Prescriptions E-learning and other

Question 1

Aseptic meaning:

Answer 1

free from contamination caused by harmful bacteria, viruses, or other microorganisms.

Question 2

What are Medicines Policies and what are the four aims of it?

Answer 2

Four aims are:
- Principle: to highlight principles by which drugs are to be stored, supplied, transported and administered within a clinical setting and so closely reflect the HMR 2012
- People: aim to ensure all members of staff are aware of their roles, responsibilities and limitaations with respect to medicine
- Audit: aim to ensure an auditable trail for the handling of medicines including controlled drugs
- RIsk management: aim to help manage the risks that drugs can pose to patients, service users, residents and staff to ensure users recieve appropriately prescrived medicine safely and effectively

Question 3

NHS hospitals

What is an Inpatient Drug Chart?

Answer 3

An ‘order’ for the administration of drugs to a patient. You would use these charts to document the drug treatement to be given to a patient during their inpatient stay. They are subject to regulations and standards of code.

Question 4

NHS hospitals - Discharge summary

What are TTOs and TTAs

Answer 4

TTO (to take out) and TTA (to take away) are used to prescribe medication to be given to inpatients on discharge. You would prescribe sufficient medication to allow time for the discharge summary to reach the patient’s GP for medication to be continued. Recommended duration is 14 days.

Question 5

How to know if a drug is controlled?

Answer 5

Schedule 2 and 3 preparations are identified by the symbols CD2 and CD3 respectively next to the drug in the BNF - You can also find it in Controlled drugs and drug dependence in the BNF

Question 6

NICE guidance on controlled drugs

What to do when prescribing CDs

Answer 6

• Document the indication and dosing regimen in the patient’s medical records
• Assess the patient’s current clinical need and adjust prescription as appropriate
• Discuss with the patient how their treatment will be reviewed and monitored.
• Be able to discuss prescribing decisions with other HPs if required

Remember to tell their GP bout this

Question 7

NICE guidance on CDs

What to do for ‘when required’ CDs

Answer 7

• Document clear instructions for when and how to take or use the CD in the patient’s medical notes.
• Annotate the dosage instructions on the prescription ie maximum dose and frequency
• Consider any pre-existing supplies of the CD the patient may have at home before supplying on discharge

Remember to tell their GP bout this

Question 8

NICE guidance for prescribing CDs

What to do when reviewing or amending a CD prescription

Answer 8

• Adhere to local and national guidance when you prescribe, review or amend a CD prescription and take into account:
• the apppropriate route
• dose
• formulation
  Clearly document any deviations from prescribing guidance in the patient’s medical notes.

Remember to tell their GP bout this

Question 9

NICE guidance for prescribing CDs

What to do when needing to prescribe multiple routes of administration?

Answer 9

• Prescribe each route as a separate item
• Clearly document on the prescription when each route can be used
• CLearly cross-reference to prevent any accidental overdose by dual administration via both routes

Remember to tell their GP bout this

Question 10

What does GSL, P and POM mean

Answer 10

GSL (General sales list)- drugs available for general sale
P (Pharmacy medicines) - Drugs restricted to sale through pharmacies
POM (Prescription only medicines) - Prescribed by practiioners only. CDs included can only be prescribed by practitioners and restrictions apply to some NMPs

Question 11

What is meant by an unlicensed medicine?

Answer 11

Medicines that have not been subject to the licensing process so doesn’t have a uK Marketing Authorisation from the MHRA. This may include:
- Clinical trial drugs
- Drugs awaiting MHRA approval
- ‘Specials’ products made specifically for a given purpose and sometimes a named patient
- A drug licensed in another country other than the UK.

The HMR allows for unlicensed drugs to be used if licensed ones aren’t available and the patient needs it

Question 12

What is meant by off-label prescribing?

Answer 12

Drug that is licensed in the uK but is being used outside the terms of its Marketing Authorisation E.G
- Drug licensed only in adults which is being used for a child (e.g lansoprazole)
- Drug used for an indication not stated in the Marketing Authorisation
- Drug administered via a route other than stated in the licensed way.

Question 13

Good practice in prescribing unlicensed or off-label drug, what to check?

Answer 13

• Be satisfied that there are no suitable licensed alternatives that would meet the patient’s clinical needs
• Be satisfied that there is sufficient evidence base and/or experience for its use
• Be prepared to take responsibility for prescribing and overseeing the patient’s care (including monitoring)
• Document your decision in the medical notes, including the rationale for the precription
• Make sure that off-label is approved (indicated in the BNF)
• Only prescribe unlicensed drugs with advice from and under the supervision of a senior clinician
• Inform your patient and gain consent where possible for the used of the drug
• Some medicines are routinely used outside the terms of their license. In this case it may be sufficient to describe why the drug isn’t licensed for the proposed use or patient.

Question 14

What to do when reviewing prescriptions?

Answer 14

• REview all medicaiton regularly
• Stop any unnecessary medicine
• Consider documenting review dates, both within the patient’s notes and on the inpatient charts

Question 15

What to do when cancelling a prescription on an inpatient drug chart?

Answer 15

• Cross through the entire entry
• Annotate the entry with your signature and a date
• Do not obliterate the entry in its entirety as the medicine is still part of your patient’s medical history
• Document any changes to your patient’s prescribed therapy in the medical notes, including the rationale for change

Question 16

Which practitioners are permitted to prescribe with accredited postgraduate training or upon graduation?

Answer 16

Pharmacist Independent Prescribers: They can prescribe medicines in both hospital wards and clinics after completing accredited postgraduate training.
Prescribing Pharmacists: Work in specialty clinics (e.g., oncology, renal transplant) or during surgical pre-operative processes​

Question 17

What is the difference between supplementary and independent non-medical prescribers?

Answer 17

• Independent Non-Medical Prescribers: Prescribe autonomously without doctor supervision, managing patient medications within their clinical role.
• Supplementary Prescribers: Prescribe in partnership with a doctor or dentist, following an agreed patient care plan

Question 18

What are the legal requirements of a prescription?

Answer 18

• Legal: Includes prescriber’s and patient’s details.
• Safe: Considers contraindications, interactions, and allergies.
• Effective: Evidence-based for clinical needs.
• Rational and Practical: Appropriate for the patient, including dosage and administration​

Question 19

What are the five rights of a safe prescription?

Answer 19

Right drug
Right dose
Right route
Right time
Right patient​

Question 20

What are the types of FP10 NHS prescriptions and who is permitted to prescribe on them?

Answer 20

• FP10NC: GPs, hospital doctors, and independent nurse prescribers.
• FP10HNC: Hospital-based doctors and authorized prescribers.
• FP10SS: Independent and supplementary prescribers, such as pharmacists and nurses.
• FP10MDA: For controlled drugs, used in substance misuse cases.

Restrictions: Some drugs, especially controlled substances, are limited to specific healthcare professionals​

Question 21

How do prescriptions in secondary care differ from those in primary care?

Answer 21

• Secondary care: Uses electronic prescribing (EP) systems with clinical decision support for complex cases requiring integration across departments.
• Primary care: Often uses FP10 forms or simpler electronic systems for outpatient treatment with less frequent medication changes

Question 22

What are the two key components of Integrated Care Systems (ICSs)?

Answer 22

• Integrated Care Board (ICB): Responsible for NHS services, health outcomes, and financial performance for the ICS area.
• Integrated Care Partnership (ICP): Brings together the NHS, local government, and other providers to produce an integrated care strategy

Question 23

What is the pharmacist’s role during inpatient care?

Answer 23

• Clinically screen inpatient drug charts.
• Ensure safe supply of medications to clinical areas.
• Conduct drug histories and medication reconciliations.
• Process medications for discharge (TTOs).
• Complete ward-based audits (e.g., controlled drugs)

Question 24

What are some responsibilities of a ward-based technician?

Answer 24

• Undertake complete drug histories.
• Identify discrepancies and assist with medicines reconciliation.
• Check patients’ own drugs (PODs) for appropriateness.
• Ensure sufficient medication supply for inpatients and on discharge.
• Support with ward-based audits​

Question 25

What are some reasons why an accurate drug history is important?

Answer 25

* Aid in diagnosis (e.g., indicators for specific diseases). * Avoid adverse drug effects. * Prevent masking of clinical signs. * Identify drug interactions. * Guide future treatment, including identifying beneficial or harmful medicines​

Question 26

What is the role of a hospital pharmacist during the patient journey?

Answer 26

* Admission: Drug history and medicines reconciliation. * Inpatient Stay: Clinical screening of drug charts, advising on prescribing. * Discharge: Clinical screening of discharge prescription, patient counseling, and medication supply

Question 27

What is medicines reconciliation and its benefits?

Answer 27

Medicines Reconciliation: Ensures that patients' medication lists are accurate and up to date when transferring between care settings. Benefits: * Reduces medication errors and adverse drug events. * Prevents missed doses. * Reduces hospital admissions/re-admissions due to medication-related harm. * Improves communication between healthcare professionals​

Question 28

What is the role of an eP Pharmacist?

Answer 28

* Maintaining the drug dictionary: Ensuring all medications are accurately listed and updated in the system. * Developing decision support: Creating tools to improve clinical decision-making and optimize treatment. * Developing new functionality: Enhancing the prescribing system to meet evolving clinical needs. * Investigating incidents: Identifying and resolving issues within the prescribing system that could affect patient safety

Question 29

What must all medicine packaging and containers be according to HMR 2012?

Answer 29

Legible, comprehensible, indelible, and provided in English.

Question 30

What are the legal requirements for packaging and labeling medicines for human use?

Answer 30

Packaging and labeling must meet HMR 2012 standards: legibility, indelibility, inclusion of specific product details (name, strength, active ingredients, usage instructions), expiry date, and appropriate warnings.

Question 31

What packaging and labeling safety features does the MHRA recommend for MA holders?

Answer 31

MHRA recommends features to minimize errors: consistent strength notation (e.g., no trailing zeros), "micrograms" spelled out, clear differentiation for drug types, full product name on at least three sides of packaging, and appropriate color use.

Question 32

How can you locate patient information leaflets (PILs), and why are they important?

Answer 32

PILs can be found on the packaging or online via MHRA resources. They are essential for educating patients on usage, precautions, interactions, and potential side effects, promoting safe medicine use.

Question 33

What is the difference between legal requirements and good practice for the packaging and labeling of prescription medicines?

Answer 33

Legal requirements (HMR 2012) mandate essential information (e.g., product name, dosage, warnings) and safety features. Good practice, guided by MHRA, includes additional labeling for clarity, such as full patient names and detailed administration instructions to enhance patient safety.

Question 34

# Labelling requirements MA holders What are all 18 requirements for medicine

Answer 34

1. Name of medicinal product (must also be in Braille) 2. Strength & pharmaceutical form 3. Whether intended for babies, children or adults (where appropriate) 4. Active substance common name (for up to 3 active substances) 5. Qualitative & quantitative expression of the active substance (common name) per dosage unit or for a given volume or weight 6. Pharmaceutical form & contents by weight, volume or number of doses 7. The method of administration 8. Where appropriate, space for the prescribed dose to be indicated (i.e., POMs require space for a dispensing label) 9. A warning that the product must be stored out of the reach & sight of children 10. Any applicable special warnings 11. Any applicable storage precautions 12. Expiry date (month and year) 13. Manufacturer’s batch number (lot no.) 14. Name & address of MA holder 15. Marketing Authorisation number (Product licence no.) 16. Legal category if P or POM and if not a POM, instructions for use 17. Any special disposal precautions 18. A list of A) all excipients for injectable, topical or eye products B) in any other case, excipients with a recognised action or effect

Question 35

Whaat are the requirements for MA Holder leaflets

Answer 35

▪ Name of medicinal product ▪ Strength & pharmaceutical form ▪ Whether intended for babies, children or adults (where appropriate) ▪ Active substance common name (for up to 3 active substances) ▪ Drug pharmaco-therapeutic group or type of activity (lay language) ▪ Therapeutic indications ▪ A list of − Contraindications (e.g., pregnancy, breastfeeding) − Precautions − Interactions (medicines and other substances) − Special warnings (e.g., possible effects on ability to drive & operate machinery) ▪ Instructions for use (e.g., dose, route, frequency etc) ▪ Adverse reactions (i.e., ALL known side-effects in descending order of frequency) ▪ Reference to expiry date, storage requirements, active ingredients & excipients, name & address of MA holder, name & address of manufacturer ▪ Information on adverse event reporting ▪ Date last revised ▪ Additional requirements for − Paracetamol, codeine & dihydrocodeine products (warnings) − Radiopharmaceuticals