Emergency Supplies Of POMs PDF

WEEK 24 Emergency Supply of a POM John Sherwood MRPharmS 8th January 2025 Slide 1 of 28 OSPAP MPHM15 Emergency Supply of a POM WEEK 24 Learning outcomes Describe the two differ...

WEEK 24 Emergency Supply of a POM John Sherwood MRPharmS 8th January 2025 Slide 1 of 28 OSPAP MPHM15 Emergency Supply of a POM WEEK 24 Learning outcomes Describe the two different types of emergency supply and be able to list the legal requirements for each, including labelling and record keeping requirements List the classes of medicines, with exceptions, that cannot legally be supplied in an emergency supply scenario Be aware of common misconceptions surrounding emergency supplies and be able to discuss them Be aware of professional considerations that must be borne in mind before deciding whether to make or refuse an emergency supply request Be able to apply legal and professional requirements to emergency supply scenarios Slide 3 of 28 OSPAP MPHM15 Emergency Supply of a POM WEEK 24 Emergency supply of a POM Reminder: POMs can only be supplied on a prescription written by an appropriate practitioner, however ‘emergency supply’ is one of the exceptions to this (see POMs lecture, week 10, slide 3) ‘Emergency supply’ means the emergency supply of a POM without a valid prescription being present at the time of dispensing This is a valuable legal exemption (originally from the Medicines Act 1968 and now HMR 2012) which can be utilised by pharmacists for patient benefit Why are some pharmacists so hesitant to use this exemption? There are a lot of myths surrounding the provision of emergency supplies amongst pharmacists There are two types of emergency supply Emergency supply at the request of a patient Emergency supply at the request of a prescriber Slide 4 of 28 OSPAP MPHM15 Emergency Supply of a POM WEEK 24 EMERGENCY SUPPLY AT THE REQUEST OF A PATIENT Slide 5 of 28 OSPAP MPHM15 Emergency Supply of a POM WEEK 24 Emergency supply at the request of a patient (1) Legal requirements that apply to this type of supply are: That the pharmacist has interviewed the patient and has satisfied themselves: 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, supplementary prescriber, community practitioner nurse prescriber, nurse/pharmacist /optometrist/physiotherapist/podiatrist/therapeutic radiographer/paramedic independent prescriber or an approved country health professional As to the dose that it would be appropriate for the patient to take Slide 6 of 28 OSPAP MPHM15 Emergency Supply of a POM WEEK 24 Emergency supply at the request of a patient (2) There is no provision for the emergency supply of schedule 2 or 3 CDs (with one exception, see later) You cannot supply more than 5 days for a controlled drug in schedules 4 or 5 You cannot supply more than 30 days for other POMs, except where the preparation is: 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 Slide 7 of 28 OSPAP MPHM15 Emergency Supply of a POM WEEK 24 Emergency supply at the request of a patient (3) An entry must be made in the POM register on the day of supply, or if impractical, the next day following stating: 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) These are legal requirements What about good practice requirements? Other information may be recorded if you think it is useful Slide 8 of 28 OSPAP MPHM15 Emergency Supply of a POM WEEK 24 POM Register Price Page 10 8th January 2025 (1) EMERGEN CY SUPPLY AT PAT IEN T 'S REQUEST Mr Martin Dale 10 Phe nytoin caps 300mg 39, St Vince nt St two to b e take n at night Gos forth Vis iting for training cours e for N e wcas tle 4 days and le ft me dication at home , take s for e pile ps y £x.xx Slide 9 of 28 OSPAP MPHM15 Emergency Supply of a POM WEEK 24 Emergency supply at the request of a patient (4) The medicine container or package must be labelled to show the following particulars; The date of supply The name, quantity and, where appropriate, the pharmaceutical form and strength of the supplied medicine 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 warning) Slide 10 of 28 OSPAP MPHM15 Emergency Supply of a POM WEEK 24 Can you emergency supply a CD at the request of a patient? Not allowed for any Schedule 1 or 2 CDs Not allowed for any Schedule 3 CDs except for phenobarbital or phenobarbital sodium if it is for use in the treatment of epilepsy If the request is made by a patient of an approved country health professional an emergency supply is not permitted if the medication is any CD in Schedules 1, 2 or 3 Slide 11 of 28 OSPAP MPHM15 Emergency Supply of a POM WEEK 24 Emergency supplies in a pandemic There are exemptions to medicines legislation in the event of a pandemic (or a pandemic situation is imminent) The pandemic must be officially announced by the DoHSC The conditions for making an emergency supply at the request of a patient is relaxed in that the pharmacist will not need to interview the person who requests the medicine Slide 12 of 28 OSPAP MPHM15 Emergency Supply of a POM WEEK 24 Myths surrounding emergency supplies at the request of a patient The patient must have had the medication dispensed from the pharmacy where the request is made on a previous occasion The patient must have ‘evidence’ with them to show that they take the medication or which confirms their identity You cannot provide an emergency supply when the doctors’ surgery is open You can only give an emergency supply in a ‘medical emergency’ (i.e. an ‘acute’ situation) Patients requesting medicines in an emergency do so because they are abusing them Supplying patients only encourages them to ask again Slide 13 of 28 OSPAP MPHM15 Emergency Supply of a POM WEEK 24 Myths surrounding emergency supplies at the request of a patient (2) Patients requesting medicines in an emergency do so because they are abusing them Supplying patients only encourages them to ask again The GPhC will not approve of the supply (the pharmacist must consider the Standards for Pharmacy Professionals and any associated relevant Guidance before supplying) but be careful because the GPhC may not approve of NOT supplying the medicine if a complaint was made by the patient or their representative Slide 14 of 28 OSPAP MPHM15 Emergency Supply of a POM WEEK 24 What are your professional obligations? Make the care of 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 compromise the patient’s care Consider the interval from when the medicine was last prescribed Consider carefully the quantity that you will supply Consider adding extra information to the POM register record 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 action Finally, what about payment? Slide 15 of 28 OSPAP MPHM15 Emergency Supply of a POM WEEK 24 Scenario 1 It is Sunday afternoon, and you are doing a locum in your local supermarket. Sharon (above) presents at your pharmacy and explains that she is on holiday with her boyfriend, Keith, and she has left her Microgynon 30 tablets at home. She has no ‘evidence’ that she takes them, but she knows they are in a green and white box. She wonders if she can buy some tablets from you. Can you help her? Slide 16 of 28 OSPAP MPHM15 Emergency Supply of a POM WEEK 24 Scenario 2 One of your regular patients, Dave (person on the left with the glow-stick) attends your pharmacy twice a week for his methadone. He takes one dose supervised and takes the remainder away with him. When he was walking home, one of the bottles fell out of the bag and smashed on the floor. He comes back to the pharmacy and states that he needs all his medication, as he is going on holiday. He is not prepared to pay for an emergency supply, as he says it wasn’t his fault the methadone fell out of the bag and smashed. Can you help him? Slide 17 of 28 OSPAP MPHM15 Emergency Supply of a POM WEEK 24 Scenario 3 Dorothy May has been coming to your pharmacy for years. Today she comes in and explains that her husband, Frank, has ran out of his Ventolin inhaler. Dorothy is in a bad mood because she says that Frank is always forgetting about his inhaler. You check your records and see that since the turn of the year, you have already made four emergency supplies to Frank. Can you help Dorothy? Slide 18 of 28 OSPAP MPHM15 Emergency Supply of a POM WEEK 24 EMERGENCY SUPPLY AT THE REQUEST OF A PRESCRIBER Slide 19 of 28 OSPAP MPHM15 Emergency Supply of a POM WEEK 24 Emergency supply at the request of a prescriber Legal conditions that apply to this supply are: The pharmacist who is supplying the POM is satisfied that the supply has been requested by a doctor, dentist, supplementary prescriber, nurse / pharmacist / optometrist / physiotherapist / podiatrist / therapeutic radiographer / paramedic independent prescriber or an approved country health professional who by reason of some emergency is unable to provide a prescription immediately That the appropriate prescriber has undertaken to supply 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 Slide 20 of 28 OSPAP MPHM15 Emergency Supply of a POM WEEK 24 Can you emergency supply a CD at the request of a prescriber? This is not allowed for Schedule 1 or 2 CDs Schedule 3 CDs cannot be supplied except for phenobarbital or phenobarbital sodium but only if it is for use in the treatment of epilepsy Good practice requirements relating to the maximum recommended duration on a prescription still apply Approved country health professionals are not allowed to request any CDs that are in schedules 1, 2 or 3 Note that if the prescriber is an approved country health professional any medicine supplied must have a UK marketing authorisation Slide 21 of 28 OSPAP MPHM15 Emergency Supply of a POM WEEK 24 Records that should be made 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 When you receive the prescription, the date on the prescription and the date when the prescription is received must be recorded There should, therefore, be three dates in the POM register entry These are legal requirements Slide 22 of 28 OSPAP MPHM15 Emergency Supply of a POM WEEK 24 POM Register Page 10 EMERGENCY SUPPLY AT GP REQUEST (2) 08/01/2025 Mr David Smiley 17, Castle Mews 28 Atenolol 100mg tablets, 1 od Wortoon Dr Nigel Smith, Castle Surgery, Cross St, Wortoon prescription received 10.1.2025 date on prescription 8.1.2025 Slide 23 of 28 OSPAP MPHM15 Emergency Supply of a POM WEEK 24 Patient’s request vs practitioner’s request At the Request of a Practitioner At the Request of a Patient Quantity of medication does not matter (but good Limited to 30 days practice requirements for CDs still apply) (but legally only 5 days for a CD) Practitioner has to furnish you with a prescription There is no prescription coming within 72 hours The words ‘emergency supply’ The words ‘emergency supply’ do not need to appear on the label must appear on the label You must record the details of the practitioner in You don’t legally have to record the details of the the POM register practitioner in the POM register An interview with the patient is not required You have to interview the patient before the supplying the medication The medication supplied The medication supplied must have can be ‘new medication’ been prescribed by a prescriber Slide 24 of 28 on a previous occasion WEEK 24 Scenario 4 It is Tuesday morning and you get a telephone call from Dr Smart. Dr Smart is based at your local doctors’ surgery just around the corner from your pharmacy. He explains that he is on a house call to see Mick Smith, a patient of his who is a recovering alcoholic. He would like to prescribe him seven diazepam 2mg tablets (take one tab at night), but he has left his prescription pad at home. Can you help him? Slide 25 of 28 OSPAP MPHM15 Emergency Supply of a POM WEEK 24 Scenario 5 It is Monday afternoon and you receive a telephone call from Dr Smart’s receptionist. She explains that Dr Smart has just been on a house call to see Sally Smith (aged 5 years) and he would like to prescribe her some amoxicillin for a chest infection. Unfortunately, he has left his prescription pad at the surgery, so he would like you to emergency supply Sally some amoxicillin. Dr Smart tried calling you earlier but your phone line was constantly engaged. He has now gone on his lunch and left instructions with his secretary to call you. Can you help? Slide 26 of 28 OSPAP MPHM15 Emergency Supply of a POM WEEK 24 Pharmacy First – Urgent supply of a POM This service is an ‘advanced service’ under the NHS community pharmacy contract in England (i.e. not all pharmacies may choose to provide this service) This NHS service allows pharmacists to supply an emergency supply to patients ‘under’ the NHS The service follows all the same legal requirements as mentioned on the previous slides under ‘request of the patient’ Patients who are exempt from paying an NHS prescription charge do not pay for the medicines supplied – this a big advantage for patients who may struggle to afford buying the medicine If the patient pays for their prescriptions they will be changed an NHS prescription charge per item supplied For more details on this please refer to the Community Pharmacy lecture (coming later in term 2) Slide 27 of 28 OSPAP MPHM15 Emergency Supply of a POM WEEK 24 Further information MEP (3.3.10 Emergency Supply) The RPS has produced a guidance sheet on ‘Emergency supplies’ available on their website Slide 28 of 28 OSPAP MPHM15 Emergency Supply of a POM