L 49

Question 1

What is a standing order?

Answer 1

silimar like a prescription
written by authorises prescriber to supply/administration of certain specified medicines to certain group of people by any specified health professional in certain circumstances.

Question 2

Where patients can use standing orders? Examples

Original x1 + evolve x4

Answer 2

Originally was used in hospitals when a doctor or medical practitioner is not available.

Use evolved though to

• Ambulance services
• Non-emergency services to populations e.g diabetics, sexual health services, etc.
• Rural areas where there are limited doctors services
• Rest homes

Question 3

what pharmacists can do with standing order?

Answer 3

it is a pathway for pharmacists to be able to supply Rx medicines.

Influenza vaccines

Meningococcal vaccines

Question 4

What must a standing order be in accordance with?

Answer 4

A standing order must be in accordance with any applicable regulations written.

Question 5

Who can issue a standing order?

Answer 5

A practitioner, a nurse practitioner, and a prescribing optometrist.

Question 6

What does a practitioner mean?

Answer 6

Medical practitioner or a dentist.

Question 7

Match the following terms to their colloquial definition:

Answer 7

Act, fine print, regulations, big picture.
Act: big picture
Regulations: fine print

Question 8

What’s the deal with midwives issuing a standing order?

Answer 8

The medicines act says that they can issue one, but they have are not included in the regulations therefore they are not actually allowed to issue a standing order.

Question 9

Who can act under a standing order?

Answer 9

• people who can supply/administer the medicine which is identified in the SO.
• The class of person are (e.g registered nurses, pharmacists, paramedics, NZ defense force medical personnel, physiotherapists).

Question 10

What medicines can be supplied/administered?

Answer 10

A prescription medicine or specified controlled drug.
Controlled drug = a drug listed in certain parts of the MDA 1975.
Note: pharmacy only and restricted medicines are also included.

Question 11

What a standing order must contain? x7

Answer 11

• issuer
• Why issued
• who is the person permitted to supply, and class of people it will be supplied to
• what level of competency required to supply/administer it
• for how long circumstances/treatments SO applies for
• Medicine, indications, dose, method of administration
• If countersigning is required during an audit at least Once a month.

Question 12

What is countersigning?

What would the process be if there was no countersigning?

Answer 12

the person will signs off to assure that the treatment been provided.

If every time want to see the issuer then the medicine provider and SO issuer will sign each time 24-48 hr of supply

otherwise at least once/month.

Question 13

Example of a standing order x1

Answer 13

CPAMS in a pharmacy

Question 14

A person supplying/administering the medicine under the SO must…. x2

Answer 14

• Competent accordance with the SO

- can Record or can identify patient assessment, treatment, monitoring and follow up.

Question 15

How often must standing orders be reviewed?

Answer 15

At least once each year

Question 16

How pharmacist can use of SO?

Example:CPAMS

Answer 16

to modify warfarin doses dependent on INR results.

supply of warfarin to selected patients and have the authority to modify warfarin prescriptions in collaboration with GP colleagues.”

Question 17

What is an unapproved medicine?

Answer 17

A medicine that has not been through the medsafe regulatory process, however can still be prescribed in NZ

Question 18

Why would unapproved medicines be used?

Answer 18

• For rere disease
• We cant access into NZ approved medicine.
• The medicines may be available in other countries, be effective and safe, but not have approval in NZ as it is not popular/necessary in NZ.

Question 19

We can access unapproved medicine in two process: S25 and S29

What does the s25 say about unapproved medicines?

Answer 19

An authorised PRESCRIBER can sell, supply, procure, administer, and arrange administration of an unapproved medicine.

(They can use any medicine for the treatment of a patient in their care, without being restricted to approved indications).

Question 20

What does the MA s29 say about unapproved medicines?

Answer 20

A MEDICAL practitioner may be supplied with an unapproved medicine for treatment of a particular patient.

Question 21

The MA s25 summary for practitioners: x2

Answer 21

• All authorised prescribers can manufacture/supply/administer medicines to their patients or if another prescriber asks.

Question 22

The MA s29 summary for pharmacists: x3

Answer 22

• Pharmacists can only supply medical practitioners (or their patients) with unapproved medicines
• Information must be provided to DGOH
• Other authorised prescribers must obtain unapproved medicines either from other authorized prescribers or by directly importing.

Question 23

Would an optometrist be able to get a section 29 medicine from the pharmacy?

Answer 23

No, they would have to directly import it themselves or get from another authorised prescriber.

Question 24

What are the 4 levels of pharmacy medicine classifications

Answer 24

Prescription only
Restricted medicine (pharmacist only)
Pharmacy-only
General sale

NOTE: there are also controlled drugs.

Question 25

How much prescription and restricted medicines be stored?

Answer 25

They must be stored in a way that prevents the public from gaining ready access to them.

Question 26

Pharmacy-only medicines must be sold ...

Answer 26

By a pharmacist or someone under the supervision of a pharmacist

Question 27

Examples of "prescription only, except when...."

Answer 27

medicines Influenza vaccines Trimethoprim

Question 28

NOTE: classification status doesn't guarantee that a product is able to be provided e.g there may not be an approved medicine that is able to be provided. EXAMPLE:

Answer 28

Econazole for vaginal use is classified as a restricted medicine, but there is no registered vaginal product in NZ.

Question 29

Where would you find classifications and registration info?

Answer 29

NZF and medsafe website

Question 30

Can midwife give a standing order?

Answer 30

No

Question 31

what S20 says?

Answer 31

for a particular patient

Question 32

S29 for Pharmacist ki?

Answer 32

only supply unapproved meds to Medical Practitioners and provide their patients.

Question 33

In terms of ordering unapproved medicine, we need to order to holseller but they need following information?

Answer 33

Dr details patinets details what that used for etc.