 2 yrs.
What is the fate of a private prescription (repeatable) once dispensed? (2)
If there’s still repeats, hand Rx back to patient or offer to keep at the pharmacy.
If final repeat is dispensed, send original to NHSBSA at the end of the month and keep a copy at the pharmacy for 2 years from the final dispensing.
