PPP Week 19 Flashcards
What are 6 examples of things someone who takes a person-centered approach does?
- establishes what the patient already knows
- identifies any concerns or worries the patient has
- addresses these concerns
- provides any other advice or information the patient would like
- explains what to do if things do not go to plan
- comes to a joint agreement about what to do next
define patient-centred consultation
a consultation where the patient is considered holistically, socially, physically, psychologically and behaviourally, in a discussion where power and decision-making is shared
What is the best consultation model?
the Calgary-Cambridge guide
What are the 5 steps in the Calgary-Cambridge guide?
- initiating the session
- gathering information
- physical examination
- explanation and planning
- closing the session
initiating the session
- first impressions
- introduce yourself
- setting the agenda
- non-verbal communication (body language)
gathering information
- open, probing and closed questions
- tell, explain, describe questions
- ideas, concerns, expectations
physical examination
- would seeing it help?
- are there any physical examinations or observations that will help?
explanation and planning
- sharing thoughts
- shared decision-making
- giving options
closing the session
- safety netting
- summarising and questions
Which technique is used to ensure a consultation is person-centered?
TED ICE
What does TED ICE stand for?
- tell, explain, describe - invites patient to tell you their issue or background
- ideas, concerns, expectations - helps reveal their view of the problem
Why is summarising so important?
- allow patient to add info
- allow patient to correct misunderstandings
- allow you to get the info clear in your own head
- shows active listening
What is important in the shared decision-making part?
using ‘we’ e.g. ‘so, we have a couple of options here….which do you think you would prefer?’
What is the most important part of closing the session?
safety netting - letting the patient know what to expect, when to seek further advice and who from
How should you end the consultation?
give the patient a chance to ask any questions and then close it
What is a hospital drug chart?
an ‘instruction to administer’ that is signed by a prescriber
What does a drug chart do?
gives a nurse all the details needed to administer medication and gives a pharmacist all details needed to understand what has been supplied, allergies, drug interactions etc
What are the 8 requirements for a prescription written on a hospital drug chart?
- patient’s name, hospital number, DOB
- drug name
- drug dose
- drug route of administration
- drug frequency and times of the day to be given
- prescription start date
- prescriber’s signature
- allergies, intolerances, preferences
What is a medicines reconciliation?
a process of finding out what a patient was taking at home
Which 3 checks are needed when a pharmacist assesses a prescription on a drug chart?
- legal check
- clinical check
- contractual check
What is included in the legal check?
does the prescription include all necessary information for a supply to be made?
this includes all information for content on the hospital drug chart, but doesn’t legally needed allergies - this is included in clinical checl
What is included in the clinical check?
3 key things:
1. patient characteristics
2. medication regimen factors
3. aspects relating to administration and monitoring of medicines
What 7 main things must be considered in a clinical check?
- drug dose, route, frequency, timings
- appropriate for THE patient?
- allergies
- contraindications / cautions
- drug-drug interactions
- drug-patient interactions
- any specific patient factors - e.g. renal impairment
What is included in the contractual check?
is the medication funded and available locally?
What are the 2 main categories of useful information sources?
- patient factors
- references
What are useful sources to find out patient demographic information?
- medical notes
- GP records
- drug chart
- patient themself
What are useful sources to find out patient’s past medical history (PMH), presenting complaint and social history?
- medical notes
- MDT handover
- PMR
- GP record
- patient
What are useful sources of current clinical status?
- lab results
- bedside observations of BP, HR etc
- patient
What does MDA stand for?
Misuse of Drugs Act
What does the MDA (1971) law do?
it imposes a total ban on the possession, supply, manufacture, import and export of controlled drugs (CDs) - however there are now many exemptions
What does MDR stand for?
Misuse of Drugs Regulations
What does the MDR (2001) permit?
possession, supply, manufacture, import and export of SOME CDs, by SOME people in CERTAIN circumstances
Who grants licences to permit the above?
the Secretary of State via the Home Office
How does the Home Office enforce these rules?
via the police
How many schedules of Controlled Drugs (CDs) are there in the MDR 2001?
5
What is included in Schedule 1?
drugs with NO therapeutic use - effectively illicit drugs
What is needed for the legal production, possession or supply of Schedule 1 drugs?
a licence from the Home Office
What are examples of schedule 1 drugs?
- ecstasy (MDMA) and related substances
- hallucinogens (e.g. LSD)
- raw opium
What are the rules regarding schedule 2 CDs?
- pharmacists (and some others named in MDR 2001) have a general authority to possess, supply and procure when acting in their professional capacity
- must be locked up
- CD register must be kept
What are examples of schedule 2 drugs?
stronger opiates such as diamorphine, morphine, methadone, amphetamines, ketamine
Which schedules need special CD prescription writing?
2 and 3
What are examples of schedule 3 drugs?
minor stimulants less likely to be misused such as benzphetamine, temazepam, tramadol, phenoartbital
Which 2 parts is schedule 4 split into?
part 1 (CD benz POM)
part 2 (CD Anab POM)
What are examples of part 1 schedule 4 drugs?
benzodiazepines, non-bz hypnotics and Sativex (cannabinoid mouth spray)
What are examples of part 2 schedule 4 drugs?
most anabolic and androgenic steroids, clenbuterol, growth hormones
What are schedule 5 drugs?
preparations of certain CDs that are exempt from full controls as they are present in low strengths- can be POM or P
When did the law regarding medicinal cannabis change?
November 2018 under Misue of Drugs (Amendments)
What did these new regulations introduce?
a definition of ‘cannabis-based product for medicinal use in humans’
Which schedule are medicinal cannabis drugs included in?
schedule 2, any not meeting the definition are schedule 1
When acting in their capacities, which drugs can pharmacist, doctors and dentists possess, supply and procure?
Schedule 2, 3, 4 and 5 CDs
What are other mechanisms for lawful possession of CDs?
- Home Office Licence
- Home Office Group Authority e.g. paramedics
- laws the allow a class of person e.g. registered midwives certain drugs
- patients who have been prescribed a CD or for an animal by a vet
What are the ONLY 2 exemptions for pharmacists to possess schedule 1 drugs without a Home Office licence?
- when possession is for the purpose of destruction
- when possession is for the purpose of handing to the police
When can schedule 1 drugs be administered or prescribed?
ONLY under a Home Office Licence
When can schedule 2, 3, and 4 drugs be administered to a patient?
- by a pharmacist independent prescriber or others acting in their own right
- a supplementary prescriber acting under a Clinical Management Plan
- a person acting in accordance with the directions of a prescriber entitled to prescribe CDs
Where do additional requirements for prescription of schedule 2, 3, 4 and 5 drugs exist?
in some healthcare settings may be in place to say who can administer drugs and who should witness it - NOT legal requirements, just medicines and patient safety
What are the rules regarding import and export of schedule 1, 2, 3 and 4 CDs?
a licence is needed
Are schedule 5 drugs restricted on import or export?
no
When is a licence not needed for schedule 4 part II CDs?
when the patient themselves carries them abroad or brings them into the UK
When do patients not need a licence to travel abroad with CDs?
patients travelling with less than 3 months supply - but advised to carry a letter from prescriber stating name, drug name, total quantity and dose taken
What are patients advised to do when travelling?
check with the embassy/high commission of the country or countries they are visiting or travelling through to ensure import and export rules are complied with
What do patients travelling abroad with more than 3 months supply of CDs need?
- must register with healthcare professional in the country they are in to access ongoing care
- or they may apply for a licence to take the quantities needed
Under which law are the safe custody requirements?
The Misuse of Drugs Regulations 1973 (schedule 2)
What do the safe custody requirements tell us?
how to keep (certain) schedule 2 and 3 CDs physically secure within the dispensary
Where must relevant CDs be kept in pharmacies, independent hospitals and care homes?
‘locked safe, cabinet or room which is constructed as to prevent unauthorised access to the drugs’
Where else may CDs be kept?
can apply for exemption certificate from the police to use other storage such as gun cabinets, old bank safes etc
Which CDs must be kept in safe custody?
- Schedule 1 drugs
- Schedule 2 drugs (except some liquid preparations)
- Schedule 3 drugs (quite a few exceptions)
What happens when these drugs cannot be stored in safe custody (e.g. when dispensing)?
they must be under the ‘direct personal supervision’ of a pharmacist
What MUST you do with patient returns and out of date obsolete stock?
segregate and clearly mark to avoid accidental dispensing - don’t know where they have been
What do safe custody requirements also apply to?
- patient returns
- out of date and obsolete CDs
What are pharmacies required to do before disposal of CDs (schedule 2, 3 and 4 part I)?
denature than using a process which renders them irretrievable
What does CD denaturing and disposal need?
a licence, but pharmacies can register an exemption with the Environment Agency
What else does denaturing of out-of-date stock sometimes require?
witness by an authorised person - this is a local health ward or the police
Why must an authorised person see the denaturing of out-of-date CDs?
to ensure the pharmacy are not misusing them - this is required where a CD register entry is needed to adjust stock levels correctly
Which CDs denaturing do NOT need to be witnessed?
CDs returning to pharmacy after patient no longer needs them, death etc
Who are witnesses authorised by?
the Home Secretary, Secretary of State for Health or an accountable officer
What do accountable officers do?
give authority to senior members of staff who are not involved in day-to-day management of use of CDs - do not witness it themselves
Where must you NOT put CDs?
down the sink or toilet etc as they must not get into the wastewater system
Which schedules of CDs must be destroyed by denaturing?
2, 3 and 4 (part I)
Where must these CDs be put after denaturing?
in a waste container and sent for incineration
What is recommended for denaturing of CDs?
CD denaturing kits - if not available, use DIY method in preference to not denaturing it
How do you denature solid dosage forms using the denaturing kit?
crush, grind or open and add to kit - add a small amount of water
What must you do for health and safety when denaturing a CD?
wear protective equipment and work in a well-ventilated area
How do you use a denaturing kit to denature liquid CDs?
pour it on the denaturing kit
