Week 10: POMs Flashcards
What is a POM? (1)
A medicinal product that can only be sold/supplied in accordance with a prescription signed by an appropriate practitioner.
What does PSD mean? (1)
Patient specific direction e.g. Rx
Give e.g. of circumstances where POMs can be legally be supplied without a Rx. (3)
PGD
Emergency supplies
Patient specific direction in hospitals.
Give e.g. of products that are always POMs. (5)
Parenteral products
CDs unless the MA of product lists it as a P/GSL.
Cyanogenic substances unless for external use.
Medicinal substances that on administration emit radiation.
New chemical entities.
Give e.g. of products that can also be pharmacy medicines. (3)
Hydrocortisone 1% cream 15g
Naproxen 250mg - primary dysmenorrhoea
Codeine, dihydrocodeine and morphine (at low strengths)
What are the legal requirement for POM prescriptions? (10)
Must be issued by an appropriate practitioner
Be signed in ink by appropriate practitioner giving it.
Written in ink or indelible.
Address of appropriate practitioner.
The appropriate date
An indication of kind of appropriate practitioner.
Name and address of px.
If person < 12 yrs, px age.
Valid for 6 months from appropriate date.
Practitioner must be registered in the UK or be an approved health professional in approved country.
When should a repeatable prescription be dispensed? (1)
Should be dispensed for the first time within 6 months of the appropriate date and in acc. with directions contained on the Rx.
What does a repeatable Rx not always specify? (2)
The no. of repeats i.e. repeated only once.
Unless it’s a Rx for oral contraceptive which can be dispensed a total of 6 times (5 repeats) or not dispensed after end of the period of 6 months from the appropriate date.
What are ‘owings’? (2)
Px are given owing slips when the full quantity of medicines can’t be supplied at the time the px comes into the pharmacy. Supplied within the legal valid period of the Rx.
State the main features of a private Rx. (8)
Follows POM legal requirements.
Can be written on anything.
Can be written by any ‘appropriate practitioner’
Date on Rx is date when it was signed.
Rx must be satisfied it’s genuine.
No restrictions on what can be Rx (competence)
All rx written by approved health professional in approved country
Can be repeated.
State the main features of a repeatable Rx. (7)
Rx that can be repeated more than once.
No repeats allowed on FP10 unless part of NHS repeat dispensing scheme.
Repeat / repeat x?
No legal limit on no. of times a prescriber may request to be repeated.
No expiry of repeat Rx after it has been dispensed for the first time but prof. judgement should be used, considering clinical issues.
Px can retain Rx between repeats - pharmacy who dispenses the Rx for the final time must retain the Rx.
Repeatable Rx should be marked with name and address of the pharmacy and dispensing date to maintain an audit trail.
State the main features of prescribing by dentists. (6)
FP10(D) Rx (yellow) written by a dentist is valid only if the medicinal products are in the Dental Practitioner Formulary (DPF)
It’s against a dentists’ Terms of Service not to follow this.
It’s against a pharmacists’ Terms of Service to dispense such Rx.
DPT only has generic names but dentists can Rx a brand version of the generic product in the DPF.
A private Rx written by a dentist can legally be for any POM, P or GSL medicines (competence)
Dentists are required by the GDC to restrict their prescribing to areas in which they’re competent. Hence, dentists should only Rx medicines which have uses in dentistry.
State the main features of prescribing by community practitioner nurse prescribers. (5)
These include community nurses (District nurses + Health Visitors) who have under extra training.
Community nurse practitioners may prescribe a limited range medicines on a NHS Rx FP10P (lilac)
Medicines are listed in Nurse Prescriber’s Formulary (NPF) for community practitioners.
Similar Terms of Service issue to dental Rx.
Prescribers are recommended to Rx generically, except where it’s not clinically appropriate or no approved generic name.
What particulars is subject to ‘due diligence’? (5)
Address of appropriate practitioner.
Appropriate date.
Indication of kind of appropriate practitioner giving it.
Name and address of px.
If person is <12 yrs, person’s age.
What is the legal definition of due diligence? (1)
The sale/supply isn’t rendered unlawful if the person making the sale or supply, having exercised all due diligence, believes on reasonable grounds that the conditions has been met/Rx is genuine.
What is the working definition of due diligence? (1)
If any of the above particulars is missing (not incorrect) on a Rx, it’s not illegal to dispense as long as you have exercised due diligence.
State the main features of original pack dispensing (OPD). (6)
Starts on the 1st Jan 2025, allows pharmacists to supply a drug in its original pack even if the quantity dispensed is a different quantity to the Rx.
Quantity of drug dispensed must be within 10% (above or below) of the quantity on the Rx.
Only applicable to EPS NHS Rx + private Rx.
Not applicable to supplies under a SSP + non-Rx supplies, CDs Sch. 2-4 + specials.
Non-mandatory.
Pharmacist must believe that giving a different quantity to what’s Rx is reasonable and appropriate and will not cause px to fail to follow ‘the medication regimen as intended by Rx.’
What is the main benefit of the Original Pack Dispensing Law? (2)
May end blister cutting + repackaging of meds - saves time for pharmacy team.
What do you need to consider when dispensing valproate-containing medicines?
Only full packs of valproate-containing medicines can be supplied to px. (Closest to quantity of Rx)
Can’t be split or repackaged!
Applicable to all Rx (NHS + Private) for male/females.
What is the main benefit of dispensing valproate-containing medicines? (2)
Ensures px can see the warnings on the box.
Already contains a PIL/px card.
What would be the main exemption of not dispensing valproate-containing medicines in its original box? (1)
When supplied under MDS - risk assessment required and px to be given a PIL.
What do you need to consider when labelling a valproate-containing product? (1)
Ensure the label doesn’t cover the px safety warnings printed by the manufacturer on the pack.
Explain the main features of an electronic Rx. (3)
All POM legal requirements apply.
Must be signed with an advanced electronic signature and sent electronically to the person dispensing it.
All drugs (incl. CDs Sch. 2/3) can legally be sent as electronic Rx.
What does advanced electronic signature mean? (4)
Uniquely linked to person giving the Rx.
Capable of identifying signatory.
Signatory can maintain under their control.
Linked to the date to which it relates to in a way that any data changes is detectable.
What are the legal requirements for non-UK Rx?
Patient’s full first name(s), surname + DOB.
Prescriber’s full first name (s), surname, prof. qualifications, direct contact details, incl. email address + telephone no. / fax no. (w/h international prefix), work address (incl. country they work in)
Name of medicine(s) (brand name where app.), form, quantity, strength + dose.
Prescriber’s signature
Date of issue (signed date)
What type of medicinal products is not eligible as a non-UK Rx? (2)
CD Sch. 1-3
Products w/out a UK MA.
What precautions do you need to consider for non-UK Rx? (6)
Rx is likely to be written in a foreign language.
Check registration status of prescriber and there’s no international database of prescribers.
Check if Rx is clinically safe.
Exercise due diligence for these Rx if unable to confirm registration status.
It’s not obligatory to dispense Rx if there’s any doubts/concerns - clinical/legal appropriateness.
If unable to dispense, need to help px obtain medicine.
What are the potential risks associated with faxed Rx? (7)
Uncertain that supply has been made in acc. with a legally valid Rx.
Risks of poor reproduction
Risks of non-receipt of original Rx = inability to demonstrate that a supply has been made in acc. to a rx.
Risks that the original Rx is amended by prescriber where the supply would not have been made in acc. with the Rx.
Risks the fax/original copy is sent to/received by multiple pharmacist and duplicate supplies are made.
Risks of Rx isn’t genuine.
Risks of the system of sending/receiving of fax/digital copy of Rx isn’t secure or from a reputable source.
Explain the benefit and risk with photos, scans or emails of Rx. (3)
+ Useful for px in confirming what has been Rx.
+ Can be shown to any HCP involved in their care.
- Not legally valid Rx for same reason as faxes i.e. they’re copies of the original Rx.
What precaution is considered when you think the Rx is forged? (1)
Exercise the due diligence clause - ‘provided that the pharmacist has exercised all due diligence and believes on reasonable grounds that the Rx is genuine.’
What factors indicate that the Rx is forged? (6)
Is a large/excessive quantity prescribed and is this appropriate for the medicine and condition being treated?
Is the prescriber known?
Is the px known?
Has the title ‘Dr’ been inserted before the signature?
Is the px’s behaviour indicative? (e.g. nervous, agitated, aggressive etc.)
Is the medicine known to be commonly misused?
If the Rx is forged, what actions is taken place? (3)
Check signature carefully (check against the genuine Rx from the same prescriber.)
Confirm details with prescriber. (E.g. whether a Rx has been issued, the original prescriber’s intention and whether there’s been any alterations).
Use contact details of prescriber that are obtained from a source other than the suspicious Rx (e.g. directory enquiries)
What are exemptions of making a POM record? (3)
Health Rx/Oral contraception Rx
Separate record made in CD register
Wholesale dealing + order or invoice (or copy of it) retained for 2 yrs.
Where can Rx records be kept? (2)
Bound book
Electronically (backups/ facility for inspections to examine them without interruption to pharmacy)
When would it be appropriate for hospital pharmacies to make Rx records? (1)
When registered under the GPhC.
When should entries be made for prescriptions? (1)
Made on the same day or if not possible, the next following day.
How long should Rx records be kept for? (1)
2 yrs (POM reg. must be kept for 2 yrs from the date of last entry)
How long should the Rx be kept for? (1)
2 yrs from date of last supply/sale.
What details should be recorded as part of the Rx? (7)
Supply date
Drug Name, quantity, form, strength.
Rx Date
Practitioner name + address
Px name + address.
Ref. no. (marked on Rx, typed onto dispensing label)
For second + subsequent supplies on a repeat, record supply date + original ref. no. of first supply.
What is the fate of a NHS Rx? (1)
Send to the NHSBSA at the end of the month.
What is the fate of a private Rx (non-repeatable)?
Keep at the pharmacy for 2 yrs.
What is the fate of a private Rx (repeatable)? (2)
If there’s any outstanding repeats, hand Rx back to patient or offer to retain at the pharmacy.
If final repeat has been dispensed, keep a copy of the Rx for 2 yrs and send the original to the NHSBSA.
Describe the Hubs + Spokes model. (2)
Dispensing a Rx via the hub pharmacy sent by the spoke pharmacy.
Must still be registered under the GPhC.
What are the advantages of dispensing from a hub? (4)
Efficient
Lower operating costs
Frees up pharmacist time = can do other clinical activities.
Use of automation = reduced errors, safer dispensing and cheaper.
What are the disadvantages of hub dispensing? (5)
Accountability/liability
Operational failure
Affect px/pharmacy relationship
Unsuitable if px needs medicines quickly/urgently
Confidentiality/security of info.
What are internet (online) pharmacies? (1)
A.K.A. distance-selling pharmacies.
