Medicines Policy PC005 · independent prescribing, supplementary prescribing, medicine, homely remedies and full and assisted administration 6.5 Updated the list of medicines that

Policy for the Supply, Administration, Safe Handling and Storage of Medicines Page 1 of 39 Version 2 November 2010

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Policy for the Supply, Administration,

Safe Handling and Storage of Medicines Reader Information

Reference MM/25

Directorate Public Health

Document purpose To ensure the safe supply, administration, handling and storage of medicines by PCT employed staff and independent contractors

Version 2.0

Title Policy for the supply, administration, safe handling and storage of medicines.

Author/Nominated Lead (Title plus contact details)

Alison Hale (0115 8837913) Prescribing Governance Adviser, Easthorpe House Coral Osborn Pharmacy Manager – Clinical Quality, Easthorpe House

Approval Date 03/02/2011

Approving Committee Medicines Management Sub Committee

Review Date Two years (February 2013)

Groups/staff consulted

Target audience PCT employed healthcare staff Independent Contractors

Circulation List Nottinghamshire Community Health NHS Nottinghamshire County Staff Linked local authority staff Sherwood Forest Hospital Trust staff Nottinghamshire Healthcare NHS Trust staff Nottingham University Hospitals Trust staff

Associated documents Nottinghamshire Community Health Policy for the Supply, Administration, Safe Handling and Storage of Medicines Sherwood Forest Hospital Trust Medicines Policy Nottinghamshire Healthcare NHS Trust- Medicines Custody and Administration procedure


Superseded documents Policy for the supply, administration, safe handling and storage of medicines 2007-08 Version 1 NHS Nottinghamshire County

Sponsoring Director Director of Public Health


Amendments

Date Section Amendment 30/12/10 All Prescribing and medicines management amended to pharmacy

and medicines management

1 Amended in line with changes to regulatory body – Care Quality Commission and standard for quality and safety

2 Nottinghamshire Community Health follow their own medicines policy

3.1

3.2 NMC standards updated 2007 Pharmacy regulator change GPhC

5 Revised wording of the following definitions Patient or client, Independent contractor, Non medical prescriber, independent prescribing, supplementary prescribing, medicine, homely remedies and full and assisted administration

6.5 Updated the list of medicines that may be administered for the purpose of saving a life in an emergency

7.1 Revised wording for CNPN and nurse independent prescribers can now prescribe limited number of CDs

7.2 Pathway for non medical prescribing policy and controlled stationary policy on the intranet added

7.3 Addition re oral syringes

7.4 Intranet pathway for lost, stolen and fraudulent prescriptions added

7.5 Intranet pathway for Controlled Drugs added

7.6 Amendment to authorisation to administer

7.7.2 Amendment to individuals who can use a PGD

7.7.6 Amendment of PGD ratification

8.4 Removed information from 8.4 pertaining to Nottinghamshire Community Health

8.9 No longer required to fax HOOFs to the PCT



10.3 Revised wording concerning inspection

10.4.1 Designated person maintain responsibility for the keys added.

10.4.6 Removed

10.5 Additional information concerning the storage of refrigerator items and NPSA alert

10.10 Reference to controlled stationary procedure added

11.1.2 Amended to individual independent contractors

11.2.1 Amended to independent contractors

12.1 Revised NMC Medicines Management standards 2008

12.2 A guide to good practice in the management of controlled drugs in primary care” (England) amended to Dec 2009 3rd edition

14 Inclusion of NPSA alert information; syringe drivers

18 New section – Medication Safety NPSA alerts

Section 18 medicines management and hence forward now section 19 etc.

19.5 Distinguished between informal and formal carers

19.8 Addition of wound management section

20.5 Documentation audit removed and requirement to retain records added


20.6.1 Use of locally agreed code to record the refusal and omission of medication

30/12/10 25 Reference to CAS

29 Reference to Care Quality Commission

30 Resources

31 References


Contents Page Number 1. Introduction 7 2. Aims 8 3. Responsibilities 8 4. Accountability 9 5. Definitions 9 6. Medicines and the Law 10 7. Prescribing of Medicines 7.1 Current eligibility to prescribe 7.2 Ordering prescription pads 7.3 Prescription requirements 7.4 Lost or stolen prescriptions 7.5 Prescriptions for controlled drugs 7.6 Drug prescription and drug administration record 7.7 Patient group directions 7.8 Prescribing of unlicensed products

11 12 12 14 14 15 15 16

8. Ordering of Medicines 8.3 Prescription items 8.4 Stock items 8.4.1 Primary Care Practice nurse base 8.4.2 Doctors on-call bags 8.5 Vaccines 8.6 Shock boxes 8.7 Oxygen

16 17 17 17 17 17 17 17

9. Transport and Receipt of Medicines 9.1 Transportation of medicines by PCT staff 9.2 Transportation and receipt of medicines to health

centres/clinics/ surgeries from pharmacy

18 18

10. Custody (Storage) of Medicines 10.1 Responsibility 10.2 Designated person 10.3 Inspection 10.4 Storage in lockable cupboards 10.5 Storage of refrigerator items 10.6 Storage in original containers 10.7 Storage in the community 10.8 Storage of medicines for clinical emergencies 10.9 Continued safe storage 10.10 Storage of prescription pads 10.11 Custody of keys 10.12 Storage of medicinal gas cylinders 10.13 Storage of controlled drugs

19 19 19 19 20 20 21 21 21 21 22 22 22

11. Administration of Medicines 11.1 Staff involved in administration 11.2 Training and competency 11.3 Administration details 11.4 Verbal and faxed messages

23 24 24 25

12. Administration of Controlled Drugs 12.3 Patients home 12.4 Educational establishments

26 26

13 Administration of Intravenous drugs 26 14.Administration of medication via a syringe driver 26 15.Administration of medication via a percutaneous endoscopic gastostomy (PEG) tube

27

16. Administration in emergencies 27


17. Oxygen Administration 27 18. Medication safety 18.1 Fire Hazard with Paraffin Based Skin Products on

Dressings and Clothing 18.2 Anticoagulant Therapy 18.3 Preventing dosing errors with opioid medicines 18.4 Reducing the risk of overdose with midazolam

injection in adults 18.5 Lithium 18.6 Low molecular weight heparins (LMWHs) 18.7 Administration of insulin

28 28 29

29 29 30 30

19. Medicines Management 19.4 Patient concordance 19.5 Principles for the use of compliance aids 19.6 Self administration of medication 19.7 Disguising medication 19.8 Wound management

31 31 32 32 32 32

20. Documentation 20.6 Recording at time of administration 20.7 Controlled drugs in general practice 20.8 Controlled drugs in a community setting

33 33 33 33

21. Investigation of drug discrepancy or loss 34 22. Disposal of medicines 22.7 Destruction of controlled drugs 22.8 Custody and destruction of medication in a registered residential care home 22.9 Destruction of medication in registered nursing home

34 34 35

35 23. Prescribing and administration errors and near miss reporting 23.1 Prescribing errors 23.2 Administration errors

35

35 36

24. Adverse drug reactions 36 25. Drug alerts 36 26. Medicine/appliance defect reporting 36 27. Working with the pharmaceutical industry 37 28. Training and support 37 29. Standards for better health and monitoring 37 30. Medicines Information 38 31. References 38


1. INTRODUCTION

1.1 This document details the Policy on the supply, administration, safe handling and storage of

medicines for NHS Nottinghamshire County (hereinafter referred to as the “PCT”). It seeks

to provide guidance and establish the principles that must be followed by PCT employed

staff and independent contractors in line with Medicines Management Outcome 9 and other

relevant outcomes as defined within the Care Quality Commission (CQC) “essential

standards for quality and safety”.

1.2 Nottinghamshire Community Health (NCH) employed staff working in the community setting

settings (including PCT run GP practices), Whatton Prison, walk in centre and intermediate

care units, where the supply, administration, safe handling and storage of medicines is

identified in their job role will continue to follow the Nottinghamshire Community Health (NCH)

medicines policy for the supply, administration, safe handling and storage of medicines.

1.3 NCH employed staff working within in-patient and day care services at John Eastwood

Hospice and Chatsworth Rehabilitation centre at Mansfield Community Hospital will continue

to follow the Sherwood Forest Hospitals Trust (SFHT) Medicines Policy. This can be found at

www.sfhnet.nnotts.nhs.uk under the following pathway: - Pharmacy and Medicines

Management/Medicines Manageemnt.

Staff working within in-patient services at the Lingsbar site will continue to follow the Nottinghamshire Healthcare NHS Trust Medicines Code. Hard copies are available on all wards and clinic areas.

1.4 Compliance with this policy by the PCT will be monitored throughout NHS Nottinghamshire

County and reported to the PCT Chief Pharmacist. Audit standards will be applied and will link into the audit programme of the PCT.

1.5 This Policy has been written in accordance with nationally agreed standards described

within the following documents (See references):

The Medicines Act 1968

The Safe and Secure Handling of Medicines 2005 (revision to the Duthie Report)

Health and Safety Regulations

Essential standards for quality and safety (Care Quality Commission) 1.6 Any additional policies or procedures referred to within this document will be located on the

PCTs intranet under My PCT/Quality and Governance/Clinical Policies and Practice Guidelines. The PCT Chief Pharmacist will have overall responsibility for any amendments to this policy, its ongoing development and distribution. Amendments will be located on the website, and will include key contact numbers.

1.7 Due to the recent NHS organizational changes, it is acknowledged that this is an evolving

policy and that there may be changes in practice and new situations that may arise before the next formal review of this policy. Linked policies are also currently under review. Staff should therefore refer to their current local policies, use professional judgment, be aware of their own limitations and seek advice and consult with senior staff where necessary

1.8 This policy is a revision of

Policy for the Supply, Administration, Safe Handling and Storage of Medicines Version 1 July 2007

1.9 The PCT is committed to ensuring that, as far as is reasonably practical, the commissioning of

http://www.sfhnet.nnotts.nhs.uk/


provision of services to the public and the way staff are treated reflects their individual needs and does not discriminate against individuals or groups on the basis of their ethnic origin, physical or mental abilities, gender, age, religious beliefs or sexual orientation.

2. AIMS

2.1 The key principle that this and supplementary policies are seeking is to ensure there is an auditable trail for medicines from their receipt by the healthcare organisation and or independent contractor to their supply or administration to a patient.

2.2 Additional aims of this Policy are to ensure that:

all patients or clients receiving treatment requiring medication do so in the correct

and proper manner;

all precautions have been taken to ensure that the proper procedures have

been followed in providing that treatment;

proper procedures have been followed such that all medicines have been stored

and transported to ensure that their integrity has been maintained and to minimise

risks to staff, patients and the public.

2.3 The result of using the Policy (in conjunction with any other appropriate local policies) should

be that the right client/patient receives:

The correct medication;

In the correct dosage;

By the correct route;

At the right time,

For the right duration, by

The appropriate staff member

3. RESPONSIBILITIES

3.1. It is the responsibility of all providers and independent contractors commissioned by the

PCT to ensure that their staff can access/ view a copy of this policy in all bases, have read it

and are in a position to implement it into practice. Any training needs linked to the policy

should be identified and be documented in the staff member’s personal development plan.

3.2. Registered healthcare professionals are expected to be familiar with, and follow at all times,

their own professional codes of practice in relation to medicines. These include:

Medical: General Medical Council guidance on good medical practice

Nursing: Nursing and Midwifery Council (NMC) Standards for medicines management (2008)

Podiatry: Medicines code (Society of Chiropodists)

Pharmacy: General Pharmaceutical Council (GPhC) Professional Standards of conduct ethics and performance

Dental: Standards for Dental Professionals 2005


3.4 Any failure to adhere to this policy should be reported through the PCTs Procedure for the Reporting of Incidents and Near Misses including Serious Untoward incidents 4. ACCOUNTABILITY

All registered healthcare professionals are accountable for their actions and omissions. In administering any medication, or assisting or overseeing any self-administration they must exercise their professional judgment and apply their knowledge and skill in a given situation.

5. DEFINITIONS

The following definitions are used throughout this Policy:

Community Services Pharmacy – Provides pharmacy services e.g. supplies of medication from the Wells Road Centre, Nottingham to health centres, clinics etc to Nottingham North and East Consortium, Nottingham West Consortium and Principia localities

Sherwood Forest Hospital Trust (SFHT) Pharmacy- Provides pharmacy services eg supplies of medication from Kings Mill Hospital to health centres, clinics etc in the North Cluster localities North Cluster Localities- Refers to Highpoint Health, Middleton Lodge practice and Newark and Sherwood PBC cluster localities

South Cluster Localities- Refers to Nottingham North and East Consortium, Nottingham West Consortium and Principia localities Community Pharmacies- Registered premises with the General Pharmaceutical Council, which provide pharmacy services including prescription dispensing, medication usage reviews, smoking cessation, emergency hormonal contraception services Registered nurse - A nurse currently registered with the NMC

Healthcare professional (HCP) – All registered medical Healthcare professionals, nurses, midwives, health visitors, allied health professionals and pharmacists

Patient or Client - A person receiving services from a healthcare professional

Independent Contractor – A provider of healthcare services to patients, includes General Practitioners (GPs), Dentists, Community Pharmacists, Opticians

Healthcare Assistant/Support Staff -Non-registered staff who support nurses and other healthcare professionals in the provision of direct care.

Carer - A person who assists a client/patient in personal care. Carers may be either formal

carers (paid, e.g. social services carers) or informal carers (unpaid, e.g. relatives), and may

or may not be related to the client/patient.

Non-Medical Prescriber – A registered healthcare professional, other than a doctor or

dentist, who has been accredited as a prescriber by their professional body. At present, such

professionals include specially trained nurses/midwives, pharmacists, optometrists,

physiotherapists, podiatrists and radiographers, working within their clinical competence as

either independent or supplementary prescribers.

Independent Prescribing – Prescribing by a practitioner, who is responsible and


accountable for the assessment of patients with undiagnosed or diagnosed conditions and

for decisions about the clinical management required including prescribing. In practice,

there are TWO distinct forms of non-medical independent prescriber

a) An independent prescriber may currently be a specially nurse, pharmacist or

optometrist who can prescribe any licensed medicine within their clinical competence. Nurse and pharmacist independent prescribers can also prescribe unlicensed medicines. Nurse independent prescribers can prescribe some but not all Controlled Drugs. Currently pharmacist independent prescribers cannot prescribe any Controlled drugs independently. Forms FP10(CN), FP10(PN) or FP10(SP) should be used for this purpose

b) A community practitioner nurse prescriber (CPNP), for example district nurse, health visitor or school nurse can independently prescribe from a limited formulary called the Nurse Prescribers’ Formulary for Community practitioners, which can be found in the British National Formulary (BNF) and part XVIIB (i) of the Drug Tariff. Forms FP10(CN) or FP10(PN) should be used for this purpose.

Supplementary prescribing - A voluntary partnership between a doctor or dentist and a

supplementary prescriber to implement an agreed patient-specific clinical management plan

with the patient’s agreement

A supplementary prescriber may currently be a specifically trained nurse, midwife, pharmacist, optometrist, physiotherapist, podiatrist or radiographer who can prescribe any medicine within their clinical competence, according to a patient specific clinical management plan (CMP) agreed with a doctor or dentist and the patient.

Medicine/medication- Any medicinal product prescribed for the purpose of treatment or

prevention of any condition, disease or illness, including drugs, vaccines, dressings and

wound care products.

Homely remedies – Medicines which are available to buy over the counter in community

pharmacies which give symptomatic relief, and which have been agreed at local level may

be administered without individual prescription at the patient’s request for up to a locally

agreed time limit, provided that staff have first ensured that there are no pre-existing factors

which contra-indicate the use of the medicine.

Staff should contact a member of the Pharmacy and Medicines Management team for further information in this area if required.

Full administration of medication - In this instance medication is selected by the healthcare

professional and given to the patient or client.

Assisted administration - In this situation the client/patient will exercise varying degrees of

responsibility for the administration of their own medication, and staff will need to provide

varying degrees of assistance short of full administration.

Self administration - In this situation the client/patient manages their own medication with no

intervention from staff.

6. MEDICINES AND THE LAW

6.1 The Medicines Act (1968) controls the manufacture, distribution and importation of

medicine and requires that medicines available only on prescription must be given as


instructed by the authorised prescriber. Changing the dose or giving prescribed medicines

to a different person without the authorised prescriber’s permission is against the law.

6.2 While the law states who can prescribe medicines it allows anyone to administer them

provided they follow the authorised prescriber’s instructions.

6.3 Non-registered healthcare professionals may only administer medicines after receiving

appropriate training and assessment at local level in accordance with local guidance.

6.4 The law states that no-one may administer an parenteral prescription only medicine

unless he is an appropriate practitioner or is acting in accordance with the directions of

an appropriate practitioner.

6.5 A limited list of medicines to be administered by injection may be legally administered without

a prescription for the purpose of saving life in an emergency (Medicines Act). Examples are

adrenaline 1 in 1000 injection, atropine sulphate injection, chlorphenamine injection, glucagon

injection, glucose injection 50%, hydrocortisone injection, naloxone injection. However, these

preparations remain prescription only medicines until such time as it needs to be

administered. Staff should refer to the PCTs current anaphylaxis policy for further information

6.6 The Misuse of Drugs Act 1971 covers specifically drugs liable to abuse e.g. Controlled Drugs 6.7 The Controlled Drugs (Supervision of Management and Use) Regulations 2006, which came

into force in England on 1 January 2007, introduces a statutory responsibility on all health and social care organisations to ensure the safe management of CDs. This legislation places responsibilities on all designated bodies, of which the PCT is one, to appoint an accountable officer to ensure the safe use and management of controlled drugs in the organisation. It also places a legal duty of collaboration on all designated and responsible bodies to share information and intelligence, within certain constraints, on the management and use of controlled drugs in the health and social care sector. All significant events involving controlled drugs should be reported directly to the Accountable Officer. The Chief Pharmacist is the PCT Accountable Officer

7. PRESCRIBING OF MEDICINES 7.1 Current eligibility to prescribe

Doctors who have successfully completed their course of study and have a valid registration with the GMC. (Doctors (and Dentists) are classified as independent prescribers)

Community practitioner nurse prescriber (CPNP) who have undertaken the required training and have valid registration with the NMC as CPNPs can prescribe medicines from the Nurse Prescribers’ Formulary for Community practitioners.

Nurses, Pharmacists, Physiotherapists, Chiropodists/Podiatrists, Radiographers and Optometrists who have undertaken the required training to become supplementary prescribers and have a valid registration with their professional body can prescribe medicines in accordance with an individual patient clinical management plan (CMP) drawn up in partnership with the independent prescriber and the patient. The supplementary prescriber will take over the care of the patient along with recurrent prescribing responsibilities according to the detail in the CMP. All GSL (General Sales List), P (Pharmacy) and POM (Prescription Only Medicines) items can be prescribed


under these arrangements. Nurse and Pharmacist Supplementary prescribers can prescribe Controlled Drugs (CD’s) EXCEPT Schedule 1 CD’s also as part of a CMP.

Nurses and pharmacists who have undertaken the required training to become an independent prescriber. Independent prescribers are able to prescribe any licensed medicines for any medical condition within their scope of competence. NB Nurse independent prescribers can currently only prescribe a limited range of CDs for specific conditions. Currently Pharmacist independent prescribers cannot currently prescribe CDs, however this is currently under national consultation.

7.2 Ordering prescription pads

GPs should complete an order form, available from Integral Facilities, based at Standard Court in Nottingham and return it to them. Prescribers should allow a 4 week lead time from ordering to delivery of the pads. Prescription pads for Sherwood Rehab Outpatient clinics, ACH outpatient clinics, IHSS and RICS are ordered via SFHT pharmacy services. Prescription pads for non- medical prescribers should be ordered, following the ‘Non-Medical Prescribing Policy’ as listed on the PCT intranet under My PCT/Public Health/Medicines Management/Prescriber Information Controlled Drug Private Prescriptions All private prescriptions for controlled drugs must be written on new private prescription forms FP10 (PCD) NC (These contain the prescribers details already printed) or Non personalised forms FP10 (PCD) SS (These allow private prescribers to print private CD prescriptions,

including their private prescriber details, using their practice computer systems). Medical or

dental prescribers who wish to prescribe controlled drugs on a private prescription must contact the PCT to register for a unique prescribing code. For further information please refer to the Controlled Stationary Procedure available on the PCT intranet under My PCT/Public Health/Medicines Management/Policies procedures and Guidlelines/Prescribing Security.

7.3 Prescription requirements

FP 10

Prescriptions must be written CLEARLY, in black ink only or computer generated such that the following information is completed:-

The patients full name and address

The date

The prescribers signature

The age and date of birth of the patient This is a legal requirement for prescriptions for POMs (Prescription Only Medicines) for children under 12 years but also preferable for all patients

The name of the medicine Chemical formulae (e.g. FeSO4) are not acceptable. Abbreviations (e.g. ISMN) are not acceptable. Generic names must be used wherever possible.


The following exceptions to generic prescribing where the brand name may be used instead of or in addition to the generic name in order to achieve greater clarity are:

o Multi-ingredient preparations, where a recognised generic name is not available.

o A preparation with specific pharmacokinetic properties, e.g. a specific modified release preparation such as theophylline, dltiazem, oral morphine or lithium.

o Dressings and appliances, unless a recognised generic name is available o Anti-epileptics

The form of the medicine (if not a tablet or capsule)

The strength of the medicine (where a strength is quoted) For liquids the strength per volume must be stated, (e.g. Xmg/5ml)

The dose and directions for use of the medicine Units of measurement

The unnecessary use of decimal points must be avoided, e.g. 3mg, not 3.0mg

Quantities of 1gram or more must be written as 1g

Quantities less than 1 gram must be written in milligrams, e.g. 500mg, not 0.5g

Quantities less than 1mg must be written in micrograms, e.g. 100 micrograms, not 0.1mg

When decimals are unavoidable a zero must be written in front of the decimal point where there is no other figure, e.g. 0.5ml, not .5ml

‘Micrograms’, ‘nanograms’ and ‘Units’ must not be abbreviated

Liquids should be prescribed as ml, as good practice, to avoid confusion.

Dose and frequency

The dose and dose frequency must be stated

For ‘as required’ medication a minimum dose interval must be stated

When doses other than 5ml are prescribed for oral liquid preparations an oral syringe will be supplied (except for preparations intended to be measured with a pipette). The oral syringe is marked in 0.5ml divisions from 1 to 5 ml to measure doses of less than 5ml (other size of oral syringe may also be available).

It is recommended that directions are written in English without abbreviations. However a standard list of Latin abbreviations is recognised. These are as follows:-

ac = ante cibum (before food) bd = bis die (twice daily) od = omni die (every day) om = omni mane (every morning) on = omni nocte (every night) pc = post cibum (after food) prn = pro re nata (when required) qds = quarter die sumendum (to be taken four times a day) qqh = quarta quaque hora (every four hours) stat = immediately tds = ter die sumendum (to be taken three times a day) tid = ter in die (three times daily)

Any additional directions such as start date, duration etc must be stated where required.


The quantity of medication This should be stated where possible, however number of day’s treatment can be added if a precise dose and dose frequency is stated. Route of Administration Where non-oral routes are required, a single route must be specified. It is not permissible to prescribe a medicine by more than one route e.g. O/IM. The route should be specified in full except for the following permitted abbreviations:

IV -Intravenous

IM -Intramuscular

SUBCUT -Subcutaneous

PR -per (by) rectum

PV -per (by) vagina

ORAL, O or PO -by mouth

SUBLING -Sublingual

Other instructions should be written in full to avoid confusion, e.g. topical, inhalation, intradermal. Unclear, ambiguous or illegible prescriptions If a prescription is in any way unclear, ambiguous or illegible, it will be queried by the dispensing pharmacist. This may result in re-writing of the prescription. Prescriptions written by a prescriber MUST NOT be amended or changed by anyone other than a prescriber.

7.4 Lost or stolen prescriptions

Please refer to the PCT procedure for lost, stolen and fraudulent prescription for information of action to take in the event of prescriptions being lost, stolen or issued fraudulently. The policy can be found on the PCT intranet under My PCT/Public Health/Medicines Management/Policies procedures and Guidelines/Prescribing Security An incident form should be completed as part of the PCTs Incident Reporting Policy and Procedure

7.5 Prescriptions for controlled drugs

The requirement that Controlled Drug prescriptions should be written in the prescriber's own handwriting was removed with effect from November 14th 2005. Prescriptions must still be written so as to be indelible and other prescription requirements (e.g. to express the total quantity in both words and figures and state the form of the preparation) still apply, but only the signature now needs to be handwritten by the person authorising the prescription. All other details on CD prescriptions, including the date, can be computer generated. This change also permits the use of stamps and allows other people to write the body of the prescription and means that prescribers no longer need to have a handwriting exemption. The PCT document “The Management of Controlled Drugs in GP Practices” is available on the intranet under My PCT/Public Health/Medicines Management/Policies procedures and Guidelines/Controlled Drugs


7.6 Drug prescription and drug administration record

Treatment can only be administered on the authorisation of a prescriber in the following manner:

A prescription form (FP10)written by the prescriber

Patient specific direction. A patient-specific direction (PSD) is a written instruction from a qualified and registered prescriber for a medicine including the dose, route and frequency or appliance to be supplied or administered to a named patient. In primary care, this might be a simple instruction in the patient’s notes. In some instances this may be an instruction on a drug administration record chart. (NB the HCP administering the medicine can transcribe the medication onto the administration record which must then be signed by the prescriber)

Under exceptional circumstances, a registered nurse or pharmacist may accept a verbal message from a prescriber (excluding Controlled Drugs)

By an appropriately authorised Patient Group Direction

7.7 Patient group directions 7.7.1 A Patient Group Direction (PGD) is a written instruction for the supply or administration of

medicines to groups of patients who may not be individually identified before presentation for treatment. It is drawn up by a multi-disciplinary group involving a doctor, pharmacist and a representative of any professional group expected to supply and/or administer medicines under the PGD.

7.7.2 PGDs must only be used by individuals who are legally allowed to use them:

Registered nurses/midwives;

Pharmacists;

Registered optometrists;

Registered physiotherapists;

Registered chiropodists

Registered orthopists;

Registered dietitians;

Registered speech and language therapists;

Registered occupational therapists;

Registered paramedics or individuals who hold a certificate in ambulance paramedic skills issued by, or with the approval of, the Secretary of State;

Dental therapists;

Dental hygienists; Registered orthotics and prosthetics;

Registered radiographers; 7.7.3 All PGDs will follow the agreed PCT format and will be developed in accordance with HSC

2000/026 Patient Group Directions. The PGD will outline the person responsible for:

Ensuring that the health care professional administering or supplying medicines under the PGD has the necessary evidence of competence, training, knowledge, experience and continuing education relevant to the clinical condition specified to which the PGD applies


Maintaining a register of those staff able to administer or supply medicines under a particular PGD,

Ensuring that a copy of the PGD has been provided to each person administering under the PGD.

7.7.4 All PGDs should include a mechanism for audit to ensure that the patient has not been

compromised and that the PGD is being adhered to. 7.7.5 All PGDs will be reviewed at an interval of no longer than two years. 7.7.6 Where an author of a PGD is an employee of the PCT this will be ratified by the PCT

Medicines Management Sub-Committee. 7.7.7 The qualified health professionals who may supply or administer medicines under a PGD can

only do so as named individuals. 7.7.8 All medicines supplied or administered under a PGD must be recorded both in the patient’s

notes and in the PGD stock record sheet. The stock record sheet is a record of those receipts from community services pharmacy and issues to patients. Supply records will be monitored during routine pharmacy monitoring visits, performed by a member of the community services pharmacy team.

7.8 Prescribing of unlicensed products

The manufacturer of a product does not accept any liability for the use of unlicensed

medicines or those used outside their licensed indications. Many medicines administered to

children are not licensed for use in children. Prescribers take responsibility for the safe use

of unlicensed medicines or medicines used outside their licensed indications, age and dose

range. The prescriber must be aware of any such use as they hold total liability for their use.

The HCP must be confident that the prescriber is aware of the unlicensed use of medicines. They can then administer them in accordance with the management plan. Any deviation in this action will result in the HCP being jointly liable for any adverse event associated with the use of the unlicensed medicine. If in any doubt the HCP administering the medication must seek advice from their line manager or a member of the Pharmacy and Medicines Management team. The policy for Policy for the prescribing and supply of unlicensed and off-label medicinal products. Information is available from the Pharmacy and Medicines Management team.

8. ORDERING OF MEDICINES

8.1 All medicines, dressings and appliances must be obtained via the PCT, supplying hospital

pharmacy or a registered community pharmacy. Samples from pharmaceutical companies

must not be accepted please refer to section 24 for further details.

8.2 Any items supplied or dispensed which do not comply with regulations, or discrepancies in dispensing, must be reported immediately to the relevant pharmacist and service managers. An incident form should also be completed as part of the PCTs Incident Reporting Policy and Procedure


8.3 Prescription items

Prescriptions written for patients should be passed to the patient or carer for them to organise supply by a Community Pharmacy or Dispensary at the dispensing doctors. Where it is essential for the healthcare professional to assist in this process, they must obtain the patients/carers consent. If the patient is exempt from paying prescription charges the HCP would need to sign the back of the prescription to confirm that the patient is exempt from charges and that they have the patients/carers written authorisation to act as a representative. In all cases the healthcare professional must ensure they have ID on them to show the community pharmacist, or dispensing doctor pharmacy.

8.4 Stock Items 8.4.1 Primary Care Practice Nurse Base

Stock required at the individual surgeries is requisitioned from the local Community Pharmacy or direct from the Regional Distribution Centre of from a local wholesaler following local procedures.

8.4.2 Doctors on- call bags

Stocks to initiate urgent treatment during an emergency situation may be stored in the doctor’s on-call bag. The GP practice will control these stocks in line with local PCT formulary guidance and be responsible for date checking them. Stock required at the individual surgeries is requisitioned from either the local Community Pharmacy or direct from the Regional Distribution Centre or from a wholesaler following local procedures.

8.5 Vaccines

GP practice stocks are ordered direct from the manufacturers, who ensure the cold chain during delivery. Please note vaccines require special attention relating to transportation and receipt please refer to sections 9.2.4, 9.3.2, 10.5

8.6 Shock boxes In locations where vaccines and/or injections are administered a shock box must available.

Independent contractors have a responsibility to check that any member of staff administering vaccines and/or injections have undertaken anaphylaxis and CPR training with respective updates every 3 years and annually

A designated person must be responsible for ensuring that the shock boxes are kept in date and are replaced when necessary. This would usually be the HCP responsible for the administration of vaccines and/or injections.

The shock box seal must not be broken unless the box contents are to be used. If the seal is accidentally broken, the shock box must be replaced

8.9 Oxygen The process for ordering oxygen changed in February 2006, a Home Oxygen Order Form

(HOOF) now needs to be completed (as well as a home oxygen consent form (HOCF) if it is the patient’s first supply) and then faxed through to Air Products Fax Number 0800 214 709 Tel Number 0800 373 580


Under the new contract, patients receiving oxygen should be assessed by specialist services. HOOF and HOCF forms are downloadable from: http://www.pcc.nhs.uk/217 Forms are also available for order from your local NHS supplier, Standard Court If you have any queries please contact a member of the Pharmacy and Medicines

Management Team or Lindsay Price, Senior Public Health Manager.

9. TRANSPORTATION and RECEIPT OF MEDICINES

9.1 Transportation of medicines by PCT staff

9.1.1 All cars used for PCT business should be insured for business purposes. This is the

responsibility of the staff member.

9.1.2 All medicines should usually be carried by PCT or other Trust Transport/ Transfer

arrangements. However, in some exceptional circumstances in community care this may

not be possible, for example, if a staff member does not drive then they may carry medicines

on foot, after discussion with their manager, following an assessment of risks to the staff

member and the public.

9.2 Transportation of medicines (including PCT staff)

9.2.1 No person should transport medicines on public transport other than in exceptional

circumstances, after discussion between staff and managers, e.g. vaccines may be carried

on public transport if the staff member does not have access to other means of transport,

following an assessment of risks to the staff member and the public.

9.2.2 A HCP should not agree to collect drugs, including controlled drugs, for the patient, to

transport in or out of their home, unless it is an exceptional circumstance. In these

circumstances, the HCP is authorized to have the drug in their possession for conveyance

only. They must carry the drug in a suitable secure container in a locked car boot and deliver it

directly to the patient’s home. A risk assessment should be carried out and documented in the

patients notes.

9.2.3 All medicines must be transported in a sealed container. Medicines obtained from SFHT or

Community Services Pharmacy will be supplied in a sealed envo-pak.

9.2.4 Vaccines and other medicines requiring refrigeration must be transported in validated cool

boxes insulated by medicools.

9.2.5 All medicines should be secured in a lockable container (e.g. car boot) out of sight. No

medicines, including those in shock boxes, must be left in an unattended car for long periods

of time (or overnight) for both security and drug stability reasons. The latter due to variations

of temperature experienced in cars.

9.2.6 Unused medicines are the responsibility of the patient or their family or carer. Any unused

medicines should be returned to a pharmacy by the patient , patients family or carer.

However, the Healthcare professional at his/her discretion can do this if the patient is unable


to do it themselves must document this in the patients notes.

9.3 Transportation and receipt of medicines

9.3.1 Providers and independent contractors must have procedures in place specifying which

members of staff can receive delivery of medicines and vaccine stock, checking of

medicines against the delivery note and action to take where discrepancies are identified.

9.3.2 Medication must be placed into a locked medicines cupboard immediately following

receipt. Vaccines and any other medication requiring refrigeration must be placed into a

locked refrigerator immediately. Upon receipt of medicines it is important to confirm if any

vaccines/ medication requiring refrigeration have been delivered and ensure these are

store appropriately. At the earliest opportunity the designated person should check the

items against the delivery note, which should be signed and dated.

9.2.6 Gases must be delivered in a van equipped to transport cylinders and be accompanied by a dispatch and receipt of goods form if supplied from community services pharmacy.

10. CUSTODY (STORAGE) OF MEDICINES

10.1 Responsibility

The Chief Pharmacist has overall responsibility for the safe management of medicines within the PCT. The Head of Pharmacy, for Nottinghamshire Community Health has responsibility for establishing and maintaining a system for the security of medicines in consultation with appropriate medical, nursing or other senior professional staff.

10.2 Designated person A designated person should control access to the medicines on any premises of independent

contractors who store medicines. That designated person should have responsibility for ensuring that the system is followed and that the security of medicines is maintained. The designated person may decide to delegate some of the duties but the responsibility always remains with that designated person.

10.3 Inspection

The commissioners may inspect premises where medicines are stored according to the

service as deemed appropriate. Premises will be monitored against a standard assessment

tool, which includes the safe supply, storage and disposal of medication. Results will be

reported the Chief Pharmacist.

10.4 Storage in lockable cupboards

10.4.1 All pharmaceutical products must be stored in accordance with guidance given in the Duthie

report and subsequent revisions. This requires cupboards located in a cool and suitably sited

area within the premises. They must be kept locked when not in use and a designated person

maintain responsibility for the keys. Inflammable and hazardous substances must be stored in

an appropriate cupboard.

10.4.2 Medicine cupboards should comply with the current British Standard(s) (The current British

Standard is BS 2881 (1989)- NHS Estates Building Note No 29)


10.4.3 A designated person in each surgery is responsible for checking the medicines on receipt

and storing them immediately. Priority should be given to those requiring special storage

conditions, such as ‘fridge lines, controlled drugs, flammable items, etc.(see also 9.3.2)

10.4.4 A designated person in each surgery must ensure that a process is in place to check the expiry and correct storage of all medicines kept on site

10.4.5 All pharmaceuticals (including those stored in doctors on call bags) must be stored in a

locked storage area or refrigerator 10.5 Storage of refrigerator items 10.5.1 Medicines requiring storage in a refrigerator will be marked ‘Store in a Refrigerator’.

Refrigeration must be between 2-8oC.

10.5.2 Guidance from the National Patient Safety Agency (NPSA) alert NPSA/2010/RRR008 “Vaccine Cold Storage” requires that:- All providers (including independent contractors) holding vaccine stocks are aware of relevant policy on safe storage. NHS Nottinghamshire County have provided local guidance which can be accessed at My PCT/Public Health/Medicines Management/Policies Procedures and Guidelines/Safe Storage and Administration The following must be adhered to

Vaccine fridges only must be used for storing vaccinations

One thermometer only should be used for each fridge

The current, the minimum and maximum temperatures must be recorded on every working day

Temperature readings must also include time of reset, signature of individual taking the reading, comment box to include what actions are taken if reading recorded out with the range 2-8oC

Individuals taking the readings must be competent to read and reset the thermometer

A designated person and deputy/ies should be responsible for the receipt and storage of vaccines

Individuals must be clear when and how to take action when readings are out with the 2-8oC range

10.5.3 Drugs, vaccines and pathological specimens must never be stored in the food refrigerator in

health premises. Nor should pathological specimens be stored in any refrigerator used to store medicines (including vaccines)

10.5.3 In the event of refrigerator temperature failure or power failure, the contents of the

refrigerator will be placed in an appropriate sealed container and transferred immediately to the nearest designated drugs refrigerator. The stock should be quarantined until further advice and assurance is received. In this case staff should contact the supplying department and or each manufacturer for advice giving details of temperatures and time exposure and report in line with the PCTs incident reporting policy and procedure.

10.5.4 The individual responsible for vaccine stock must maintain close stock control and stock

rotation. For the majority of vaccines GP practices should limit stocks to no mi=ore that two to four weeks stock at any time.

10.6 Storage in original containers All medicines must be stored in their original containers. Any special storage conditions will be

identified on the packaging and the person responsible for putting medicines into storage will:-

Store medicines in accordance with any special requirements


Ensure stock is rotated such that those items with the shortest expiry date are used first

10.7 Storage in the community

It must be remembered that, in the community, medicines are the property of the patient

concerned and should be kept in the patient’s home setting. Where the healthcare

professional is concerned about the possible misuse of medication by the patient or other

person, the healthcare professional should take reasonable steps to control the patient’s

access to the medicine in the home, but only if this is considered to be in the patient’s best

interest. The healthcare professional should discuss the matter with their line manager, the

GP responsible for the patient’s care and the patient and/or their carer. A risk assessment

should be completed and an incident form.

10.8 Storage of medicines for clinical emergencies 10.8.1 Emergency medication e.g. for cardiac arrest or anaphylaxis shall be kept available in

strategic and accessible sites. A process must be in place to ensure the integrity of this medication.

10.8.2 The HCP is responsible for the administration of vaccines and/or injections and is also

responsible for ensuring that the shock boxes are kept in date and are replaced when

necessary.

10.8.3 The emergency box seal must not be broken unless the box contents are to be used. If the seal is accidentally broken, the box must be replaced.

10.9 Continued safe storage

When a medicine or chemical has been removed from its storage facility for use it must remain under the direct supervision of the person who has been delegated to use the agent concerned, and it is the responsibility of that person to ensure continued safe custody.

10.10 Storage of prescription pads.

Prescription pads are controlled stationery and their security is the responsibility of the

individual prescriber. Prescription pads must be kept in a secure locked drawer or cupboard

within a locked room when stored on PCT premises.

Immediately upon receipt of any prescription pads, a designated person should record the following:-

Exactly what has been received e.g. 2 pads for Dr A or for Nurse X The serial numbers of the prescriptions Where the pads are stored

For further information and guidance please refer to the controlled stationary procedure and the lost, stolen and fraudulent procedure available on the PCT intranet Issue to prescribers When a prescriber needs a new prescription pad, the first and last serial numbers of the pad should be recorded, along with details of the prescriber it was issued to. Prescription pads in use


At the end of each session the prescriber should record the current date and the serial number of the next prescription in the pad, in a diary or record book, then lock the pad away in a desk (or ideally the store cupboard). At the beginning of the next session, the serial number of the next prescription should be matched up to ensure none have gone missing. This is not practical for blank FP10(SS) prescriptions used in printers, however it is advisable to limit the number of printers that contain prescriptions and only put a small number of prescriptions in the printer tray at a time. Printers should not be left unattended where the public may have access, and if possible prescriptions should be removed from all printer trays when not in use. Existing prescribers When a prescriber leaves the GP practice, no further prescription pads should be ordered for them, and any existing prescription pads should be recovered and securely destroyed e.g. by shredding and placing in confidential waste. The person destroying the forms should record the details in the stock control records and ideally this destruction should be witnessed. Clinical systems should also be updated so previous prescriber’s details are no longer printed onto any blank FP10s. Non-medical prescribers should refer to their current Non-medical Prescribing Policy for further information in this area If prescriptions are stolen please refer to section 7.4

10.11 Custody of keys.

The designated person in charge of a service area for a span of duty must ensure the safe

custody of all medicines cupboard keys, know their whereabouts at all times, and always

ensure they are handed personally from one member of staff to another. The person who has

the keys in their custody is responsible for ensuring their safe-keeping. Keys must be

returned to a locked cupboard when not in use. Spare keys must also be kept securely in a

central location, which is known by the designated person. Medicine cupboard keys should not

be labeled as such to increase security.

10.12 Storage of medicinal gas cylinders

The designated person and a deputy in each clinic must be responsible for ensuring the

safe handling of gas cylinders. Line managers are also responsible for documenting any

related training a staff member has undertaken in their personal development plan.

10.13 Storage of controlled drugs

Controlled drugs must be stored in a locked receptacle which can only be opened by a

designated person or a person authorised by them. The keys should be kept by that

designated person or they should know where they are kept at all times. The designated

person remains ultimately accountable for the management of the controlled drugs. Each

area that stores controlled drugs MUST have a standard operating procedure to cover

their storage arrangements, particularly, who has access to the controlled drugs, where

they are stored and who is to be alerted if complications arise. Safe storage requirements

apply regardless of how long the controlled drugs are to be stored.

Staff should refer to the PCT Management of Controlled Drugs in GP practices for further

information


11. ADMINISTRATION OF MEDICINES

11.1 Staff involved in administration

11.1.1 The Medicines Act (1968) states that any person may legally administer a prescription-only

medicine provided that this is done in accordance with the written directions of a qualified prescriber

(independent or supplementary). This task is, therefore, not legally restricted to medical and

nursing staff. Examples of staff therefore include:-

A registered medical practitioner

A registered nurse but only with the valid, legal prescription signed by a prescriber, except in an emergency

A student nurse as part of their training, but only under direct supervision of a registered nurse who must accept full responsibility for the correct administration and recording of the medicines prescribed.

A health care assistant working within an individualized planned package of care, but only after undergoing approved training and assessment. Where health care assistants are involved in drug administration, there must be an individualized care plan naming both the patient and the health care assistant. Health care assistants are NOT authorized to administer controlled drugs.

11.1.2 Individual independent contractors will need to decide through local policies which bands

of staff may administer medication, and their training requirements. There may, therefore,

be some variation as to which staff undertakes this duty.

11.1.3 All medical and dental practitioners and registered nurses can perform full administration of

medicines. Other staff may only administer medicines after receiving appropriate training and

assessment at local level in relation to the task to be performed.

11.1.4 Provided the individual is competent to administer medicines safely, a second person is not

routinely required for the procedure. A staff member should however countersign the signature

of any student who is being supervised in the administration of medicines.

11.1.5 If, in exceptional circumstances e.g. for CDs, it is felt necessary for the preparation and administration of medicines to be carried out in the presence of a witness then this can be undertaken. The responsibility for the correct administration and recording of the prescribed medicines however still remains with the healthcare professional carrying out the procedure.

11.1.6 The administration of medicine by injection may only be carried out by:

A medical or dental practitioner

A registered nurse;

Support staff who have been trained to administer a specified medicine to a specified client;

Other healthcare professionals who have been authorised to administer specific named medicines

Note: Vaccines may only be administered by registered healthcare professionals who have undergone accredited training.

11.1.7 Podiatrists and midwives may administer medicines to clients in the course of their duty,

in accordance with the requirements of the Medicines Act, associated regulations, and

local protocols.


11.2 Training and competency

11.2.1 Independent contractors must ensure that staff carrying out the administration of medicines

have received appropriate training which is documented as part of their personal

development plan.

11.2.2 The member of staff carrying out the administration of medicines must have been

deemed competent by their line manager to carry this out and be documented in their

personal record.

11.3 Administration details

11.3.1 Registered nurses may administer medicines alone without a second check, in

accordance with the policy and procedure of their employing organisation and NMC

guidance.

11.3.2 Members of staff administering medicines must always check the following items prior

to administration:

Correct and legible completion of all details on the administration record, prescription chart, prescription or PGD. If there is doubt or the prescription is ambiguous the prescriber must be contacted for clarification i.e. Use of terms such as “As directed” is not acceptable – staff must ensure that specific dosage instructions are stated

The identity of the client against the name and date of birth on the administration record , prescription chart, prescription or PGD

The name, form and strength of the medicine to be administered

The calculation of the correct dose to be administered

The date and time of dosage

The time of last dosage, i.e. that the dose has not already been given

The route of administration

Any special guidance relating to the dose offered, e.g. dilution with water, before or after food etc

Expiry date

Any drug sensitivities

The prescription is signed by the prescriber

11.3.3 It remains the responsibility of the person administering patient/clients’ own medicines to

ensure that the correct dose is administered to the patient/client and that this policy is

followed.

11.3.4 Where a liquid medicine is prescribed and the dose is not a multiple of 5ml, an oral syringe must be used to prepare and/or administer the dose. Syringes compatible with IV cannulae or other parenteral devices MUST NOT be used for oral administration. If patients or carers are required to administer their own oral liquid medicines, they should also only be given an oral syringe.

Guidance from the National Patient Safety Agency (NPSA) Safer practice 19 “Promoting safer

measurement and administration of liquid medicines via oral and other enteral routes” states that:-

o Healthcare staff should be informed that using intravenous syringes with male luer

slip or male luer lock tips for measuring and administering oral liquid medicines, INCREASES THE RISK of wrong route errors.


o All oral/enteral syringes containing oral liquid medicines must be labeled with the

name and strength of the medicine, the patients name and the date and time it was prepared, by the person who has prepared the syringe, unless preparation and administration is one uninterrupted process and the unlabelled syringe does not leave the hands of the person who has prepared it. Only one unlabelled syringe should be handled at a time.

11.3.5 If a label on a drug container is altered, damaged or obliterated in any way the

container must be returned to the local community pharmacy or pharmacy service

provider.

11.3.6 Every effort will be taken whenever possible towards encouraging clients to

participate in self-administration.

11.3.7 In areas where it is appropriate to undertake the administration of homely remedies a

definitive list must be drawn up in agreement with the doctors and the pharmacist.

Administration of these remedies must be limited to the period of time agreed and be within

a specific dose schedule.

Staff may refer any queries in this area to a member of the Pharmacy and Medicines Management team, who can access a copy of the current Homely Remedies guidance.

11.4 Verbal and faxed messages In an emergency it may be necessary to receive an instruction by telephone to administer

medication to a patient.

The healthcare professional must verify the message by repeating it to the prescriber

The healthcare professional must then immediately write up the telephone instructions on the patient’s drug prescription and drug administration record, indicating that it was a verbal message given by …. With the date and time received, before giving the medicine

The prescriber must counter sign the message within 72 hours. This also applies during out of hours where it is the responsibility of the nurse taking the verbal order to get this countersigned

The healthcare professional MUST NOT administer Controlled Drugs on a verbal instruction from a medical Healthcare professional, instructions should be in writing.

12 ADMINISTRATION OF CONTROLLED DRUGS

12.1 The administration of Controlled Drugs must follow legal requirements. The NMC has

published “Standards for Medicines Management 2008“which includes guidance on

controlled drugs and is available at www.nmc-uk.org

Staff should refer to the PCT Management of Controlled Drugs in GP practices for further information (available on the PCT intranet)

12.2 Nurses may administer controlled drugs to a patient in their care as long as they

are acting in accordance with the directions of a doctor or dentist. Nurse

independent prescribers or nurses acting under the direction of a nurse

independent prescriber can administer controlled drugs for a specified range of

medical conditions. (See “A guide to good practice in the management of

http://www.nmc-uk.org/


controlled drugs in primary care” (England) Dec 2009 3rd edition) at

www.npci.org.uk

12.3 Patients home 12.3.1 Controlled drugs which are kept in the patient’s home are the patient’s property and the

patient or carer should be given instructions with regard to their safe keeping and disposal. This should also be documented in the patient’s notes.

12.3.2 It is recommended that a stock record balance is initiated at commencement of treatment.

The stock balance is checked and recorded at each administration in the nursing documentation and should include batch numbers and expiry dates as well as a record of any drug wastage.

12.4 Educational establishments 12.4.1 Wherever possible, dosing regimens should be designed to allow medicines to be taken

outside school hours. For some patients, there may be valid clinical reasons for medicines being taken during school hours so arrangements need to be in place to allow this to happen.

12.4.2 The Department for education and skills has produced guidance entitled “Managing

Medicines in schools and early years setting” (March 2005) this guidance includes a specific section on controlled drugs with the following points:-

Any member of staff may administer a controlled drug to the child for whom it has been prescribed. Staff administering medicines should do so in accordance with the prescriber’s instructions.

It is permissible for schools to look after a controlled drug, where it is agreed that it will be administered to the child for whom it has been prescribed

Schools should keep controlled drugs in a locked non-portable container and only named staff should have access. A record should be kept for audit and safety purposes. The PCT requires that the record should be signed by the person administering the drug to the child/young person plus a witness.

A controlled drug, as with all medicines, should be returned to the parent when no longer required, to arrange for safe disposal. If this is not possible, it should be returned to the dispensing pharmacy.

The full guidance can be found at http://publications.teachernet.gov.uk Controlled drugs are also prescribed for young people in boarding schools, residential special schools and secure children’s units. As well as the guidance above, these educational establishments have additional guidance in the National Minimum Standards, published by the DH.

13. ADMINISTRATION OF INTRAVENOUS DRUGS Staff should refer to their current IV policy 14 ADMINISTRATION OF MEDICATION VIA A SYRINGE DRIVER

The National Patient Safety Agency (NPSA) issued an alert (NPSA/2010/RRR019) in December 2010 highlighting that there have been a number of errors reported involving some older types of ambulatory syringe drivers that have rate settings in millimetres (mm) of syringe plunger travel. Errors included the wrong rate of infusion caused by inaccurate measurement of fluid length or miscalculation or incorrect rate setting of the device.

http://www.npci.org.uk/

http://publications.teachernet.gov.uk/


The NPSA recommend the following safety features should be considered before ambulatory syringe drivers are purchased: a) rate settings in millilitres (ml) per hour; b) mechanisms to stop infusion if the syringe is not properly and securely fitted; c) alarms that activate if the syringe is removed before the infusion is stopped; d) lock-box covers and/or lock out controlled by password; e) provision of internal log memory to record all pump events.

Staff should be aware of the type of ambulatory syringe driver currently in use in their locality and refer to their current policy Nottinghamshire Community Health has a Clinical Practice Guidance for the use of Graseby / SIMS / Smiths MS16A Syringe Drivers in Palliative Care available on the intranet which staff may refer to.

15. ADMINISTRATION OF MEDICATION VIA A PERCUTANEOUS ENDOSCOPIC

GASTROSTOMY (PEG) TUBE

Staff should refer to the current policy

16. ADMINISTRATION IN EMERGENCIES

It is within the person’s professional accountability to decide upon administration in a life-

threatening situation. It is the responsibility of the healthcare professionals line manager to

ensure through the staff review process that individual members of staff have completed

anaphylaxis (3 yearly) and CPR (annually) training.

17. OXYGEN ADMINISTRATION

17.1 Patients should be correctly assessed for the use of oxygen. A risk assessment must be

included in relation to safety and recorded in the patient’s notes.

17.2 Medical grade oxygen is regarded as a drug and may only be ordered by a doctor or

appropriately qualified Healthcare professional. The HOOF should include the type of

appliance to be used, the appropriate percentage of oxygen, the flow rate and the duration of

administration.

17.3 Patients and carers must be educated in the safe use of oxygen in relation to smoking and

hygiene of tubing and mask.

17.4 Safety guidelines must be adhered to and appropriate warning notices displayed on

vehicles in which oxygen cylinders are transported.

17.5 Concentration of oxygen and duration of administration should be the minimum required for efficacy and patients and carers should be educated in its safe usage.

17.6 A requirement of the Healthcare Commission and Health Technical Memorandum 2022 is that

all personnel involved with the use, storage or transportation of medical gases receive auditable Medical Gases safety training

18 MEDICATION SAFETY Through analysis or reports of patient safety incidents, and safety information from other sources, the National Reporting and Learning Service (NRLS) a division of the Patient Safety Agency (NPSA) develops advice for the NHS that can help to ensure the safety of patients. Advice is issued to the NHS as and when issues arise via the Central Alerting System (CAS)


All PCT employed staff and independent contactors must ensure relevant alerts are cascaded and acted upon as appropriate. The alerts cover a wide range of topics from vaccines to patient identification for further information concerning storage of vaccines and the safe use of oral syringes please refer to sections 10.5.2 and 11.4.4 respectively. Alerts have been issued by the NPSA concerning the medicines described below, this list is not exhaustive please refer to the NPSA website www.nrls.npsa.nhs.uk for further information. 18.1 Fire Hazard with Paraffin Based Skin Products on Dressings and Clothing – NPSA rapid response report 4 The NPSA have identified that bandages, dressings and clothing in contact with paraffin based products, for example White Soft Paraffin, White Soft Paraffin plus 50% Liquid Paraffin or Emulsifying ointment are easily ignited with a naked flame or cigarette.

The NPSA require the following actions to be applied to all patients in all settings being dispensed, or treated with, large quantities (100g or more) of paraffin based products:

1. Information should be given about the potential fire risks of smoking (or being near to people who are smoking), or exposure to any open flame or other potential cause of ignition during treatment; and about regularly changing clothing or bedding impregnated with paraffin based products (preferably on a daily basis) as the paraffin soaks into the fabrics and can potentially be a fire hazard.

2. This information should be given on the first occasion that such treatment is prescribed, dispensed or administered by a healthcare professional and a record kept confirming that such advice has been given. A check should be made on subsequent occasions that the advice has been received previously and understood.

3. Fire safety information should be displayed prominently in every clinical area where patients may be treated with large quantities of paraffin based products.

4. If, against advice, a hospitalised patient intends to leave the ward to smoke, they should be informed of the risk and advised to wear a thick outer covering that has not been contaminated with paraffin based products.

5. Relatives or carers should be informed if a patient does not comply. 18.2 Anticoagulant Therapy – NPSA/2007/18 The NPSA issued an alert in 2007 identifying the steps healthcare organisations and independent contractors must take to manage the risks associated with the prescribing, dispensing and administration of anticoagulants.

1. All staff who are involved must be properly trained and competent be undertake these tasks 2. Up to date written procedures and clinical protocol which reflect safe practice must be in

place. 3. Organisations and independent contactors involved with the prescribing, dispensing and

administering of anticoagulants must undertake regular audit of anticoagulant services using BSH/NPSA safety indicators.

4. All patients who are prescribed anticoagulants must receive appropriate information. 5. Prescribers and pharmacist should check patients’ blood clotting (International Normalised

Ratio INR) is monitored regularly and the INR level is safe before issuing or dispensing repeat prescriptions for oral anticoagulants

6. Where a patient already on an oral anticoagulant is co-prescribed one or more clinically significant interacting medicines the prescriber should arrange for additional INR blood tests and inform the anticoagulant service that an interacting medicine has been prescribed.

7. Dental practitioners must ensure that patients on anticoagulants are managed according to evidence-based therapeutic guidelines.

http://www.nrls.npsa.nhs.uk/


8. Prescribing of anticoagulant preparations must be in line with agreed formulary decisions of Nottingham University Hospitals (NUH) and Sherwood Forest Hospital Trusts (SFHT). Prescribing of non formulary anticoagulants (preparations and non formulary strengths) should only be restricted to situations where its use has been risk assessed.

9. Healthcare professionals should liaise with colleagues operating in social care settings to promote safe practices in these settings.

18.3 Preventing dosing errors with opioid medicines – NPSA/2008/RRR005 This Rapid Response Report alerts all healthcare professionals prescribing, dispensing or administering opioid medicines to the risks of patients receiving unsafe doses. Healthcare professionals who prescribe, dispense or administer opioid medicines have a responsibility to check that the intended dose is safe for the individual patient. Knowledge of previous opioid dose is essential for the safe use of these products. There is a wide variety of opioid medicines, and supply shortages may result in products being used which are unfamiliar to practitioners. The NPSA alert requires that: When prescribing, dispensing or administering these medicines the healthcare practitioner or their clinical supervisor should:

1. Confirm any recent opioid dose, formulation, frequency of administration and any other analgesic medicines prescribed for the patient.

2. Ensure where a dose increase is intended, that the calculated dose is safe for the patient. 3. Check the usual starting dose, frequency of administration, standard dosing increments,

symptoms of overdose, and common side effects of that medicine and formulation. 18.4 Reducing the risk of overdose with midazolam injection in adults - NPSA/2008/RRR011 The presentation of high-strength midazolam as 5mg/ml (2ml and 10ml ampoules) or 2mg/ml (5ml ampoule) exceeds the dose required for most patients. The NPSA has identified that there is a risk of administering the entire contents of high-strength ampoules, when only a fraction of this dose is required.

The reversing agent, flumazenil, is frequently used to treat inadvertent benzodiazepine overdose. Occasionally, no account is taken for the shorter half life of flumazenil (compared to midazolam), leading to residual re-sedation.

The NPSA alert requires that: Healthcare organisations and independent contractors should:

1. Restrict the storage and use of high strength midazolam to clinical areas/situations where its use has been risk-assessed.

2. Replace the storage and use of high-strength midazolam with low-strength midazolam in other clinical areas.

3. Clarify guidance on the use of midazolam. Ensure that the risks are fully assessed. 4. Ensure that staff involved in sedation techniques have the necessary skills. 5. Ensure that flumazenil is available where midazolam is used. Audit the use of flumazenil as

a marker of excessive dosing of midazolam. 6. Ensure that sedation is covered by organisational policy. Assign overall responsibility to a

senior clinician 18.5 Lithium - NPSA/2009/PSA005 Patients taking Lithium should have regular blood tests and their dosage adjusted as necessary. Clinically significant alterations in lithium blood levels occur with commonly prescribed and over the


counter medicines. The blood level of lithium is dependent on kidney function and lithium has the potential to interfere with kidney and thyroid functions. Where lithium therapy is initiated, prescribed, dispensed and monitored the following must occur

1. Patients prescribed lithium are monitored in accordance with NICE guidance. 2. Systems are in place to ensure blood test result are communicated between laboratories

and prescribers 3. Patients must receive appropriate and ongoing verbal and written information at the start of

lithium and throughout their treatment and the NPSA record book to track lithium blood levels and relevant clinical tests

4. When a prescription is issued or dispensed the prescriber or pharmacist respectively must check that blood tests are monitored regularly and that it is safe to issue a repeat prescription and/or dispense the prescribed lithium.

5. Implementation of a system to identify and deal with medicines that might adversely interact with lithium

18,6 Low molecular weight heparins (LMWHs) – reducing treatment dose errors -

NPSA/2010/RRR014 The prescribed dose of LMWHs for the treatment of thromboembolic events is dependent on the weight of the patient and renal function. Under dosing has an increased risk of a further thromoembolic event while overdosing can increase the risk of bleeding. The following actions must be followed as appropriate.

1. Calculation of the required treatment dose of LMWH must be based on the patient’s weight in kilogram (kg). Patients should be weighed at the start of therapy and, where applicable during therapy.

2. Renal function must be considered when prescribed treatment doses of LMWHs. The renal function test should not delay initiation of the first dose but every effort must be made to base subsequent dosing on these results.

3. Dose calculation tools are available for a range of body weights, specific clinical indication and LMWH products. Choice of LMWH product should be in line with Nottingham University Hospitals and Sherwood Forest Hospitals Trust’s formulary

4. When care of a patient is transferred (e.g from secondary care to primacy care by discharge letters) essential information such as dose, weight, renal function, indication and duration of treatment must be communicated to ensure that future doses are safe. Where this information is not available steps should be taken to obtain it prior to prescribing a LMWH.

5. Healthcare professional who review, dispense or administer LMWH should undertake dosing checks when this information is readily available to them.

6. System improvements should be demonstrated through the collection and review of data, such as incident reports, clinical pharmacy interventions, audit or other relevant outcome measures.

18.7 Administration of insulin – NPSA/2010/RRR013 Incorrect administration of insulin can have severe consequences and there have been instances where an error in administration has resulted in a fatality. Two common errors have been identified

The inappropriate use of non-insulin (IV) syringes, which are marked in ml and not in insulin units.

The use of abbreviations such as ‘U’ or ‘IU’ for units there have been incidences where this has resulted in the dose being misread, e.g. 10U is read as 100

To reduce the risk of error all medical/nursing/pharmacy staff must ensure that:

1. An insulin syringe or commercial insulin pen device is used to measure and administer all regular and single (bolus) doses. Intravenous syringes must never be used for insulin administration

2. Whenever insulin is prescribed, dispensed, recorded on drug charts (medicine administration


records) the term ‘units’ is used in all contexts. Abbreviations, such as ‘U’ or ‘IU’ must never be used

3. All clinical areas and staff treating patients with insulin must have adequate supplies of insulin syringes and subcutaneous needles available at all times

4. An insulin syringe must always be used to measure and prepare insulin for an intravenous infusion. Insulin infusions are administered in 50ml intravenous syringes or larger infusion bags. Consideration should be given to the supply and use of ready to administer infusion products e.g. prefilled syringes of fast acting insulin 50 units in 50ml sodium chloride 0.9%

5. All healthcare staff that may prescribe, prepare, dispense or administer insulin should satisfy themselves they are competent to do so.

6. Healthcare organisations and independent contractors must have in place a policy and procedure which complies with the NPSA safer administration of insulin alert (NPSA/2009/PSA005) for the preparation and administration of insulin and insulin infusions in clinical areas.

19 MEDICINES MANAGEMENT

19.1 Medicines management has been identified as a high priority within the National Service

Framework for Older People (DOH 2001). There is high drug use in this age group and

adverse drug events and inappropriate drug usage are a major cause of hospital

admissions and ill health in older people.

19.2 It is therefore recommended that older people should have a regular medication review by

their GP. In particular the following patients are at greater risk of medicines-related problems:

Patients who are taking 4 or more medicines

Post discharge from hospital

In care homes

Where medicine-related problems have been identified

Patients aged over 75

Following an adverse change in health

19.3 As part of the ongoing assessment of their patients, Healthcare professionals should ensure

that this review takes place by communicating this to the patients GP and recording this in the

patient’s notes. Ultimately, however, it is the responsibility of the patient’s GP to ensure that

this review is conducted.

19.4 Patient concordance

19.4.1 Patient concordance is an essential part of ensuring a successful outcome for the

patient. The Healthcare professional is well placed to help patients comply because of

his/her continuing contact with the patient over a long period of time.

19.4.2 Before embarking on a course of action to improve patient concordance it should be

considered whether drug therapy is the most appropriate form of treatment and whether

improved compliance will assist in achieving therapeutic objectives.

19.4.3 Effective ways of improving concordance rates involve the use of educative, practical and

emotionally and behaviorally supportive interventions, rather than the provision of information

alone. There is evidence to support the use of self management programmes raising the

patient’s sense of self-efficacy and confidence in improved concordance with drug therapy.

19.4.4 Healthcare professionals must respect the autonomy of the individual and his/her right to


make informed choices concerning his/her treatment.

19.5 Principles for use of compliance aids

Some patients may benefit from having their medicines dispensed in a compliance aid which

helps them to remember when to take (and whether they have already taken) their prescribed

medication. A range of compliance aids are available for patients e.g. reminder charts and

Dosette boxes. Each patient should be referred to their community pharmacist who will

undertake a review of the patient’s suitability to receive a compliance aid and also which

device suits their circumstances best.

Responsibility for filling compliance aids

Compliance aids including monitored dose systems should only be filled by the patient’s

community pharmacist to ensure the correct dispensing procedure has been completed.

Simple compliance aids may however be filled by patients/clients or informal carers where this

will enable the patient/client to manage their medication independently. Where a patient

/client requires further assistance from a healthcare professional or formal/paid carer to

manage their medication this assistance must only be given for medication that is in the

original container supplied by the pharmacy.

Monitoring

The healthcare professional should regularly review how the client is coping with their

compliance and should refer to the community pharmacist, if necessary. 19.6 Self administration of medication

Prescribed medicines are the property of the patient and should remain in the patient’s home. Where possible the HCP has a responsibility to ensure that the patient understands their medication regimen and to offer advice on the storage of medicines in the home particularly if children are present. The HCP has a responsibility to recognize the side effects of medicines and should try to ensure compliance with the prescribed regimen. Staff should refer to their current policy on the self administration of medication for their particular service area if applicable.

19.7 Disguising medication

Nursing staff should refer to the NMC (2007) advice in this area. 19.8 Wound management Careful and accurate assessment of a wound is required to ensure successful management of the wound. Use of a standardised wound assessment tool is good practice to ensure valid, reliable and consistent information is documented. The prescribing, supply, application of woundcare dressings should be in line with either the South or North woundcare formulary for the South and North cluster respectively. These formularies are available on the Nottinghamshire APC website www.nottsapc.nhs.uk under formularies. Where individuals consider there is an evidence based clinical rationale to deviate from the formulary further advice should be sought from a tissue viability nurse. Wounds should be regularly reassessed to evaluate the treatment given consequently

http://www.nottsapc.nhs.uk/


prescriptions/supply for woundcare dressings should be limited to 14 days supply only.

20. DOCUMENTATION

20.1 Records must meet any statutory requirements and be available for inspection at all

times.

20.2 Documentation relating to the order, supply, administration and disposal of medicines and

any medication errors must be maintained within each service area.

20.3 In the case of clients undertaking assisted/self-administration of medicines, the system of

monitoring and assessment must be recorded in the care plans.

20.4 A record of all FP10(HP) forms (prescriptions issued by doctors within hospital and

similar trusts for clients to take to a community pharmacist) must be maintained.

20.5 Records must be maintained for a specified length of time (see information governance guidelines)

20.6 Recording at the time of administration

20.6.1 Where medication is administered the healthcare professional must sign in the column of

the drug prescription and drug administration record at the time of administration. If a medicine

is refused or omitted for any reason the locally agreed code must be entered on the drug

administration sheet. In both cases an explanation must be recorded in the patient’s notes.

20.6.2 For all controlled drugs, injections and vaccines, both the batch number and the expiry date must be recorded.

20.6.3 Medicines administered in general practice must be recorded in the patient’s records.

20.7 Controlled drugs in general practice

20.7.1 Records must be kept for all stock controlled drugs in general practice; these can be written

or computerized. The full requirements of a controlled drugs register are outlined in the

current legislation. Stock levels must be checked when controlled drugs are entered into

stock or are dispensed or administered. The running balance of stock remaining should be

calculated and recorded after each transaction and balances should be checked with the

physical amount of stock at regular intervals.

20.7.2 The accountability for maintaining the correct balance lies with the professional in charge. The register must then be kept for two years after the last date of entry. A separate register should be kept for controlled drug stock held within a doctor’s bag for home visits.

20.8 Controlled drugs in a community setting

Controlled drugs used in the community setting are classed as patients own medication. Where the health care professional is administering controlled drugs a running stock record balance must be initiated at the commencement of treatment. The stock balance is checked and recorded at each administration in the nursing documentation or directly on the chart and should include batch numbers and expiry dates as well as a record of any drug wastage.


21 INVESTIGATION OF DRUG DISCREPANCY OR LOSS

Any knowledge or suspicion of drug loss or discrepancy identified either in general practice or the community setting must be reported to the line manager and an incident form completed, in line with the PCT incident reporting policy and procedure.

22. DISPOSAL OF MEDICINES

22.1 The PCT Chief Pharmacist has overall responsibility for ensuring the safe and legal disposal

of medicines. This does not take away responsibility from individual Healthcare

professionals or members of staff.

22.2 All medicines no longer required for use must be returned in a secure manner (i.e. via a

sealed container in PCT transport, or via the staff members car, it must be stored out of sight

and not left unattended for long periods of time ) to the supplying pharmacy for destruction,

including vaccines. Medicines no longer required should not be disposed of down sinks or

toilets - waste disposal regulations specify that medicines must never be disposed of through

the domestic sewerage system.

22.3 Unused medicines must not be returned to their original containers, unless the whole container is to be destroyed.

22.4 Opened ampoules or syringes must be destroyed by placing them directly into a

sharps bin. Diabetic patients should be informed of the systems available to them

for the disposal of their sharps containers i.e. specialist designated health centres

or the council referral scheme.

22.5 Where possible, healthcare professionals should encourage their patients to identify

medicines that are no longer required. It must be remembered that medicines purchased by

the patient or obtained on prescription are the patient’s own property and unused medicines

should be returned to a community pharmacy by the patient, their family or carer. If a patient

has stock medication in their home ie not dispensed by a community pharmacy on a

prescription then this must be returned as per 22.2 to community services pharmacy or SFHT

pharmacy.

Patient own medicines should not be taken from a patients home unless the HCP gains consent to do so. In no circumstances should this medicine be supplied or administered to another individual, this includes dressings and appliance aids.

22.6 All medical sharps must be disposed of in sharps boxes. Refer to the PCT Sharps policy

22.7 Destruction of controlled drugs

Wherever possible the patient, relative or carer should accept responsibility for the return of any unused medication to the community pharmacy or dispensing practice. However, where this is not possible, controlled drugs should be signed over to the HCP by the patient/carer.

No HCP should routinely destroy CDs, but may be involved with the removal of medication, for destruction by an authorised individual, such as a community pharmacist. These must be kept in safe storage e.g. locked car boot and taken to the local community pharmacy for destruction at the nearest opportunity. The HCP must obtain the pharmacists signature in their nursing notes to illustrate the formal receipt of the medication.


In the case of a part ampoule or unfinished syringe driver, the contents should be destroyed in the home in the presence of a witness (where possible). The contents are expelled directly to render it irretrievable and disposed of in the sharps container. All actions should be clearly documented in the patient’s notes. Expired general practice stocks of controlled drugs must be destroyed by a person authorised by the secretary of state, e.g. chief pharmacist, prescribing adviser or police constable. Please refer to a member of the Pharmacy and Medicines Management team for further information.

22.8 Custody and destruction of medication in a registered residential care home

All medication remains the property of the patient when they enter a care home.

Under care home regulations, care homes are required to retain patients’ own medication (including controlled drugs) for SEVEN days following the death of a resident. In all cases the medication remains the property of the patient. On the death of the patient, the responsibility passes to the family/home or carer for the patient. Consent must always be sought when any removal and destruction of medication occurs. Following the death of a resident, if the medication is being stored in the care home rather than being returned directly to a community pharmacy it is recommended that the HCP ‘signs over’ the medication to the home. This is not a legal requirement but is good practice and a risk management recommendation. The responsibility for safe storage of the medication until the appropriate destruction at a community pharmacy then passes to the home. The care home should return the medication to the community pharmacy for destruction after the seven day period.

22.9 Destruction of medication in a registered nursing home

Patients’ medication in nursing homes cannot be returned to a community pharmacy for destruction. It must be removed from the nursing home by the PCTs nominated waste contractor. Under care home regulations, this must not take place until SEVEN days following the death of a resident.

23 PRESCRIBING AND ADMINISTRATION ERRORS AND NEAR MISS REPORTING

A near miss is defined as any unplanned events/occurrences that result, or had potential to

result in injury to persons and/or damage to/loss of property/equipment.

23.1 Prescribing errors

The Director of Nursing Governance has overall responsibility, delegated from the PCT Chief Executive, for significant event reporting. The investigation of such occurrences related to prescribing will be carried out in line with the PCT incident reporting procedure and guidance for conducting investigations (complaints, incidents and claims.) Details will be notified to the Chief Pharmacist via the performance review process and further action agreed as required. An incident form must be completed on all occasions and forwarded in line with the PCTs incident reporting procedure.


23.2 Administration errors

As soon as it is realized that there has been an administration error or near miss the following

action must be taken:-

When necessary, remedial action taken to ensure the safety of the patient

The appropriate doctor should be contacted

The incident should immediately be reported to the line manager or in the case of doctors the medical director.

In the case of out of hours, the senior manager on call should be contacted as per on- call policy

An incident form must be completed and forwarded in line with the PCTs Incident reporting procedure. Supporting statements may be required from all staff concerned, these are essential if there is any possibility of serious injury to the patient or of litigation.

24. ADVERSE DRUG REACTIONS

All HCP and members of the public can now freely report adverse drug reactions to the Commission on Human Medicines (CHM) and the Medicines and Healthcare products Regulatory Agency (MHRA) via the yellow card scheme. Reports can be made on prescribed medicines, over the counter medicines and on complimentary medicines including herbal remedies. Online reporting can be accessed through www.mhra.gov.uk or telephone the Yellow card hotline on free phone 0808 100 3352. Paper copies of the Yellow card are also available from community pharmacies, GP surgeries and other NHS outlets as well as at the back of the BNF, NPF and MIMS companion. Healthcare professionals should also complete an incident form as part of the PCTs incident reporting policy and procedure.

25. DRUG ALERTS

Organisations and independent contractors must ensure they are in receipt of drug alerts and

have their procedures in place for cascade of hazard/recall notifications. These procedures

should specify who to contact and must be kept up to date.

Refer to the NHS Nottinghamshire County Central Alerting System Procedure (available on the intranet my pct/quality and governance) and the Central Alerting System website at https://www.cas.dh.gov.uk/Home.aspx.for further information.

26. MEDICINE/APPLIANCE DEFECT REPORTING

NB This section refers to locally identified defects not national defect alerts. All suspected medicine or appliance defects should be reported to a staff member’s line manager and an incident form completed using the incident reporting process. Remedial action should be taken to minimise the immediate risk to patients, staff and the environment. Advice may be sought from the community services pharmacy team/medicines management department on action to be taken if required.

The defective medicine or appliance should be labeled clearly, isolated and retained for safe keeping. If a patient is involved, use of the suspected material must be immediately discontinued and the healthcare professional in charge of the patient notified. If a defective medicine or appliance is discovered out of hours, the professional should

http://www.mhra.gov.uk/

https://www.cas.dh.gov.uk/Home.aspx


complete an incident form and contact the senior nurse, midwife or appropriate professional on duty. Reports will be notified to the Chief Pharmacist via the incident reporting process and further action taken as required. In all cases if there is any doubt about a medicines or appliance then a report must be made. Examples of possible medicines defects include finding a cloudy ampoule, incorrectly labeled medication, medication whose appearance has changed from normal e.g. unusual odour.

27. WORKING WITH THE PHARMACEUTICAL INDUSTRY

Accepting product samples can lead to the increased prescribing of products, which are not in adherence with the PCTs policy on cost effective, quality prescribing and hospitality. Therefore the PCT does not support the utilization of product samples obtained from the pharmaceutical industry or other related organizations. HCPs must not accept samples unless it is done as part of an agreed initiative, details of which should be recorded on the hospitality register. Caution must be used when inviting pharmaceutical representatives to staff meetings. It is accepted that there are circumstances where this may be applicable, for example, funding to facilitate training and educational initiatives, which are aimed at improving the management of a clinical condition or system or other sponsorship of events or initiatives where the overall aim is to facilitate primary healthcare professionals to improve patient care. However it must be remembered that representatives are promoting their companies products and the evidence supporting their use may not be substantiated. The aim of the PCT is to work in partnership with companies whose product promotion is in line with evidence based high quality care and not solely through brand recognition or goodwill activities. The PCT policy for working with the pharmaceutical industry is currently being reviewed; in the interim therefore staff are asked to contact their line manager, or a member of the Pharmacy and Medicines Management team or Community Services Pharmacy Team, if they have a query in this area. Further information available from the

28 TRAINING & SUPPORT

28.1 Staff must not undertake prescribing, supply or the administration of medicines unless they

are legally authorised and they are deemed competent by their line manager, which is

recorded in their personal staff record.

28.2 Independent contractors have a responsibility to ensure that suitable training is carried out

and staff are competent to undertake any of the above tasks

29 ESSENTIAL STANDARDS OF QUALITY AND SAFETY

The commissioning organisation may inspect the storage, safe administration and handling of

medicines as necessary and or request evidence of compliance with the relevant standards of

quality and safety

Independent contractors registered with CQC who undertake activity involving medicines must


demonstrate their compliance with essential standards of quality and safety as specified by

CQC

30 MEDICINES INFORMATION

The following medicines information services are available to

Prescribing Policy queries

The PCT Pharmacy and Medicines Management team are available for advice during normal office hours (9am to 5pm), Telephone 0300 300 1234.

Drug Information queries

Sherwood Forest Hospital Trust and Nottingham University Hospitals Trusts have a medicines information service also and can be contacted as follows:-

Sherwood Forest Hospital Trust – 01623 672213 NUH (QMC campus)- 0115 9249924 ext 65954 NUH (City campus) – 0115 9691169 ext 54935

The following prescribing and medicines management publications: are also published regularly for staff

Nottingham Prescriber

Area Prescribing Committee (APC) bulletins

Prescribing Guidelines

Shared Care Protocols

Traffic Lights Drugs List

and are available electronically from the APC website http://www.nottsapc.nhs.uk

31 REFERENCES

1 NHS Nottinghamshire County Policy for the Supply, Administration, safe Handling and Storage of Medicines, July 2007 2 Nottinghamshire Community Health Policy for the Supply, Administration, safe Handling and Storage of Medicines, July 2007

3 Royal Pharmaceutical Society of Great Britain Medicines, Ethics and Practice July 2010

4 National Patient Safety Agency website

5 Medicines Management A-Z advice sheet-Nursing and Midwifery Council, July 2006

6 Standards for dental professionals- General Dental Council Standards Guidance, May 2005

7 Care Quality Commission website

8 National Prescribing Centre Website

Documents referred to as part of references 1,2,3,4:5-

Nursing & Midwifery Council (2008). Standards for Medicines Management


Nursing & Midwifery Council (2007). Covert Administration of Medicines: Disguising medicine sin food and drink.

National Patient Safety Agency Patient safety resources at http://www.nrls.npsa.nhs.uk/resources/

Society of Chiropodists (updated 1994). Medicines guide

Department of Health. Immunisation Against Infectious Disease (‘the Green Book’ latest edition) and subsequent updates – available from Department of Health website (http://www.dh.gov.uk/)

Medicines Act (1968) and associated regulations

Royal Pharmaceutical Society of Great Britain (2005). The Safe and Secure Handling of Medicines: A Team Approach. A revision of the Duthie Report

Care Quality Commission. Standards for Quality and Safety

Health Services Circular 2000/026 Patient Group Directions

Royal College of Paediatrics and Child Health (2000). The use of unlicensed medicines or licensed medicines for unlicensed applications in paediatric practice (Policy statement)

Department of Health. Chief Medical Officer Updates

NPC A quick guide for commissioners March 2010 Non medical prescribing