MEP Summary - Lecture notes mep 41 PDF

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Aelisha Shakya

What records need to be kept in the pharmacy from signed order?

➢ The signed order needs to be retained for two years from the date of supply or an entry made into the Prescription only-medicine (POM) register. ➢ Even where the signed order is retained it is good practice to make a record in POM register for audit purposes. ➢ In line with normal record keeping requirements an entry in the POM register must include: ○ Date the POM was supplied ○ Name, quantity and where it is not apparent, formulation and strength of POM supplied ○ Name and address, trade, business or profession of the person to whom the medicine was supplied ○ The purpose for which it was sold or supplied. What other information could the pharmacist be asked to provide during signed order?

The pharmacist could be also be asked to: ➢ Explain how to use a salbutamol inhaler and any associated information ➢ Advise schools on the selection of the most appropriate spacer device for the different age groups and how to use them correctly. Note:

Legislation came into force on 1 October 2015 that enables lawful drug treatment services to obtain naloxone from a wholesaler and people engaged or employed in their services to be able, as part of their role, to make a supply of naloxone available to patients for the purpose of it being available to save life in emergency, without a prescription, patient group direction (PGD) or patient specific direction (PSD).

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Aelisha Shakya

For example, a worker in a lawful drug treatment service can supply naloxone for use in an emergency, to a family member or friend of a person using heroin, or to an outreach worker for a homelessness service whose clients include people who use heroin, without a prescription, PGD or PSD

3.3.11 SELF-PRESCRIBED PRESCRIPTIONS AND PRESCRIPTIONS FOR CLOSE FRIENDS AND FAMILY 3.3.12 SUPPLYING ISOTRETINOIN AND PREGNANCY PREVENTION

3.3.13 DISPENSING VALPROATE FOR GIRLS AND WOMEN

What are the requirements to check while dispensing valproate for female patients?

➢ Check female patients of childbearing age who are prescribed valproate have had a discussion with their doctor about the risks ➢ Manufacturers have distributed patient alert cards to pharmacies and these should be issued to patients unless the patient already has one ➢ Use the information on the card to support discussions with the patient, encourage the patient to read the card and enter their details ➢ Women of childbearing age who are using valproate medicines should be advised on the use of effective contraception ➢ Those planning pregnancy should be advised to schedule an appointment with their prescriber to review treatment and to continue with contraception and valproate treatment in the meantime ➢ If there is an unplanned pregnancy whilst a patient is taking valproate medicines advise the patient NOT to stop their treatment and to arrange to see their prescriber urgently to review treatment ➢ Report any suspected side effects to valproate medicines via the Yellow Card Scheme (see section 3.5.9 Reporting adverse events).

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Aelisha Shakya

3.3.14 EXPLAINING BIOSIMILAR MEDICINES

CAN PRESCRIBE CONTROLLED DRUGS (SCHEDULE 2 TO 5) ON A PRESCRIPTION

What are the prescribing requirements for CDs, unlicensed, other medications and emergency supply for :

1. 2. 3. 4. 5.

Dentist registered in the UK Supplementary Prescriber (mnoppprc) Nurse Independent Prescriber Pharmacist Independent Prescriber Vet Surgeon and Practitioner

➢ Dentist registered in the UK ○ Can prescribe any sch drugs 2 to 5 (but not cocaine, dipipanone or diamorphine for treating addiction) on a Rx ○ Address of prescriber must be within the UK unless prescribing Schedule 4 or 5 Controlled Drugs ○ Can prescribe unlicensed medicines, (subject to accepted clinical good practice) ○ Only for dental problems ○ Only prescribe if expertise and competence in that sector. ○ NHS dental prescriptions are restricted to medicines within the Dental Formulary (See BNF) ○ Emergency supply : ■ Includes phenobarbital for epilepsy but not Schedule 1, 2 and 3 Controlled Drugs (see section 3.3.10.2) ➢ Supplementary Prescriber (MNOPPPRC) Pharmacist ,Midwife, Nurse, Chiropodist, Dietitian, Podiatrist, Physiotherapist, Radiographer or Optometrist

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Aelisha Shakya

○ Can prescribe any sch drugs 2 to 5 (but not cocaine, dipipanone or diamorphine for treating addiction) on a Rx ○ Address of prescriber must be within the UK unless prescribing Schedule 4 or 5 Controlled Drugs ○ Can prescribe unlicensed medicines, (subject to accepted clinical good practice) ○ Only prescribe if expertise and competence in that sector ○ Only prescribe within a clinical management plan agreed ○ Emergency supply : ■ Includes phenobarbital for epilepsy but not Schedule 1, 2 and 3 Controlled Drugs (see section 3.3.10.2) ➢ Nurse Independent Prescriber ○ Can prescribe any sch drugs 2 to 5 (but not cocaine, dipipanone or diamorphine for treating addiction) on a Rx ○ Address of prescriber must be within the UK unless prescribing Schedule 4 or 5 Controlled Drugs ○ Unlicensed medicines are excluded from the Nurse Prescribing Formulary in Scotland and therefore not reimbursed on NHS prescriptions ○ Also can prescribe for any medical conditions prescribe if expertise and competence in that sector. ○ Emergency supply : ■ Includes phenobarbital for epilepsy but not Schedule 1, 2 and 3 Controlled Drugs (see section 3.3.10.2) ➢ Pharmacist Independent Prescriber ○ Can prescribe any sch drugs 2 to 5 (but not cocaine, dipipanone or diamorphine for treating addiction) on a Rx ○ Address of prescriber must be within the UK unless prescribing Schedule 4 or 5 Controlled Drugs ○ Can prescribe unlicensed medicines, (subject to accepted clinical good practice)

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Aelisha Shakya

○ Also can prescribe for any medical conditions prescribe if expertise and competence in that sector. ○ Emergency supply : ■ Includes phenobarbital for epilepsy but not Schedule 1, 2 and 3 Controlled Drugs (see section 3.3.10.2) ➢ Veterinary Surgeon and Veterinary Practitioner ○ Can prescribe only for the treatment of animals ○ Address of prescriber must be within the UK unless prescribing Schedule 4 or 5 Controlled Drugs ○ Prescriptions for Schedule 2 and 3 Controlled Drugs must include the Royal College of Veterinary Surgeons registration number of the prescriber ○ Can prescribe unlicensed medications. ■ subject to the veterinary Cascade, see section 3.6) ○ Emergency Supply: not applicable

What are the prescribing requirements for CDs, unlicensed, other medications and emergency supply for doctors registered in the UK?

➢ Doctors registered in the UK ○ Can prescribe any sch drugs 2 to 5 (but not cocaine, dipipanone or diamorphine for treating addiction) on a Rx ■ Home Office licence is required to prescribe cocaine, dipipanone, or diamorphine for treating addiction Address of prescriber must be within the UK unless prescribing Schedule 4 or 5 Controlled Drugs ○ Can prescribe unlicensed medicines, (subject to accepted clinical good practice) ○ Only prescribe if expertise and competence in that sector ○ Emergency supply : ■ Includes phenobarbital for epilepsy but not Schedule 1, 2 and 3 Controlled Drugs (see section 3.3.10.2) 5

Aelisha Shakya

What are prescribing requirements for physiotherapist IP and Podiatrist IP?

➢ Physiotherapist IP: ○ Only the following Controlled Drugs can be prescribed on a Rx: ■ diazepam, dihydrocodeine, lorazepam, oxycodone and temazepam for oral administration only; ■ morphine for oral administration or for injection; ■ fentanyl for transdermal administration ○ Can prescribe Only ‘off-label’ medicines subject to accepted clinical good practice ○ Also can prescribe for any medical conditions prescribe if expertise and competence in that sector. ○ Emergency supply : ■ Cannot prescribe CD Sch 1,2,3 including phenobarbital for epilepsy. ■ Can prescribe other controlled drugs (4 and 5). ➢ Podiatrist IP: ○ Only the following Controlled Drugs for oral administration ■ diazepam, dihydrocodeine, lorazepam and temazepam ○ Also can prescribe for any medical conditions prescribe if expertise and competence in that sector. ○ Emergency supply : ■ Cannot prescribe CD Sch 1,2,3 including phenobarbital for epilepsy. ■ Can prescribe other controlled drugs (4 and 5). Who are not allowed to prescribe Sch 1,2,3 including phenobarbital for epilepsy?

➢ Physiotherapist IP ➢ Podiatrist IP 6

Aelisha Shakya

➢ Therapeutic Radiographer IP Who cannot prescribe CD drugs on a RX?

➢ Optometrist IP ➢ Therapeutic Radiographer IP??? ➢ Community Practitioner Nurse. Optometrist IP ➢ ➢ ➢ ➢

Cannot prescribe CD sCH 2 to 5 on a Rx Only ‘off-label’ medicines subject to accepted clinical good practice For ocular conditions affecting the eye and surrounding tissue only EMERGENCY SUPPLY: ????

Therapeutic Radiographer IP??? ➢ At the time of writing proposed changes to legislation in relation to the use of certain Controlled Drugs were still to be considered by the Home Office ➢ Only ‘off-label’ medicines subject to accepted clinical good practice ➢ Also can prescribe for any medical conditions prescribe if expertise and competence in that sector. ➢ Emergency supply : ■ Cannot prescribe CD Sch 1,2,3 including phenobarbital for epilepsy. ■ Can prescribe other controlled drugs (4 and 5). Community Nurse Practitioner: ➢ Cannot prescribe any CD drugs. ➢ Cannot prescribe unlicensed medications ➢ Others ○ Restricted to dressings, appliances and licensed medicines which are listed in the Nurse Prescribers’ Formulary (see BNF) ➢ Emergency Supply: ???

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EEA OR SWISS DOCTOR OR DENTIST

➢ Can prescribe only CD Sch 4 AND 5 drugs. ➢ Cannot prescribe unlicensed medications ➢ Others: ○ Can only prescribe items which have a recognised marketing authorisation within the UK ➢ Emergency ????

3.4 WHOLESALE DEALING:

➢ Legislation does not specify the details that need to be included on a signed order although local SOPs may require templates to be used. ➢ It would be advisable for the details required for a POM register entry (i.e. the list above) to be requested as a minimum for a signed order as this information would be required to complete the POM register An entry in the POM register must include the: ➢ Date the POM was supplied ➢ Name, quantity and, where it is not apparent, formulation and strength of the POM supplied ➢ Name and address, trade, business or profession of the person to whom the medicine was supplied. ➢ Purpose for which it was sold or supplied.

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