SOPS for Scripware Processes PDF

SOPs Table of contents: Page 2-> Processing an FP10 prescription Page 5-> Processing CD prescription FP10 Page 6-> Process of MDA instalment prescriptions Page 8-> How to approach a private prescription including the POR registry entry Page 10-> Processing a requisition/signed order Page 12-> Vete...

SOPs Table of contents: Page 2-> Processing an FP10 prescription Page 5-> Processing CD prescription FP10 Page 6-> Process of MDA instalment prescriptions Page 8-> How to approach a private prescription including the POR registry entry Page 10-> Processing a requisition/signed order Page 12-> Veterinary requisition Page 14-> Signed order from principal/headteacher Page 18-> Processing a midwife supply order Page 21-> Emergency supply Page 24-> Emergency supply at the request of the prescriber Page 27-> Processing dentistry prescriptions Page 29-> Palliative care prescriptions Page 34-> which register entry for which type of prescription and relevant links for SLS, DPF/NPF, blacklisted medicines and what medicines are allowed for each practitioner? Processing an FP10 prescription Classify: FP10SS for type of form Legal category of each item- use the BNF or veterinary formulary. Patient Medication Record (PMR): If same medicine on prescription is on PMR- do the strengths, form, dose match? Is there an interaction between drug on the prescription and PMR? Keep in mind any additional notes- do they affect the drug e.g., renal function- renal impairment, hepatic impairment and other sections in the BNF Verify: For each item on the current prescription, you need to consider: 1. Have they had it before? If so, (a) Is it still appropriate for this patient? (b) Is it the same dose, strength, etc. as before? 2. Is it a new item? If so, is it appropriate for this patient? Dose- check BNF, is it clinically valid? Think about both previous medicines and past medical history. Interactions and contraindications. This means that you should check if the prescription or requisition is eligible for supply. 1. Is it legal? 2. Are there any details missing that you need before you can dispense the medicine? And for prescriptions 3. Are there any issues arising from the PMR? 4. Are there any interactions? 5. Check the dose. Legal requirements for prescriptions- The sale, supply and administration of prescription-only medicines (POMs) are restricted by the Human Medicines Regulations 2012. Signature of prescriber- must be appropriate practitioner. Name, qualifications and address of prescriber Date- prescription is valid for up to six months from the appropriate date. For an NHS prescription, the appropriate date is the later of either the date on which the prescription was signed or a date indicated by the appropriate practitioner as the date before which it should not be dispensed. Prescription can be future dated as well. Name of patient Address of patient Age of patient if they are under 12. Prescriptions need to be written in indelible ink. Drug- Name, strength- does it match the PMR if it’s been prescribed before? form, is dose correct for age/weight/indication, is the timing correct- see BNF, quantity. If it is prescribed by a community practitioner nurse- see NPF by the BNF If it is prescribed by dentist- check the DPF by the BNF Profession specific information for dentists and paracetamol Calpol 6 plus is blacklisted. Remember SLS if it is not there- click drug is not in the formulary in the drug section in verify tab for SLS endorsement. Nurse and pharmacist IPs can prescribe all classes of drugs including CDs and unlicensed. If they have a doctor's name at the bottom of prescription, then they are supplementary. If it's their name at the bottom of prescription, then they are independent Optometrist Ips have a very restricted list- POMs and unlicensed but not CDs. Optometrist Independent Prescribers can prescribe any licensed medicine for ocular conditions affecting the eye and the tissues surrounding the eye, except Controlled Drugs or medicines for parenteral administration. Podiatrist IP: all POMs plus some CDs including dihydrocodeine and temazepam and unlicensed. Physiotherapist IP: all POMs plus some CDs including dihydrocodeine, fentanyl, morphine, oxycodone and temazepam and unlicensed. Supplementary prescribers are restricted to prescribing in conjunction with another prescriber. Prescribe within the range of that CMP plan. All classes of drugs including CDs and unlicensed. MEP 3.3.14 Register: No register for POMs unless on private prescription or requisition etc. Label: Use scripware handbook. Name of medicine Directions for use KOOSAROC and other ancillary labels. Name of patient Name and address of pharmacy Date of dispensing. If medicine is to be taken for one week (1/52) write WEEK not 7DAY e.g. 2T QID WEEK A BD ATHLETE- for cream for athlete’s foot If both eyes not specifified for eye drops then just put into affected eye- dose code E For steroids- 8T SD OD 7DAY REDUCE If number of days’ treatment put on prescription include it in label e.g. 1T BD 3DAY Eye drops need STB, NTBT and D28 ancillary labels. Nasal spray needs STB, NTBT Patches need FEUO ancillary label. Always check if medicine name and strength is available by looking at BNF. Liquids need STB, for a child dose code 5G BD SYRINGE or 5G QID AC for example not 5. Have you included the correct ancillary labels from the BNF? Are any extra labels needed? Is the dose on the label clear and correct as per the prescription? Any spelling errors on the label? Endorse: Pharmacy stamp and pack size File: Send to PPD-NHSBSA Make sure the name of the drug is spelt correctly. Check that the practitioner is allowed to prescribe that particular drug. If dentist is prescribing with NHS prescription they need to prescribe within Dental formulary If Community Practitioner Nurse Prescribers (CPNP) they are qualified to prescribe only from the Nurse Prescribers Formulary (NPF) for Community Practitioners. This formulary contains appliances, dressings, pharmacy (P), general sales list (GSL) and thirteen prescription only medicines (POMs). Independent nurse prescribers- they can prescribe any medicine provided it is in their competency to do so. This includes medicines and products listed in the BNF, unlicensed medicines and all controlled drugs in schedules two - five. CD prescription with register amendment Classify- FP10SS for green prescription with CD drug on it Legal categories see on BNF. Check PMR- check if there are interactions with drugs on PMR or contraindications with conditions and drugs. If the patient has had a particular brand for a specific drug, choose that brand again when doing the CD entry. Verify- Patient name and address, DOB Prescriber- name, address, registration number and signature Drug name and spelling, form, strength, dose (check MEP 3.6.7 for what abbreviations you are allowed to use), quantity in words and figures (you can make amendment if it is not there) Date- to understand 28 day validity Date on this prescription was 05-08-23. Add 28 the date comes to 02-09-23, that is how long the prescription was valid for. Today is 09-09-23, so the prescription is out of date. Signature authenticity check required- make sure that the signature belongs to the prescriber, make sure it is his Authorising signature- for midwife signed orders. Purpose- for veterinary prescriptions and other types of singed orders/requisitions. Register- Check what ID the patient has given you first. CD register for Sch 2 and 3. Drug class Brand- look at the CD cupboard or the PMR. Date supplied- todays date. CD prescription with a technical amendment Process of MDA instalment prescriptions Blue prescription FP10MDASS NHS prescriptions for the treatment of drug misusers - FP10 (MDA) Classify- FP10MDASS, GP or hospital. PMR Verify- Check - Prescription requirements for Schedule 2 and 3 Controlled Drugs and an instalment direction combines two pieces of information: on Quizlet Check that the drug on the prescription is either a schedule 2 CD, buprenorphine, buprenorphine/naloxone (Suboxone) and diazepam. Check that the drug name is spelt properly and that the drug can be found on the BNF. Where a prescription for a Schedule 2 or 3 CD contains a minor typographical error or spelling mistake, or where either the words or figures (but not both) of the total quantity has been omitted, a pharmacist can amend the prescription indelibly so that it becomes compliant with legislation. The prescription must also be marked to show that the amendments are attributable to the pharmacist (e.g. name, date, signature and GPhC registration number, etc.). Check that the practitioner is allowed to prescribe the above drugs. If prescribed previously, check that the correct dose, form and strength that matches the PMR is prescribed. If not query it by asking the prescriber. Maximum 14 days’ supply. 1st instalment must be within 28 days of the appropriate date. Using the MEP 3.6.7 check that Home Office approved wording has been used for instalment prescribing and that the dose is written in a way that is legally acceptable for CD prescription. Quantity in words and figures, dose abbreviations have to be appropriate for CD prescription requirements. For FP10MDASS if the intervals and days in which each instalment should be dispensed are missing- in the verify section go to drug, quantity and then exact intervals are not specified. This patient was due to get their Saturday instalment which was double the 40ml dose, when you turn form over- the quantity column should be the quantity for one dose. Same thing for quantity in the label section. On page for Physeptone 1mg/ml Oral Solution, Amount supplied should be 40 in the CD register. If Sch 2 or 3 signature authenticity check required. To meet the NHS requirements for instalment dispensing you need to endorse the back of the prescription. For FP10 (MDA) both GP and hospital forms will have an extra choice for registers of ‘Turn form over’. Put date on prescription for that days’ supply in the date column. In the item column write the name of the drug as it appears when you search the name in the labelling section. Put quantity as it is written in prescription for that day e.g. 2 tabs CD register too if the drug is schedule 2. Look in the virtual controlled drug cabinet to see what brand for the drug. Label what directions are on prescription for the dose, but quantity only for the instalment on a particular day. If it is a tablet- check that it is not a sublingual tablet, if so use dose codes - 1SL Dissolve ONE tablet under the tongue, 2SL Dissolve TWO tablets under the tongue or 1-2SL Dissolve ONE or TWO tablets under the tongue. If a liquid makes sure to use ancillary label STB. Endorse pharmacy and pack size. Retain until complete or PPD-NHSBSA when completed. How to approach a private prescription including the POR registry entry. Can be a dental private prescription or from a GP surgery. It is a white form. Patient name and drug name strength form and dose which means we have a prescription. For Sch 2 and 3 pink form FP10PCDSS. Private prescriptions that are not on the designated standardised form must not be accepted unless they are veterinary prescriptions. Classify- Private Type of prescriber Legal classification of drugs listed- look in BNF for drugs PMR- Look at allergies. Verify- Only need age if patient is under 12. DOB is not required on prescription if we saw the patient’s age on PMR. Name, qualifications, and UK address for prescriber Patient name, only need age if patient under 12, patient address, DOB not legal requirement if patient is an adult. On a private prescription (if dentist) the prescriber just needs to prescribe within their field and practice- don’t need to check DPF) For CD prescriptions MEP 3.6.7 Name of patient Address of patient Prescriber’s address- must be in UK for Sch 2 and 3 Name of CD- you can make spelling amendments The formulation must be stated; the abbreviations ‘tabs’ and ‘caps’ are acceptable. The strength only needs to be written on the prescription if the medicine is available in more than one strength. The dose does not need to be in both words and figures; however, it must be clearly defined (see Table 14). The total quantity must be written in both words and figures. You can make quantity amendemnts The Department of Health and the Scottish Government have issued strong recommendations that the maximum quantity of Schedule 2, 3 or 4 CDs prescribed should not exceed 30 days. This is not a legal restriction but prescribers should be able to justify the quantity requested (on a clinical basis) if more than 30 days’ supply is prescribed. Where the CD prescription is written by a dentist, the words ‘for dental treatment only’ must be present. Date Signature If amendments need to be made: Y Al Sheikh Ali, date, 20328574 Register- prescription only register and CD register for pink form. In POR date of dispensing is today’s date Can put dose in abbreviations or full words. Long box beneath drug and dosage instructions in POR is the date on the prescription. Remember POR reference number on label. POR REGISTER: The record must include: Ref number Date of dispensing- The date on which the medicine was sold or supplied Name of patient Address of patient Name of practitioner Address of practitioner Drug name, strength, form, dose and quantity as it appears on prescription. Date on prescription. Price. CD REGISTER: Check ID patient provided first. Check brand from drug cabinet. Date supply received or date supplied column- today’s date. Person or Firm Supplied- patient name and address. Authority column- prescriber name with qualifications, their GMC number and form type. Person collecting column- patient, patient’s wife etc. Proof requested column- yes. Proof provided column- bank card is ok. Amount Supplied Balance column If amendments need to be made: 20328574, date, initials Label- make sure to put POR reference number. Endorse- pharmacy stamp and POR stamp. File- FP10CDF retain copy for 2 years and send original to PPD-NHSBSA Private prescriptions for a POM must be retained for two years from the date of the sale or supply or for repeatable prescriptions from the date of the last sale or supply. Processing a requisition/signed order Remember optometrist or podiatrist signed orders MEP 3.3.10. Pharmacists working in a registered pharmacy can supply certain POMs directly to patients in accordance with a signed patient order from any registered optometrist or podiatrist. https://www.gov.uk/government/publications/rules-for-the-sale-supply-and- administration-of-medicines/rules-for-the-sale-supply-and-administration-of- medicines-for-specific-healthcare-professionals 3.4.4 signed orders and requisitions 3.6.6 control drug requisition Classify- Requisition Which healthcare professional has written the requisition- look at scrip ware handbook for the qualification’s abbreviations. No PMR Verify- Don’t need drug dose because it is a request for stock in a practice. Prescriber name, qualifications and address. Signature of recipient. Purpose of requisition. Drug name, strength form and quantity. Requisitions by law don’t need a date on them. Authorising signature is need for CD drug. Register- POR- look in Scripware handbook e.g. No label Endorse- pharmacy and POR File- retain 2 years Don’t need patient DOB. If two medicines, check for interactions!! Veterinary requisition- VP2 Classify- Requisition Vet- check qualifications MEP 3.5 for legal category check NOAH compendium https://www.noahcompendium.co.uk/?id=-312921 No PMR Verify- Purpose needed. Recipient signature. Recipient name, address. Drug strength, form and quantity. In case of control drug- THE LEGAL REQUIREMENTS FOR A CONTROLLED DRUG REQUISITION ARE: 1 Signature of the recipient 2 Name of the recipient 3 Address of the recipient 4 Profession or occupation 5 Total quantity of drug 6 Purpose of the requisition Register- POR- use veterinary name if available for drug name in POR. what about batch number as it states in scripware handbook If CD Sch 2 CD register no label Endorse- pharmacy and POR File- retain 3 years. Sch 2 and 3 CDs- retain 5 years Signed order from principal/headteacher- MEP 3.3.10 Classify- Requisition School No PMR Verify- Name of school Product details (inc strength/spacer where appropriate) Total quantity required. Purpose Signature Register- Record of wholesale dealing in POR Endorsements- Pharmacy POR No label File- Must be retained for 2 years from the date of supply. SO2- Classify- requisition School POM No PMR Verify- The signed order should contain: Name of the school Product details (including spacer if relevant) Strength (if relevant) Purpose for which the product is required. Total quantity required. Signature of the principal or head teacher Ideally, appropriately headed paper should be used; however, this is not a legislative requirement. POR Register look at scripware handbook. Endorsements- Pharmacy and POR No label File- The signed order needs to be retained for two years from the date of supply or an entry made into the POM register. Even when the signed order is retained, it is good practice to make a record in POM register for audit purposes. Processing a midwife supply order MEP 3.6.6  Midwives do not need a prescription or a PGD to supply and/ or administer certain medicines. Sale/ supply of GSL, POM and P medicines- D&A 249 Classify- Requisition Midwife Legal category- check the medicine exists by looking for it in the BNF. Midwife can request morphine, diamorphine, and pethidine. Check PMR Verify- THE LEGAL REQUIREMENTS FOR A CONTROLLED DRUG REQUISITION ARE: 1 Signature of the recipient 2 Name of the recipient 3 Address of the recipient 4 Profession or occupation 5 Total quantity of drug 6 Purpose of the requisition The order must contain the following: Name of the midwife Occupation of the midwife Name of the person to whom the CD is to be administered or supplied Purpose for which the CD is required Total quantity of the drug to be obtained  Signature of an appropriate medical officer – a doctor authorised (in writing) by the local supervising authority or the person appointed by the supervising authority to exercise supervision over midwives within the area Signature checking for S2 or S3 Signature checking for authorising officer. Register- On page for Diamorphine 5mg Ampoule(s)- CD register- Person or firm supplied should be Maureen Wilkes Newstead House Main Street Nottingham Notts. Authority should be Signed order Midwife for use in childbirth for treating Veronica Snow Dr A Shaw FRCP. Person Collecting should be Maureen Wilkes Healthcare professional Newstead House Main Street Nottingham Notts. You claimed to have requested the proof, but you didn't! Proof Provided should be Yes. Balance column should be 34. POR: Reference number(s) Date dispensed. Drug details in POR should be Diamorphine 5mg Ampoules 10 Prescriber details in POR should be Maureen Wilkes Newstead House Main Street Nottingham Notts Purpose is Requisition from midwife authorised by Dr Andreas Shaw for use in childbirth. Price details in POR should be the word Price. Endorse- pharmacy and POR File- Emergency supply MEP 3.3.10 Ask for the patient’s name and age. Any allergies, pregnant or breastfeeding? Do they need this medicine immediately? What are the circumstances as to why they have run out or need this medicine? Why do they need this medicine? Have they been previously prescribed this medicine- if so what strength, form and dose, length of treatment? How long ago were they prescribed this particular medicine- the patient must have been prescribed this medicine within the last year. Previous treatment- SCR, repeat slip, GP, packaging from previous dispensing, reorder slip, hospital discharge. Cannot supply controlled drug Schedule 1, 2 and 3 (except phenobarbitone or phenobarbitone sodium for epilepsy). Note: an EEA or Swiss doctor/dentist cannot request a Schedule 1, 2 and 3 controlled drug or medicines that do not have a UK marketing authorisation Medicines that cannot be stopped abruptly- long term corticosteroids prednisolone DOACs- depends on what they’re taking it for, their individual risk factors, AF not so much but recurrent DVTs or had a thrombotic event in the last 3 months they’re at higher risk if they stop meds suddenly Digoxin for arrythmias beta-blockers e.g., propranolol progesterone-only contraceptive pills anticoagulants seizure medication insulin and diabetes agents clonidine opioids If the emergency supply is for a CD (i.e. phenobarbital or Schedule 4 or 5 CD), the maximum quantity that can be supplied is for five days’ treatment. For any other POM, no more than 30 days can be supplied except in the following circumstances: If the POM is an insulin, an ointment, a cream, or an inhaler for asthma (i.e. the packs cannot be broken), the smallest pack available in the pharmacy should be supplied If the POM is an oral contraceptive, a full treatment cycle should be supplied. If the POM is an antibiotic in liquid form for oral administration, the smallest quantity that will provide a full course of treatment should be supplied. (NB: Pharmacists should also consider whether it is appropriate to supply less than the maximum quantity allowed in legislation. Professional judgement should be used to supply a reasonable quantity that is clinically appropriate and lasts until the patient is able to see a prescriber to obtain a further supply). Supply the medicine at the dose the practitioner last prescribed it at. Refusal to supply If a pharmacist decides not to make an emergency supply after gathering and considering the information discussed in this guidance, the patient should be advised on how to obtain a prescription for the medicine or appropriate medical care. This could involve referral to for example, a doctor, NHS 111, NHS walk-in centre or to an Accident and Emergency department. The following prescribers are able to request emergency supplies: – an EEA or Swiss doctor or dentist – the following prescribers registered in the UK: a doctor, dentist, supplementary prescriber, community practitioner nurse prescriber, nurse independent prescriber, optometrist independent prescriber, pharmacist independent prescriber If the healthcare professional is calling by phone, you have to be satisfied that the person calling is legitimate- GMC number Cannot supply controlled drug Schedule 1, 2 and 3 (except phenobarbitone or phenobarbitone sodium for epilepsy). Note: an EEA or Swiss doctor/dentist cannot request a Schedule 1, 2 and 3 controlled drug or medicines that do not have a UK marketing authorisation Cannot supply more than 5 days treatment of controlled drugs (i.e. phenobarbitone, phenobarbitone sodium, Schedule 4 and 5) Prescriber has to provide prescription within 72 hours. The prescriber needs to provide directions on the use of the medicine. An entry needs to be made in the POR register (or if impractical the day after) the date the POM was supplied the name (including strength and form) and quantity of medicine the name and address of the patient requesting the POM information on the nature of the emergency, such as why the patient needs the POM, why a prescription cannot be obtained, etc The words ‘emergency supply’ must also be stated in the POR register entry. Usual labelling requirements apply except this time you also need to write Emergency supply on the label. If GP is open call them and ask them to send prescription electronically Register as temporary resident with local GP. Emergency supply at the request of the prescriber: Classify- Form type- emergency supply Prescriber request Legal classification of medicine requested- check BNF Check PMR for any interactions, see if he has had medicine before. VP5- 5 - Label: For Item 1, label should show Cyclizine 50mg/ml 1ml Ampoule(s) (you wrote ) 5 - Label: For Item 1, dose should be 1G TDS (and not ). 10 - Label: Drug 1: Name of patient missing 5 - Label: Drug 1: Quantity should be 15 (and not [missing]) 5 - Label: Drug 1: No reference number given 5 - Ancillaries: Item 1 KOOSAROC missing 2 - POR: Reference number(s) missing 10 - POR: Date dispensed missing 10 - POR: Patient's details in POR should be George Mellor 5 Brookhill Ave Attenborough Nottingham NG10 6YI 10 - POR: Prescriber details in POR should be Dr Sam Reed 1 Union Road Attenborough Notts NG10 8WR 10 - POR: Drug details in POR should be Emergency supply at the request of the prescriber Cyclizine 50mg/ml Ampoules 1 Ampoules TDS 15 10 - POR: Prescription date should be the word Date 10 - POR: Date details in POR should be the word Date to acknowledge future receipt 1 - POR: Price details in POR should be the word Price Endorse- Pharmacy stamp and POR File- Nothing to file What is he taking it for? - nausea and vomiting in palliative care By syringe driver 50mg, 1ml 3x a day 1ml ampoule so give 9 ampules for Saturday, Sunday and Monday Diamorphine and oramorph The medicines are not all being mixed in the syringe driver Name and address of patient He has no cyclizine left Supply it. Patient can’t easily obtain medicine otherwise. It is an emergency- palliative care patient and nausea and vomiting can be distressing. Do we know who Dr reed is, where does he work? Dosing instructions needed. Check GMC register if don’t know him, not local. Cyclizine is a POM, CD 4 and 5 is acceptable. How much does the doctor need- 5 days’ worth so 15 ampoules. Prescriber’s particulars- their qualifications and address. Phone number too. Patient details. Is he on any other medicines, anything we need to tell the patient? Make record on the day or day after. 2 - POR: Reference number(s) missing 10 - POR: Date dispensed missing 10 - POR: Patient's details in POR should be Elsa Quinn 12 Hylton Road Sunderland SR4 7XF 10 - POR: Drug details in POR should be Phenobarbital 60mg Tablets 2 on 6 10 - POR: Emergency supply at the request of the patient and Nature of emergency is Emergency supply at the patient\'s request Visiting family and left medicine at home Surgery closed 1 - POR: Price details in POR should be the word Price Processing dentistry prescriptions  When prescribing on an NHS dental prescription, dentists are restricted to the medicines listed in the Dental Prescribers’ Formulary (Part 8a of the Drug Tariff for Scotland or Part XVIIa of the Drug Tariff for England and Wales). The dental formulary is also reproduced within the British National Formulary. Classify- FP10D Legal classification of medicine PMR for allergies, patient’s age, conditions, other medicines Verify- Check drug is in the DPF. Overdose or underdose. Check strength, form and drugs is available by looking in the BNF. No register required unless control drug is schedule 2. Label as normal for other NHS prescriptions Endorse pharmacy stamp and pack size. file- send to PPD-NHSBSA Palliative care prescriptions https://www.england.nhs.uk/north/wp- content/uploads/sites/5/2018/06/Palliative_Care_Prescribing_Guidelines_- _May_2014_Blackpool.pdf PZ1 From the BNF- Palliative care In the control of pain in terminal illness, the cautions listed should not necessarily be a deterrent to the use of opioid analgesics. Classify as normal- can be FP10SS or private prescription. PMR- could say in additional notes: Palliative Care patient under Macmillan Cancer network. Macmillan update (today’s date) - patient to be switched to syringe driver today due to 6 doses of breakthrough opiate used along with modified-release opiate in past 24 hours. Verify- Check if the dose, form and strength of a drug match with PMR if it was previously prescribed and query it. Prescription needs to be dated, signed and with prescriber and patient details as normal. Signature authenticity check required if CD Sch 2 or 3 If the signature belongs to a different prescriber than the one named on the prescription the CD register entry should record the details of the actual prescriber (the signatory) rather than the named prescriber. However, the address of the prescriber needs to be applicable to the signatory for the prescription to be legally compliant. Who can prescribe Sch 2-5 CDs- Doctors Dentists Veterinary surgeon (but for Sch 2 and 3 they must include RCVS registration number of prescriber) Nurse independent prescriber (but not cocaine, diamorphine or dipipanone for treating addiction) Midwife independent prescriber (but not cocaine, diamorphine or dipipanone for treating addiction) Pharmacist independent prescriber (but not cocaine, diamorphine or dipipanone for treating addiction) Supplementary prescriber dietician, midwife, nurse, optometrist, paramedic, pharmacist, physiotherapist, podiatrist/chiropodist, radiographer (diagnostic/therapeutic- (but not cocaine, diamorphine or dipipanone for treating addiction) Who cannot prescribe any Sch 2-5 CDs- Community practitioner nurse prescriber Therapeutic radiographer independent prescriber Paramedic independent prescriber (advanced paramedics) Optometrist independent prescriber Who can prescriber some Sch 2-5 CDs- Physiotherapist independent prescriber- For oral administration- diazepam, dihydrocodeine, lorazepam, morphine, oxycodone and temazepam For injection- morphine For transdermal administration- fentanyl Podiatrist/chiropodist independent prescriber- For oral administration- diazepam, dihydrocodeine, lorazepam and temazepam EEA or Swiss registered approved healthcare professionals- Schedule 4 and 5 CDs only Pharmacist independent prescribers, nurse independent prescribers and supplementary prescribers may not prescribe cocaine, diamorphine or dipipanone for treating addiction, but may prescribe these medicines for treating organic disease or injury. From MEP- https://www.rpharms.com/mep/3-underpinning-knowledge-legislation-and- professional-issues/33-professional-and-legal-issues-prescription-only-medicines/3314- prescriber-types-and-prescribing-restrictions#gsc.tab=0 The appropriate date on the prescription is the date on which it was signed. The appropriate date is either the signature date or any other date indicated on the prescription (by the prescriber) as a date before which the drugs should not be supplied – whichever is later (see also under 'Instalment direction'). It is good practice to write the name of the medicine in full as it appears in the manufacturer's summary of product characteristics. The formulation must be stated; the abbreviations ‘tabs’ and ‘caps’ are acceptable. It should be clear and unambiguous if the prescriber intends a supply of m/r , s/r etc. The strength only needs to be written on the prescription if the medicine is available in more than one strength. To avoid ambiguity, where a prescription requests multiple strengths of a medicine, each strength should be prescribed separately (i.e. separate dose, total quantity, etc.). For quantity- The Home Office advise: “If there are different strength tablets, the quantities for each strength must be listed in words and figures, either as: ‘numbers of tablets’ e.g. 7 (seven) x 8mg tabs, 14 (fourteen) x 2mg tabs or as:  ‘milligrams’ e.g. 56 (fifty-six) mg as 8mg tablets 28 (twenty- eight) mg as 2mg tablets The Department of Health and the Scottish Government have issued strong recommendations that the maximum quantity of Schedule 2, 3 or 4 CDs prescribed should not exceed 30 days. Table 14: Examples of doses that are, and are not, legally acceptable (not exhaustive) Label as normal, for prescription above dose should be 15 EV 4H6 PRN and remember STB ancillary label needed. For station 1- complete a register entry Prescription already handed out. Already clinical and accuracy checked. Do need to endorse it and file it. CD register Sch 2 CD Make sure entry is made on the right page. Look at virtual control drug safe- https://xerte.nottingham.ac.uk/play_30677#page3 Date should be today’s date. Person or firm supplied should be patient name and address. Authority should practitioner name with qualifications (e.g., Dr or MRCVS), their registration number and prescription type (e.g., FP10SS) For proof requested and proof provided check the ID the patient provided before completing the CD entry. Write amount supplied and opening balance. POR register Private prescription, requisition, vet prescription, emergency supply, midwife signed order. Vet prescriptions Classify- Private Vet PMR- If your patient is an animal start the surname with c/o (care of). Just put c/o in surname box and search Verify- From MEP- The following must be present for a veterinary medicine prescription to be valid: 1 Name, address, telephone number, qualification and signature of the prescriber. Where Schedule 2 or 3 CDs have been prescribed, the Royal College of Veterinary Surgeons (RCVS) registration number of the prescriber must also be included. 2 Name and address of the owner. 3 Identification and species of the animal and its address (if different from the owner’s address). 4 Date. prescriptions are valid for six months or shorter if indicated by the prescriber (the Veterinary Medicines Directorate (VMD) has confirmed in the case of repeatable prescriptions all supplies must be made within 6 months or shorter if indicated by prescriber). Prescriptions for Schedule 2, 3 and 4 CDs are valid for 28 days. 5 Name, quantity, dose and administration instructions of the required medicine NB: The VMD advises that ‘as directed’ is not an acceptable administration instruction. 6 Any necessary warnings and if relevant the withdrawal period (i.e. the time that must elapse between when an animal receives a medicine and when it can be used for food). 7 Where appropriate, a statement highlighting that the medicine is prescribed under the veterinary Cascade (e.g. ‘prescribed under the Cascade’ or other wording to the same effect). 8 If the prescription is repeatable, the number of times it can be repeated. Note also: Where Schedule 2 or 3 CDs have been prescribed, a declaration that ‘the item has been prescribed for an animal or herd under the care of the veterinarian’ – usual CDs prescription requirements apply (see section 3.6.7). Purpose needed for requisition, if it is a prescription no need. Breed of animal and weight. Animal’s name and owner’s surname Age and DOB of animal not particularly relevant. Address of patient. Prescriber’s name and qualifications (MRCVS) and registration number (for control drugs). Drug name and spelling should be correct, not blacklisted. Strength, overdose or underdose- using the weight of animal check the NOAH compendium (datasheets of authorised veterinary medicines). If prescription says ‘this item/prescription has been prescribed under the veterinary cascade’ can supply human versions of medicines that don’t have a veterinary version. Date on prescription Signature of prescriber POR register because all veterinary prescriptions are private prescriptions. Reference number Date dispensed. Patient's details in POR should be Fredthedog c/o Andrew Hodgson 9 Old School House Trowell Nottingham Prescriber details in POR should be Frances Drew White House Main Street Trowell Nottinghamshire NG27 5WA 0115 434 5694 Drug details in POR should be Vetergesic 300mcg/ml Ampoules 1ml 1ml prn 5 If there is veterinary version of medicine write the veterinary name. Prescription date Price details- price Do a CD entry too if the drug is Sch 2 or 3 Add on the label what the drug name on the prescription is even if you supplied a veterinary version. Name of patient written as Fredthedog c/o Andrew Hodgson We need batch number (e.g., BN 1234) and expiry date of the product (e.g., EXP 09/02/21) after the dose codes. Prescriber details- Frances Drew Owner’s address- 9 Old School House Trowell Nottingham Endorse pharmacy and POR stamp. File- retain for 5 years. Selected List Scheme https://www.drugtariff.nhsbsa.nhs.uk/#/00841024-DC/DD00840307/In%20England: blacklisted medicines https://www.england.nhs.uk/wp-content/uploads/2018/07/items-which-should-not-be- routinely-precscribed-in-primary-care-consultation-report.pdf https://en.wikipedia.org/wiki/NHS_treatments_blacklist DPF/NPF https://www.nice.org.uk/bnf-uk-only https://www.nice.org.uk/bnf-uk-only What medicines are allowed for each practitioner? https://www.gov.uk/government/publications/rules-for-the-sale-supply-and-administration- of-medicines/rules-for-the-sale-supply-and-administration-of-medicines-for-specific- healthcare-professionals#optometrists https://xerte.nottingham.ac.uk/play_30742#page9