Emergency Supply of POMs (PM2D) PDF

1 Emergency Supply PM2D by Pooja Kashyap Aim To describe the legal framework allowing pharmacists to supply prescription only medication (POMs) to patients in an emergency situation Learning Outcomes You should be able to: Define different kinds of Emergency...

1 Emergency Supply PM2D by Pooja Kashyap Aim To describe the legal framework allowing pharmacists to supply prescription only medication (POMs) to patients in an emergency situation Learning Outcomes You should be able to: Define different kinds of Emergency Supply Describe legal requirements and records required Consider ethical issues Emergency Supply In an emergency, a pharmacist working in a registered pharmacy can supply POMs to a patient (humans not animals) without a prescription on the request of a 'relevant prescriber' or a patient. Each request should be considered on a case-by-case basis, using professional judgement in the best interests of the patient. MEP 2019 Underpinning legislation Human Medicines Regulations (HMR) 2012 (Part 12 Regulation 224 & 225) Community Pharmacist Consultation Service (CPCS) (29/10/2019 onwards) Included in the new NHS Community Pharmacy Contractual Framework 2019-24 (CPCF) as part of an Advanced service Scotland – national PGD allows supply of medicines for urgent provision of current repeat medicines Emergency Supplies Request made by: A prescriber: HMR 2012 Part 12 Chapter 3 Regulation 224 A patient: HMR 2012 Part 12 Chapter 3 Regulation 225 Different conditions apply to each type Emergency Supply-Request Made by Prescriber Prescriber contacts pharmacy by phone personal visit by fax/emailing prescription to the pharmacy? Make sure the phone message is clear- pharmacist should take the call confirm what is required ask for further details if necessary Prescribers who can request an Emergency Supply Doctor Dentist Supplementary prescriber Community practitioner nurse prescriber Independent prescriber (nurse, pharmacist, optometrist, podiatrist, physiotherapist) EEA or Swiss health professional (EEA – European Economic Area - doctor, dentist, nurse, midwife, pharmacist defined within meaning of Council Directive 2005/36/EC)  Emergency supply at Prescriber’s request Prescriber must be registered in the UK or EEA/Switzerland Pharmacists must be satisfied that the request is made by an appropriate prescriber- CHECK QUALIFICATIONS Dieticians Chiropodists/Podiatrists Paramedics Physiotherapists Emergency supply at Prescriber’s request Reason of some emergency is unable to provide a prescription Prescriber promises to supply a prescription within 72 hours POM is sold or supplied in accordance with the directions of the prescriber What does this mean? -You need enough information to complete clinical check, label, dispense, supply, complete POM register………………with no prescription POM is NOT a CD Schedule 1, 2, or 3 except phenobarbital used in the treatment of epilepsy Any quantity of medication can be requested Usual dispensing label requirements apply EEA/Swiss Prescribers POM CANNOT be a Schedule 1, 2 or 3 CD (even phenobarbital) Can only request medicines with a marketing authorisation valid in the UK Emergency supply at Prescriber’s request It is good practice to: Clinically validate the emergency supply, especially if a new medicine Check: o Patient age o Dose o Interactions (PMR) o Is it an appropriate medication for the patient? Check with prescriber whether private or NHS prescription will be written- Why? Emergency supply at Prescriber’s request - records The record in the POM register (same day or next day) must state: Date the medicine was sold or supplied Name, form, strength, quantity of product Name & address of prescriber Name & address of patient Date on prescription Add later Date prescription received Emergency supply-request of prescriber* NHS paid/exemption, fee for private Rx* Dosage of medication* POM register reference number* (same number on dispensing label) *red=good practice, not legal requirement Example of POM register entry Emergency Supply at the Request of a Prescriber *red= good practice Reference Details Cost Number 7.001 Emergency supply at the request of Dr Jones Prescriptio Date of n charge Supply John Coates Dr P J Jones (NHS or 9 The Avenue The Surgery private) or Anytown Anytown details of exemption Flucloxacillin 250mg capsules x 28 (NHS) 1 QDS Date on prescription form…………….. Date prescription form received………. Questions 1. Can a GP receptionist ring you to request an emergency supply? Yes/no 2. Can the doctor prescribe a new drug? Yes/no 3. How many days supply can a Dr ask for?...................... 4. Do the words EMERGENCY SUPPLY need to be on the label? Yes/no 5. Is a fax or emailed prescription an emergency supply? Yes/no 6. Can an independent nurse prescriber request diazepam (Sch 4(1) CD)? Yes/no Assume the 1. Dr faxes a prescription for prescriber is oxycodone from out of hours Dr service at the weekend. Patient in genuine. intense pain. Has cancer. Would you 2. Dentist phones to supply supply? tramadol capsules 50mg for a patient on FP10D on Saturday Consider: morning -In patient’s best interest? 3. Dr wants patient to have phenobarbital 60mg tabs x 84- -Is the supply requests over the phone and legal? going to post prescription. -If illegal, is there Summary-Emergency Supply at the Request of a Prescriber (UK) Request made by an appropriate prescriber; Unable to furnish a prescription without undue delay, due to an emergency Prescriber promises to supply a prescription within……………hours The POM is not a CD schedule 1, 2, or 3 except ……………………..used in the treatment of epilepsy Make sure sufficient information to supply ‘in accordance with the directions of the prescriber’ –to dispense, supply and write POM register entry Take request from prescriber Ensure supply is legal and safe for patient Document the request If appropriate, label and dispense medication Document supply in POM register Patient or representative collects medication-take Rx charge if necessary Receive prescription and finish off POM register entry Emergency Supply at Patient’s Request Patient asks for a supply of medicine without a prescription- usually they have run out Usually visit the pharmacy in person Rarely a phone call from the patient Sometimes a representative is sent: o Parents/guardians o Carers o Relatives/ friends Emergency Supply at Patient’s Request Pharmacist (Responsible Pharmacist) MUST interview the patient him/herself and be satisfied that: Immediate need for the POM Impracticable to obtain a prescription without undue delay Treatment has previously been prescribed by a UK registered appropriate prescriber for the patient or EEA or Swiss health professional (this is usually interpreted as regular medication) It is an appropriate dose for that patient in the circumstances Emergency Supply at Patient’s Request No greater than 30 days treatment should be supplied except: Ointments, creams or aerosol (e.g. inhaler) – supply smallest pack Oral contraceptive – give full cycle Antibiotics in liquid form –smallest quantity to complete the course Insulin – smallest pack Controlled Drugs (CDs) Schedule 2 and 3 CANNOT be supplied, except for phenobarbitone (phenobarbital) for epilepsy ONLY (Sch 3 CD) Phenobarbitone/phenobarbital or a Schedule 4 or 5 CD can be supplied for no more then 5 days treatment. If you are not going to supply, what action should you take? Emergency Supply at Patient’s Request A record in the POM register must be made on the day (or next day if impractical) Patient of an EEA or Swiss health professional CANNOT obtain any Schedule 1, 2 or 3 CDs (even phenobarbital) or medicines without a UK Marketing Authorisation (MA) There is also a list of substances that cannot be supplied to a patient as an emergency supply HMR 2012 (Schedule 18)  Substances not Permitted (Emergency Supply Patient’s Request) Methohexitone sodium Ammonium bromide Tacrine hydrochloride Hexobarbitone sodium Fencamfamin hydrochloride Prolintane hydrochloride Pemoline Calcium bromide Thiopentone sodium Hydrobromic acid Fluanisone Sodium bromide Piracetam Calcium bromidolactobionate Hexobarbitone Meclofenoxate hydrochloride Potassium bromide Strychnine hydrochloride Embutramide REF: HMR 2012 (Schedule 18) Emergency Supply at Patient’s Request in a Pandemic HMR 2012 Part 12 Chapter 3 Regulation 226 Pharmacists: Do not need to interview the patient Need to be satisfied that the treatment has previously been prescribed by an appropriate practitioner and the dose is appropriate Legislative change 29/04/2020: CDs Schedule 2 and 3 can be supplied if: Secretary of State makes a statement to allow it specifying: Area covered (local area, region or country within UK) Particular circumstances (e.g. a GP practice closure) Timeframe for using this legislation Emergenc Record in the POM register must state: y Supply Date the POM was sold or supplied Name, form, strength, quantity of product at Name & address of patient requiring the POM The nature of the emergency Patient’s Ref HMR 2012 (Schedule 23) AND Request – Emergency supply-request of patient* POM GP name and address* Dosage of medication* Register Amount paid* …..or exemption/paid status if receiving a prescription retrospectively*- ‘lending’ is common practice although not legally defined Records POM register reference number (same number on dispensing label)* * Good practice but not legal requirement  Example of a POM register entry for an emergency supply at the request of a patient Reference Details Cost Number 7.0001 Emergency supply at the request of a patient Cost of drug Date of + % mark up Supply John Coates Dr Marshall + professional 9 The Avenue The Surgery fee Anytown Anytown + VAT Phenobarbital 30mg tablets x 2 one to be taken at night Patient is epileptic and has used the last of his tablets. Patient cannot obtain prescription before Monday – GP surgery shut (Saturday afternoon) Red=good practice Emergency Supply at Patient’s Request – Labelling Requirements Container or packaging must be labelled as normal PLUS the words “EMERGENCY SUPPLY” Date of supply Name, form, strength, quantity of product Patient name Name and address of the pharmacy The words “Keep out of the sight and reach of children” The words “EMERGENCY SUPPLY” *Usually also add dose of medication and ref number as good practice Example of a label for an emergency supply at the request of a patient Keep Out of the Sight and Reach of Children University of Reading Pharmacy , Whiteknights Campus, Reading Phenobarbital 30mg Tablets 2 tablets Take ONE tablet at night EMERGENCY SUPPLY (7.0001) Warning: This medicine may make you sleepy. If this happens do not drive or use tools or machines. Do not drink alcohol Mr John Coates Date of dispensing Would you Patient needs flucloxacillin capsules urgently on a Sunday for a new rash-had 4 months ago supply? for the same rash Consider: Patient has run out of sildenafil In patient’s best Patient’s wife forgot to pick up prescription from surgery before the weekend –she calls in interest? to see if we can lend her husband a few simvastatin 10mg until Monday. Regular Is the supply patient legal? Substance misuse regular patient on 90ml methadone 1mg/1ml daily (supervised What questions consumption) states that clinic is closed (Wed pm). He forgot to collect new prescription on would you need Wed morning so has no Rx. to ask?  Patient is visiting relatives and has forgotten Would you supply? to bring aspirin 75mg dispersible tablets Consider: Patient wants codeine tablets as they have run out. They ran out last month and you In patient’s best provided a supply until they could get a Rx interest? Is the supply legal? Customer calls in, stung by wasp a minute ago. Allergic-face/lips/hands visibly swollen, What questions would red rash. Usually has Epipen (adrenaline) you need to ask? with them but forgot it What actions would you need to take? Patient on holiday. Forgot to bring warfarin. Can’t remember dose Summary of Emergency Supply at Request of Patient Pharmacist must interview the patient him/herself except in a Pandemic It must be an emergency Must be previously prescribed by an appropriate prescriber Must know appropriate dose Not more than 5 days supply for CDs Sch 3 (phenobarbital), 4 and 5 30 day maximum supply for other POMs except for…reg 225! No CDs Sch 1, 2 and 3 except phenobarbital for epilepsy For patients with an EEA/Swiss prescriber, CANNOT supply CDs Sch 1,2,3 at all and only supply medication with a UK MA Must make records in POM register Normal labelling requirements but in addition have the words “emergency supply” on label  Summary of Emergency Supply at Request of Patient Take request from patient – ask about prescriber, what medicines patient needs, previous use, length of supply needed etc Assess validity and legality of request Ensure supply is safe for the patient If supply appropriate, label and dispense medication Supply to patient (or representative) and charge if necessary Document supply in POM Register 27/01/25 31 Community Pharmacist Consultation Service (CPCS) Advanced Service Service Design: Emergency medicines supply requests from patients, received by NHS 111 call handlers or via NHS 111 online (111.nhs.uk), are referred to pharmacy (instead of NHS 111 doctors writing a prescription) NHS 111 contacts the pharmacy (via CPCS IT system or NHS email account) Patient phones pharmacy Patient visits pharmacy and pharmacist completes emergency supply according to HMR 2012 Regulation 225 (pharmacist may not supply-depends whether it is appropriate) Patient pays as if an NHS Rx (or exempt) Pharmacist claims for service and drug costs (Patients with minor ailments (low acuity conditions) are also referred from NHS 111 with CPCS) References / Further reading Medicines, Ethics & Practice Guide July 2019 Pharmacy Law and Ethics 10th Edition http://www.legislation.gov.uk/uksi/2012/1916/part/12 https://psnc.org.uk/services-commissioning/advanced-services/co mmunity-pharmacist-consultation-service/