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POM Flashcards

(59 cards)

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1
Q

define emergency supply

A

means the emergency supply of a
POM without a valid Rx being present at the time of
dispensing

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2
Q

what are the two types of emergency supplies

A

1- emergency supply at the request of a patient
2- at request of prescriber

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3
Q

what are the conditions that must be met for the emergency supply at the request of a patient?

A
  • That the pharmacist has interviewed the patient and is
    satisfied:
  • That here is an ‘immediate need’ for the POM and it is
    impractical to obtain a prescription without ‘undue delay’
  • That the POM has on a previous occasion been prescribed
    by a doctor, dentist, SP, community practitioner nurse
    prescriber, nurse/pharmacist/ optometrist / podiatrist /
    physiotherapist/ therapeutic radiographer / paramedic
    independent prescriber, an approved country health
    professional
  • As to the dose that it would be appropriate for the patient
    to take
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4
Q

what CDs can be supplied for an emergency supply at the request of a patient?

A
  • There is no provision for the emergency supply of schedule 2
    or 3 CDs (except for phenobarbital or phenobarbital sodium
    provided that it is for use in the treatment of epilepsy)
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5
Q

what is the max days which you can supply a CD for an emergency supply to a patient?

A

5 days

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6
Q

what is the max days you can supply for an emergency supply at request of a patient?

A

30

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7
Q

what are the exceptions to the 30 day max supply (emergency) at the request of a patient?

A
  • Insulin, ointment / cream, inhaler for the relief of asthma –
    the smallest pack available should be supplied
  • An oral contraceptive –supply a full treatment cycle
  • An antibiotic in liquid form for oral administration –the
    smallest quantity that will supply the full course of
    treatment should be supplied
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8
Q

what records must be kept for an emergency supply at the request of a patient?

A

POM register

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9
Q

what details must be included in the POM register for an emergency supply at the request of a patient?

A
  • The date on which the POM was supplied
  • Name, quantity and, except where it is apparent from the
    name, the pharmaceutical form and strength of the POM
    supplied
  • The name and address of the person requiring the POM
  • The nature of the emergency (i.e. why the person needs
    the POM and the reason why a prescription cannot be
    obtained)
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10
Q

what must the label show for an emergency supply at the request of a patient?

A
  • The date of supply
  • Name, quantity and, except where it is apparent from the
    name, the pharmaceutical form and strength of the POM
  • The name of the person requesting the POM
  • The name and address of the pharmacy
  • The words ‘Emergency Supply’
  • The words ‘Keep out of the reach of children’ (or similar
    warnings)
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11
Q

can you emergency supply a CD at the request of a patient?

A

no CD 1/2
and no CD 3 except phenobarbital or phenobarbital sodium- epilepsy

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12
Q

what are your professional obligations when making an emergency supply

A
  • Make the care of your patients your first concern
  • You must consider the medical consequences, if any, of not making the
    supply and be satisfied that your decision will not adversely affect the
    patient
  • Consider any interval since when last prescribed
  • Consider carefully the quantity you will supply
  • If you consider an emergency supply not to be appropriate, you must
    advise the patient on how to obtain essential medical care
  • The key is that you can justify your actions
  • Consider adding extra information to the POM register record
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13
Q

what are the conditions for an emergency supply at the request of a prescriber?

A
  • The pharmacist who is supplying the POM is satisfied that the supply has been requested by a doctor, dentist, SP, community practitioner nurse prescribers, nurse / pharmacist / optometrist / podiatrist / physiotherapist / therapeutic radiographer / paramedic independent prescriber, an approved country health professional
    who by reason by some emergency is unable to furnish a
    prescription immediately
  • That the appropriate prescriber has undertaken to provide the person lawfully conducting the retail pharmacy business with a
    prescription within 72 hours
  • That the POM is sold or supplied in accordance with the directions of the appropriate practitioner
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14
Q

can a prescriber request an emergency supply of a CD?

A

not for CD 1/2
not for CD 3 except phenobarbital or phenobarbital sodium

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15
Q

are approved country health professionals allowed to request CD emergency supply?

A

no

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16
Q

what records should be made for an emergency supply at the request of a prescriber?

A

An entry should be made in the POM register on the day of supply or,
if impractical, the next day following, stating;
* The date on which the medicine was supplied
* Name, quantity and, except where it is apparent from the name, the pharmaceutical form and strength of the POM supplied
* The name and address of the practitioner requesting the
emergency supply
* The name and address of the patient
* The date on the prescription and the date when the prescription is received (these may be entered on the day the prescription is
received)

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17
Q

what happens to emergency supplies in a pandemic?

A

exemptions to medicines legislation
pandemic has to be officially announced by dep of health
conditions for emergency supply are relaxed

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18
Q

do you have to pay for an emergency supply?

A

yes- not part of the nhs
unless you go through NHS 111 and get referred

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19
Q

what is a PGD?

A

a written instruction for the sale, supply and/or administration of named medicines in an identified clinical situation. It applies to groups of patients who may not be individually identified before presenting for
treatment”

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20
Q

who may supply a PGD/

A

Only certain qualified professionals may supply or administer under a PGD nurses, midwives, health visitors, optometrists, pharmacists, chiropodists, radiographers, orthoptists, orthotists, prosthetists, physiotherapists, dental hygienists and dental therapists, dietitians, occupational therapists, podiatrists, speech and language therapists, paramedics but only as named
individuals

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21
Q

what details should a PGD contain?

A
  • Name of organisation
  • Date of PGD and date it expires
  • Details of medicines to which it applies
  • Class of professionals who may supply/administer
  • Signature of doctor/dentist and pharmacist
  • Signature from appropriate health organisation
  • Clinical condition to which PGD applies
  • Details of patients who are excluded
  • When further advice/referral should be sought
  • Dose, route, frequency, duration of treatment
  • Warnings, including of potential side effects
  • Details of any necessary follow-up action
  • Details of records to be kept
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22
Q

what medicines can be included on a PGD?

A
  • All POMs, Ps, GSLs
  • Only certain CDs
  • Sch 2, only diamorphine, morphine and ketamine (NB
    only by certain persons)
  • Sch 3 only midazolam
  • Any S4 part 1
  • Any S5
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23
Q

what are PGDs suitable for?

A
  • Best for single treatment episodes:* Nitrofurantoin for urinary tract infections
  • Emergency hormonal contraception
  • Topical antimicrobials for impetigo, conjunctivitis
  • Analgesia (acute)
  • Immunisation programmes
  • Antiviral medicines for influenza
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24
Q

how should POMs under a PGD be labelled?

Study These Flashcards
A

Note that POMs supplied under a PGD should be labelled in the same way as if supplied against a prescription

25
what is an exception for a supply of a POM?
prescribing POMs in hospitals for inpatients- PSD
26
do PSD need to comply with prescription requirements?
no
27
what is good practice for a PSD?
for this transposition to be made by a pharmacits/ checked by a pharmacist
28
what are the two different types of non-medical prescribing?
* Independent prescribers (IP) * Supplementary prescribers (SP)
29
who can the non-medical prescribers be?
* Nurses * Pharmacists * Other healthcare professionals
30
what is the difference between IP and SP?
* Independent prescriber (IP) * Responsible for the initial clinical assessment and preparation of a plan for clinical management of a patient * Supplementary prescriber (SP) * Can take responsibility for management of a patient who has been assessed by the independent prescriber
31
What criteria applies to SP?
Supplementary prescriber must be a nurse, midwife, pharmacist, chiropodist, dietitian, physiotherapist, podiatrist, optometrist or radiographer who has undertaken an extra period of training
32
who must an IP be?
Independent prescriber must be a doctor (or dentist) – can’t be a nurse or pharmacist
33
what is the framework for supplementary prescribing?
no legal restriction on range of meds/ conditions that can be treated Any medicine can be prescribed (including CDs, unlicensed medicines, ‘off label’ use) as long as the medicine is included in the clinical management plan * No restriction on the location of supplementary prescribing
34
what is a clinical management plan?
* Written plan relating to the treatment of an individual patient * Agreed by the patient, the doctor or dentist (who is the IP) and the SP
35
what must a clinical management plan include?
* Name of the patient * Illness and conditions to be treated * Date when it starts and date of review by the IP * Reference to the class of medicine to be prescribed * Any restrictions or limitations of prescribing * Sensitivities of the patient * How any adverse drug effects should be reported * Any circumstances when the SP should refer to the IP or seek advice of the IP
36
what are the criteria for IPs?
Nurses and pharmacists may be empowered to prescribe any drug for any condition provided they: * are fully trained and accredited * prescribe within their area of competence * have access, in normal circumstances, to the patient record and, therefore, to the diagnosis when prescribing for an existing long term condition or to information on which to base an accurate diagnosis * take responsibility for their actions
37
What does prescribing within competence mean?
Must be aware of limits of skills, knowledge, competence and work within these * Must seek advice and make referrals where appropriate
38
what are the 3 different types of nurse prescribers?
community practioner nurse prescriber nurse SP nurse IP
39
how do you check the prescribing status of a non-medical prescriber?
The professional register will be annotated to show what prescribing rights (if any) the healthcare professional has
40
what is the attitude towards self-prescribing and prescribing for family/ friends?
not good practice judgement may be swayed hard- impossible to examine ones self
41
what are the legal requiremets for labelling of a medicinal product?
1. Name of person to whom the medicine is to be administered 2. Name and address of person who sells or supplies 3. Date of dispensing 4. Name of the product 5. Directions for use of the product 6. Precautions relating to the use of the product
42
what is good practice to put on a label of a medicinal product?
‘Keep out of the sight and reach of children’ * ‘Use this medicine only on your skin’ where applicable Also good practice to include * BNF cautionary and advisory warning labels * Other non-BNF labels
43
what does the HMR2012 do?
Removes the requirement for a pharmacist to contact the prescriber before making changes to the dispensing label
44
what can a pharmacist change due to the HMR2012?
* Directions for use * Name of the medicine * Precautions relating to its use
45
does the HMR 2012 allow for generic substitution?
no as this would be illegal as it is a different medicine.
46
what must be on the label of a medicine from a broke down bulk containers?
* Name of product * Appropriate quantitative particulars (i.e. the ingredients) * Quantity in the container * Special handling or storage requirements (if any) * Expiry date * Batch reference preceded by BN or Lot No
47
what does assembly and pre-paxking medicines require?
Assembly or pre-packing medicines by a pharmacy which are to be supplied to a separate legal entity (e.g. to another NHS trust or pharmacy) requires a licence from the MHRA
48
define wholesale dealing
The selling of a medicinal product is classed as ‘wholesale dealing’ if it is sold to a person who: a) Sells or supplies it to someone else, or b) Administers it to someone else in the course of their business
49
what are the requirements for wholesale dealing for a pharmacy?
* Takes place not more than on an occasional basis and * The quantity supplied is small and * The supply is made on a not for profit basis and * The supply is not for onward wholesale distribution
50
which professionals may a retail pharmacy wholsale deal to?
* Sales of POM medicines may only be made if the purchaser is authorised to sell or supply the goods or to administer them to human beings in the course of their business or professional practice* NHS Trusts * Owner or master of a ship * Armed forces * Many, many others
51
what records need to be made if the pharmacy does not have a wholesale dealers license?
No legal obligation to make a record in the POM register so long as the signed order is kept for 2 years from the date of supply * But it is good practice to make a record in the POM register (and keep the invoice for 2 years)
52
if there is no signed order what records need to be kept?
* If there is no signed order then legally a POM register entry must be made * Details to be recorded in the POM register: * Date when POM was sold * Name, quantity, pharmaceutical form and strength of the medicine supplied * Name, address, trade, business or profession of the purchaser * Purpose for which the POM is sold or supplied
53
what medicines can schools obtain? how?
Schools can obtain supplies of adrenaline auto-injectors (AAIs) and salbutamol inhalers from a pharmacy on a signed order
54
when can medicines which were supplied by a signed order be used in a school?
These can be administered in an emergency by persons trained to administer them, to pupils previously prescribed such medication and where parental consent has been received
55
what is good practice to appear on a signed order for a supply of medicines to a school?
* Name of the school * Name of the medicine and strength (if relevant) * Purpose for which the product is required * Total quantity required * Signed by the principal or head teacher
56
what records need to be made for supply of medicine to schools?
Keep the signed order for 2 years and it is good practice to make a record in the POM register
57
what is a dispensing error?
An error made during the dispensing process from receipt of the Rx through to the supply of the dispensed medicine, where the error means the patient receives a medicine which differs in some way from that intended by the prescriber
58
what is section 64 under the medicines act 1968?
No person shall, to the prejudice of the purchaser, sell any medicinal product which is not of the nature or quality demanded by the purchaser
59
what is a pharmacists legal defence?
* Making a dispensing error is not a criminal offence if * Medicines are prepared by a registrant (pharmacist or PT) or acting under their supervision AND * Medicines were supplied from a registered pharmacy premises AND * Registrant was acting in the course of their profession AND * Medicines were supplied in pursuance of a Rx or from the direction of a prescriber AND * If you are aware of the error there was a prompt notification of the error if all above apply, this is the legal defence to section 64
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