POMs 1 Flashcards
What is a POM?
medicine listed in the POM Order
OR
a medicine where the MA lists the classification as POM
OR
medicinal product that can only be sold with a Rx and signed by appropriate practitioner
PSD - patient specific direction
a prescription
instruction from a prescriber for a medicine to be supplied to a named patient after assessment of patient
How to legally supply POM without Rx (only exceptions)?
PGD
emergency supply
patient spesific directions in hospitals
supply vs sale of POM
dispensing NHS Rx = supply
dispensing private Rx = sale
products that are always POMs
- parenteral products
- CDs (unless MA lists it as P/GSL)
- cyanogenic substances (unless external use)
- med substances that on admin emit radiation
- new chemical entities
How can some products also be P or GSL?
depending on indication, pack size, strength, formulation, route of admin
example of POM that can be P based on strength, form, route of admin, pack size
hydrocortisone – 1% cream 15g [P]
example of POM that can be P based on specific indication
naproxen 250mg – primary dysmenorrhea in women aged between 15 and 50 years [P]
example of POM that can be P for CDs at low strengths
codeine, dihydrocodeine, morphine and pholcodine
- exempt from POM status when in preparations containing only one of the controlled drugs below the stated strength
legal requirements for prescriptions for POMs
Issued by an appropriate practitioner and:
1. signed in ink by the appropriate practitioner
- written in ink or otherwise so it’s indelible
- contain the following particulars:
- address of the appropriate practitioner
- appropriate date
- indication of the type of app. practitioner
- name and address of the patient
- if U12, pt’s age - valid for 6 months from the appropriate date
- practitioner MUST be REGISTERED in the UK or be an approved health professional in an approved country
time for repeatable Rxs to be dispensed
first time within 6 months of appropriate date
Repeatable prescriptions that do not specify the number of repeats, how many times can they be dispensed?
can be repeated only once
** unless Rx for an oral contraceptive, then can be dispensed a total of six times (5 repeats)
can repeats be on normal NHS Rxs?
NO
** only on NHS repeat dispensing scheme
Who can issue POM Rxs?
appropriate practitioner
approved countries
EEA countries and Switzerland
other things needed to dispense POM that AREN’T legal, clinical about drug
- name of drug
- form
- strength
- dose
- frequency
- quantity
private Rxs
- same legal requirements
- can be written on anything (no specific template)
- can be repeated
- no restrictions on what can be prescribed (as long as prescriber is competent to do so)
- can be written by any ‘appropriate practitioner’
- date on private prescriptions is the date when it was signed
- all prescriptions written by health professionals in an approved country are private prescriptions
colour and name of dentist Rx
yellow
FP10 D
FP10 D limitations
only valid if the medication is in the Dental Practitioners’ Formulary (DPF)
Can dentists prescribe generics or branded meds?
generic AND branded if in DPF
private dentist Rx
can legally be for any POM, P or GSL medicine
but
should be in area they’re competent, should prescribe medicine for use in dentistry
colour and name of Community Practitioner Nurse Prescribers Rx
lilac
FP10 P
meds Community Practitioner Nurse Prescribers can Rx on NHS Rx
a limited range of meds listed in the Nurse Prescribers’ Formulary for Community Practitioners (NPF)
Community Practitioner Nurse Prescribers and generics
recmmended to Rx generically except where no approved generic name
missing info on Rx (ONLY address, app date, name, age)
not illegal to dispense if exercised DUE DILIGENCE when dispensing
Are faxed Rx legal?
NO (not signed by prescriber)
if dispensing faxed Rx
MUST ensure the original Rx will be with pharmacist within a short time
ways to avoid faxed Rx if need POM in emergency
emergency supply
electronic prescriptions
faxed Rx and CD 2 & 3
criminal offence to dispense faxed Rx of CD 2 & 3 because Rx not present in the pharmacy
photos of Rxs
not legally valid
printing out photo/email of Rx
not the original copy
like faxed Rx
not legal Rx
forged Rxs
dispensing forged = criminal offence
need to exercise all ‘due diligence and believe that the Rx is genuine’
signature on electronic Rx
must be signed with ‘an advanced electronic signature’
What drugs can be sent as electronic Rxs?
all drugs (incl CD2 & 3s)
What does ‘advanced electronic signature’ mean?
- uniquely linked to the person giving the Rx
- can ID the prescriber
- created using means that the prescriber can maintain under their control
- linked to the data to which it relates in such a way that any subsequent change of the data is detectable
What does pharmacy do with electronic Rxs?
sent from GP to pharmacy via NHS spine
printed out in pharmacy and known as ‘dispensing tokens’
printed in pharmacy on FP10 DT
legal requirements for non-UK Rxs
- patients full first name, surname and date of birth
- prescriber’s full first name, surname, professional qualifications, direct contact details, including email address and PHONE NUMBER or fax number (with international prefix), work address (including the country they work in)
- name of medicine (brand name where appropriate), form, quantity, strength and dosage details
- prescriber’s signature
- date of issue
CDs and non-UK Rxs
CDs in Sch 1, 2 or 3 and products without UK MA can NOT be prescribed
cautions with non-UK Rxs
- likely written in foreign language (legally ok)
- need to check registration status of the prescriber and there is no international database of prescribers
If unable to confirm the registration status of non-UK Rx?
due diligence
When do Rx records NOT need to be made for supply of a POM?
- on a health Rx or a Rx for an oral contraceptive
- a separate record is made in the CD register
- wholesale dealing and the order or invoice (or a copy of it) is retained for two years
where to keep records
POM register/Rx book
Electronically - need backups and facility for inspector to examine without disrupting the dispensing process
hospital pharmacies and POM records
hospital pharmacies only need to make records if they are registered as a pharmacy with the GPhC
When should entry be made in POM register?
on same day as the sale/supply
or if not reasonably practical, the next following day
How long to keep POM records for?
2 years from date of the last entry in the book
How long to keep POM PRESCRIPTIONS for?
for 2 years from date of last supply/sale
details to be recorded in POM register
- date of sale/supply
- name, quantity and, except where it is apparent from the name, the form and strength of POM supplied
- date on Rx
- name and address of prescriber
- name and address of patient
- entry needs ref no., put this on Rx and onto dispensing label
records for subsequent supplies of a repeat Rx
record date and original reference number of the first supply
Where to send NHS Rxs?
send to NHSBSA (business services authority) prescription services division
at the end of the month
Where to send private Rx (non-repeatable)?
keep at the pharmacy for 2 years
Where to send private Rx (repeatable)?
- if still repeats outstanding, give Rx back to patient or offer to retain at the pharmacy
- if final repeat has been dispensed, keep at the
pharmacy for 2 years from the date of the final dispensing
hub and spokes
- Rx handed in at spoke, sent to hub, hub sends meds to spoke, spoke supplies pt
- Rx handed in at spoke, sent to hub, hub supplies Rx to patient (sent/delivered)
only chain pharmacies can use this (dispensing and supply to pt has to be done by same retail business - law)
hub registered with GPhC
but doesn’t need NHS contract to dispense NHS Rxs
** not dispensing from distance selling pharmacy
avantages of dispensing from a hub
- better efficiency
- lower operating costs (but initial set up costs high)
- free up pharmacists’ time at spoke for other activities
- use of automation in the hub (reduced errors, safer dispensing, cheaper) – but hubs don’t have to use automated systems - dispensing robots
disadvantages of dispensing from a hub
- concerns about accountability and liability
- legally, responsibility for the dispensing of the prescription is with pharmacist who supplies the med
- clinical check is the responsibility of the spoke and
the accuracy check is the responsibility of the hub? - operational failure in a hub could have consequences for patients
- confidentiality and security of information is more complicated
- could it affect the patient/pharmacy relationship (esp if the hub
supplies the medicine to the patient directly) - not suitable if the patient needs medicine quickly/urgently
Is supply from hub to spoke wholesale dealing?
NO
questions about hub and spoke dispensing?
which address should go on dispensing label?
concerns with online pharmacies
- high risk med/repeat supply and no monitoring
- Rx meds outside of prescribers’ scope of practice
- high volumes of Rxs issued in short period of time
- risk of meds liable to abuse/OD (CDs, Z drugs, weight loss meds)
logo for online pharmacies
shows registered with GPhC
SSPs
serious shortage protocols
What are SSPs?
allow pharmacist to supply a different med to what’s on the Rx
4 possible actions that can happen with SSPs
- dispense a smaller quantity
- dispense an alternative formulation or strength (of the same drug)
- dispense a generic equivalent for a branded Rx
- dispense an alternative drug with a similar therapeutic effect
informing GP about SSP
patient’s GP must be informed if a SWITCH of medicine has occurred
- but not if a different form or quantity has been dispensed
When only can SSPs be used?
- if prescription presented is legally valid
- patient has to consent to receiving the medicine supplied under the SSP – if they do not, then they need to be referred back to prescriber
original prescription and supply under SSP
if supply made under a SSP (even if lower quantity of the med supplied), the original Rx is no longer valid and no further supply can be dispensed from it
the dispensing label and SSPs
the dispensing label needs to indicate that a supply was made
under a SSP and state the reference number of the SSP
charge and SSPs
if pt usually pays Rx charge but receive a smaller quantity of the medicine, they’re exempt from a prescription charge payment
drugs NOT elegible for SSPs
if brand prescribing is therapeutically important
certain drugs used for epilepsy
admin of parenteral POM
unlawful to admin a parenteral POM other than to yourself unless you are an appropriate practitioner or you are acting in accordance with the directions of an appropriate practitioner
parenteral products exempt from restriction
- if administered for the purpose of saving life in an emergency
- adrenaline (epinephrine) injection
- glucagon injection
- certain hc professionals can also admin meds in
accordance with a PGDs
legal restrictions when admin non-parenteral POMs
there are no LEGAL restrictions on the administration of non-parenteral POMs
(but organisations should have policies covering this)
