Sale and Supply 3

Question 1

Incomplete prescriptions

Answer 1

Details of the medicinal product e.g. name, strength, form, quantity and dose are clinical requirements under the terms of service for doctors, but not legal requirements
Pharmacist must use professional judgement
Name/address/age of patient can be amended by pharmacist, mostly would send script back to prescriber for amendment
Certain situations may not allow the prescriber to amend the script in reasonable timescale

Question 2

Faxed prescriptions

Answer 2

Not a legally valid Rx- not written in indelible ink and not signed by an appropriate practitioner
Adequate safeguards must be in place to ensure integrity of original Rx
Must make arrangements to get original Rx asap
Not allowed for schedule 2 and 3 CDs

Question 3

Problems with faxes

Answer 3

Uncertainty that legally valid prescription exists
Risks of poor reproduction
Risks of non-receipt of the original prescription
Risks that the original prescription is subsequently amended by the prescriber
Risks the fax is sent to multiple pharmacies
Risks that the prescription is not genuine
Risks that the fax system is not secure

Question 4

Repeat dispensing service- NHS

Answer 4

Patients who have stable conditions requiring long term medication can have repeat supplies managed by the patient’s pharmacy of choice
The prescriber produces an authorising prescription and a set of identical batch forms- the number required is equal to the number of times the prescription is to be repeated and this is to be indicated on the form

Question 5

Repeat dispensing: aims of the service

Answer 5

Increase patient choice and convenience- obtaining regular prescribed medicines and appliances directly from a community pharmacy for a period agreed by the prescriber
Minimise wastage by reducing the number of medicines and appliances dispensed which are not required by the patient
To reduce the workload of general medical practices, by lowering the burden of managing repeat prescriptions

Question 6

Repeat dispensing: service outline

Answer 6

Community pharmacies will dispense in accordance with the directions given on the repeatable prescription
Repeatable prescription needs to be dispensed for the first time within six months of being written
Batches can then only be dispensed subsequently for up to a year from being written or until any expiry date specified by the prescriber, whichever is less

Question 7

Repeat dispensing: prior to each dispensing the pharmacist will ensure:

Answer 7

Patient is still taking or using the medication/appliances appropriately
That the patient is not suffering any side effects
No alterations in the medication regimen
No other changes in the patient’s health

Question 8

Repeat dispensing: batch issue forms

Answer 8

Maximum number is equivalent to one year duration of prescribing
Should contain the same prescriber, patient and prescribed medicine details as the authorising forms
Batch issue forms should not be signed, however the prescriber’s signature box should be annotated with text displaying the words repeat dispensing: xx of yy

Question 9

Submission of repeat dispensing forms

Answer 9

Dispensed batch issue forms should be submitted to the prescription pricing division
Authorising forms should be submitted to the prescription pricing division in the month following that in which all batch issue forms have either been dispensed or expired, or the medication is no longer required
All should be dispensed from the same pharmacy

Question 10

Electronic prescriptions

Answer 10

Available in England- Dr writes script and sends to spine, patient nominates pharmacy, nominated pharmacy retrieves script from spine and dispenses, patient collects medication
Not yet available in Wales- 2D barcode scripts only, the prescriber prints a paper prescription, including a unique barcode Rx, pharmacy can then scan the barcode to download the electronic method

Question 11

Legal basis for electronic prescriptions

Answer 11

An electronic message becomes a legal prescription where:
The prescription has been created in electronic form
Is signed with an electronic signature
Must be sent via the NHS Electronic Prescription Service and no other messaging system
Is then transferred to the dispensing site as an electronic communication

Question 12

What prescriptions can be electronic?

Answer 12

Acute prescriptions
Repeat prescriptions (repeat prescribing)
Repeat dispensing prescriptions (batch scripts)
Each electronic prescription may contain up to 4 items

Question 13

Supply of medicines in hospital setting

Answer 13

HMR 2012 provides exemptions for the need for a prescription for POMs
A number of these exemptions are collectively known as Patient Specific Directions
Not specifically defined in legislation

Question 14

Patient Specific Directions (PSD)

Answer 14

Generally accepted to mean a written instruction from a doctor, dentist or other independent prescriber
For a medicine to be supplied or administered
To a named patient after the prescriber has assessed that patient on an individual basis
Different from a Patient Group Direction (PGD)

Question 15

Hospital inpatient charts

Answer 15

In hospital wards, PSDs are encountered on inpatient charts as directions to administer medication
Though no legal stipulations as to what should be included in a PSD, sufficient information must be available for the person administering the specified medicine to do so safely
If sufficiently clear the PSD may also be a direction to make a sale or supply

Question 16

Hospital medicine supply SOPs

Answer 16

Each hospital will have its own SOPs governing the sale and supply of meds
Each hospital will also have its own formulary of medsto use
Hospital doctors can write FP10s that patients can take to a community pharmacy or the hospital pharmacy but only if it possesses an NHS contract
Hospital pharmacies must also adhere to RP legislation

Question 17

Labelling of dispensed medicinal products: there is a legal requirement for the following to appear on the dispensing label:

Answer 17

There is a legal requirement for the following to appear on the dispensing label:
Name of the patient, name and address of the supplying pharmacy, date of dispensing, name of the medicine, directions for use, precautions relating to the use of the medicine
Recommended:
Keep out of the reach and sight of children, use this medicine only on your skin where applicable

Question 18

Emergency supply

Answer 18

In an emergency and under certain conditions, a pharmacist can supply POMs to a patient without a prescription if requested by a prescriber or the patient
Each request should be considered on a case-by-case basis
Need to use professional judgement to decide what is in best interest of patient

Question 19

Emergency supply at request of prescriber

Answer 19

Pharmacist satisfied that supply has been requested by an appropriate prescriber
Reason for emergency must be stated explaining why practitioner is unable to furnish prescription immediately
Practitioner must provide prescription within 72 hours
Supplied in accordance with the practitioners directions
Cannot be made for schedule 1, 2 or 3 CDs, except phenobarbitone fr the treatment of epilepsy
Entry made in the prescription only register on the day or the following day

Question 20

ES at request of prescriber: record

Answer 20

Must include: date the POM was supplied, the name, strength, quantity and form supplied, the name and address of the prescriber, the name and address of the patient, the date on the prescription, the date on which the prescription was received

Question 21

Es at request of patient

Answer 21

Pharmacist required to interview patient
Must be satisfied there is an immediate need for the POM
POM requested must previously have been prescribed
The pharmacist must be satisfied of knowing the dose that the patient needs to take
Not controlled drugs, except phenobarbital for the treatment of epilepsy
Entry made into register on same day or next day

Question 22

ES at request of patient: record

Answer 22

Must include: the date the POM was supplied, the name, strength, form and quantity supplied, the name and address of the patient, information on the nature of the emergency such as why a prescription cannot be obtained

Question 23

ES at request of patient: supply

Answer 23

Supply no more than 5 days in the case of CDs (phenobarbitone or other schedule 4/5)
30 days supply can be given for other POMs, unless insulin, contraceptive, cream, ointment, aerosol, antibiotic liquid (then enough to providefull course of treatment) i.e. smallest pack supplied
Labelling must include the words emergency supply