Emergency Supply of Prescription-Only Medicines

OSPAP Programme: Emergency Supply of a POM

• Emergency supply of POMs is an exception to the need for a prescription.
• POMs can only be supplied on a prescription written by a qualified medical professional.
• Emergency supply allows dispensing without a prescription in special circumstances.
• This exemption is legally allowed under the Medicines Act 1968 and HMR 2012.

Learning Outcomes

• Two different types of emergency supply are discussed, with separate legal requirements and labelling/record keeping protocols.
• Understand the classes of medicines ineligible for emergency supply.
• Understand common myths surrounding emergency supplies.
• Aware of professional considerations influencing emergency supply decisions.
• Apply legal and professional requirements in emergency supply scenarios.

Emergency Supply of a POM - Reminder

• POMs can only be supplied on a prescription from an appropriate medical professional (except in cases of emergency supply).
• Emergency supply means the provision of a POM without a valid prescription present during dispensing.
• Pharmacists can utilize this legal exemption (from the Medicines Act 1968 and the HMR 2012) for patient benefit.
• There are myths surrounding the supply procedure and potential hesitancy from pharmacists.

Emergency Supply at the Request of a Patient (1)

• The pharmacist must interview the patient.
• The need is immediate and obtaining a prescription would cause undue delay.
• The POM has been prescribed previously by a qualified medical professional (doctor, dentist, etc.).
• The dose is appropriate for the patient.

Emergency Supply at the Request of a Patient (2)

• There are restrictions to emergency supply of Schedule 2 or 3 controlled drugs (CDs).
• Maximum supply duration for controlled drugs (Schedules 4 and 5) is 5 days; for other POMs, it is 30 days.
• Specific preparations, such as insulin, ointments, asthma inhalers, contraceptives, and certain antibiotics, have allowances beyond the 30-day limit.

Emergency Supply at the Request of a Patient (3)

• The POM register must detail the date of supply, the name/quantity/type of POM, the patient's name and address, the nature of the emergency, and reasons a prescription isn't immediately obtainable.
• These requirements are crucial and legally binding.
• Additional data points are helpful to document, beyond the required registration.

POM Register Example

• A specific example of a POM register entry, including details of the patient, medication, and circumstances, is shown for a patient requesting 10 Phenytoin capsules.

Emergency Supply at the Request of a Patient (4)

• The container or package for dispensed medication needs labelling.
• This must include the date of supply, the patient's info, the name/quantity/type of medication, the pharmacy details, 'Emergency Supply' and a 'Keep out of reach of children' warning.

Can you Emergency Supply a CD at the Request of a Patient?

• Schedule 1 or 2 CDs cannot be supplied.
• Certain Schedule 3 CDs (phenobarbital or phenobarbital sodium) are an exception only if for epilepsy treatment.
• The request must be by a qualified country health professional.
• If the medication is a CD in Schedules 1, 2, or 3, emergency supply is not allowed.

Emergency Supplies in a Pandemic

• Exemptions exist for medicines legislation in pandemic situations (which must be officially declared).
• The pharmacist doesn't need to interview the person requesting the medication.
• The conditions of making emergency supplies are relaxed in a pandemic.

Myths Surrounding Emergency Supplies at the Request of a Patient.

• Patients might request emergency supplies due to inappropriate misuse, rather than actual emergencies.
• Frequent requests can undermine the rationale for emergency supply policies.
• Supplying emergency supplies at patient requests frequently does not result in a medical emergency.
• The GPhC (General Pharmaceutical Council) will not sanction supply without thorough professional assessment and relevant guidance.

What are Your Professional Obligations?

• A pharmacist must prioritize patient care and must consider possible adverse consequences of declining the patient's request.
• The interval from the last time the patient received the medicine is a key consideration.
• Careful quantity consideration is essential.
• Detailed record-keeping (with the specific reasons for supply).
• Clear advice about alternative options if the supply is not deemed appropriate.
• Understanding the justifications for your actions to avoid potential challenges.

Additional Scenarios

• Various scenarios (1 - 5) demonstrate practical applications of the guidelines, highlighting different situations and ethical considerations.

Emergency Supply at the Request of a Prescriber

• Conditions for emergency supply by a prescriber are addressed based on the pharmacist's satisfaction about the request's legitimacy.
• The request must be for a valid reason (e.g., emergency situations, inability to provide immediate prescription).
• The prescribed medicine must be dispensed according to the prescriber's instructions.
• All other professional and legal considerations from the previous sections apply.

Can you Emergency Supply a CD at the Request of a Prescriber?

• No emergency supply is allowed for Schedule 1 or 2 CDs.
• Schedule 3 CDs may be supplied, with exceptions, if prescribed for epilepsy treatment by a qualified health professional.
• Current good practice guidelines for the maximum duration of a prescription still apply, regardless of the supply request type (emergency or general).

Records that should be Made

• Clear records are critical to maintain for emergency supplies.
• The POM Register must record the date of supply, the patient's and prescriber's contact info, the details and type of medicine, and when the prescription will arrive.
• These are strictly legal requirements.

Patient's Request vs. Practitioner's Request Summary

• Key differences between a patient's request and a practitioner's request for emergency supply are summarized.
• A table effectively compares the quantities, prescription requirements (prescription availability, delay, etc.), details needed in the POM register, interview regulations, and the nature of medication supplies.

Further Information

• The guidance sheets on emergency supply are available on the RPS (Royal Pharmaceutical Society) website.
• The Medicines and Healthcare products Regulatory Agency (MHRA) also publishes pertinent information about the emergency supply of medicines.