Emergency Supplies

[tinx25388]

I just wanted a few opinions on this- we lost a Care home yesterday over this issue, and whilst I respect the views of the Pharmacist I was working with, I was wondering what other views people have.

Care Home patient taking 10mg Nitrazepam at night. Has been on it for as long as we have records for (over a year.) Home contact us, as the patient has run out, and been without it for 2 days already. They ask if we have received the prescription from the surgery, which we havent. They ask if we will supply it in advance of the prescription.

Having worked with this Pharmacist several times before, I know it is rare for her to give an emergency supply, so I tell the home that it is unlikely, but I will ask if we could make an exception.

I spoke to the Pharmacist, who as I expected, refused, as the prescriber may not want her to continue on it so long term, and suggested that they contact on-call care.

I informed the carer at the home of this. A couple of minutes later, I received a call from the Home Manager demanding to speak to my Manager (who was off, but came in for me!) and saying that they were leaving.

Would you have given the emergency supply?

[El-loco]

Nitrazepam is a Schedule 4 controlled drug (CD Benz POM) which may be supplied in an emergency, subject to the conditions set out in the MEP on pages 17 and 18, without a prescription for up to five days use. I suggest you read these conditions if you get the chance as they will clarify "where your pharmacist is coming from". This is different to non-CD drugs which may be supplied for up to 30 days use.

Supply in advance of a prescription would be illegal because it may only be supplied from the date on the prescription until 28 days later.

Personally (although I do not know all the details in this case) I would be very reluctant to make an emergency supply as the drug is addictive, abusable and failure to take it would not be life threatening such as would be the case with insulin for example. There may be a risk of convulsions but you say the patient had already been without it for two days.

It probably all comes down to the four bank holidays we have had over the last week and a half. One thing you can be sure of -the home manager would not dare take this attitude with the surgery.

When you say that the home said they "were leaving" did you mean they were going to take their business elsewhere? If you have lost them anyway it might be worth notifying the CD accountable officer at the PCT of an "incident" involving a controlled drug since it appears that the home is unaware of the regulations surrounding their use and procurement and of the differences between CDs and other drugs. All for the benefit of the home of course.

[johnep]

"When you say that the home said they "were leaving" did you mean they were going to take their business elsewhere? If you have lost them anyway it might be worth notifying the CD accountable officer at the PCT of an "incident" involving a controlled drug since it appears that the home is unaware of the regulations surrounding their use and procurement and of the differences between CDs and other drugs. All for the benefit of the home of course."

Yes they should be reported. Clear case of incitement to commit a criminal act, and blackmail. 'if you don't do this, I will do so and so'.

Too often we are expected to break the law for other people's convenience,
(pedants, advice if apostrophe incorrect)
johnep

[tinx25388]

Thanks- I thought that we were in the right! I can now relax!

The surgery in question has a habit of promising to fax/send prescriptions through, and then not delivering, leaving us to pick up the pieces! Therefore the home need a Pharmacy that can mind-read and break rules. Luckily, there is an Independant Pharmacy not far from us that is rumoured to be "relaxed with the rules" and is therefore very popular with Care Homes. Wouldn't surprise me if they are planning to go there...

[Pharmanaut]

I informed the carer at the home of this. A couple of minutes later, I received a call from the Home Manager demanding to speak to my Manager (who was off, but came in for me!) and saying that they were leaving.

Would you have given the emergency supply?

Decision of RP at the time; I'm not happy with ES of anything scheduled.
Otherwise policy is that I'm not there to let people go without medicines, but want to be assured that I'm continuing existing treatment and not being used as a convenience.
Imagine the media furore if anything went wrong...
If the regular manager wants to do this when they are signed in as RP its up to them.

[tinx25388]

Didnt make it clear - my Manager is not a Pharmacist, and would always support the Pharmacists decision, her role was to take the brunt of his general annoyance rather than actually being able to supply!

[bobbin]

Would you have given the emergency supply?

Possibly, but only for a very small quantity, and only if it had proved impossible to obtain a prescription from an out-of-hours doctor... which is pretty unlikely. After long-term treatment with nitrazepam, withdrawal symptoms can be severe. The patients safety needs to be considered in this case.

[STC]

Of course the other consideration here, apart from the obvious CD Benz argument is the one I regularly quote.

The MEP is very clear on the fact that it should be 'Unreasonable to expect the patient to obtain a prescription'. This is relatively unequivocal in my eyes. If the surgery is open, then I will never make an emergency supply. All too often I have been working in a pharmacy where a patient says, 'Can I order my repeat and loan some tablets please. They loaned me some last month.' Well I am sorry but where the law and my profession are concerned, if the surgery is open you go and get a script. The same applies to nursing/residential homes. Supplying as a so called 'loan' or emergency supply when the surgery is open should just not happen.

Stephen

[Pharmanaut]

Didnt make it clear - my Manager is not a Pharmacist, and would always support the Pharmacists decision, her role was to take the brunt of his general annoyance rather than actually being able to supply!

I don't live in utopia - there are always circumstances and the patient is the one who we must have the best interests.
There would have to be a reasoned argument and a balanced decision.
If the non-pharmacist manager does not support the pharmacist then its a vote of 'no confidence'.
The RP is the one carrying all the legal responsibility.

It springs to mind that one of the care staff, perhaps even the manager of the home could have been diverting medication and using their position and influence to cover their tracks? (AKA barking orders to the community pharmacy down the phone) Don't tell me this would never happen.
The PMR would show what has been issued - and if there's a discrepancy...

I'm a suspicious crusty old beggar today

[DavidS]

I would have contacted the surgery, asked them to write a script then and there - telling them what the care home is like, etc etc, and send someone to get the script. This would have pleased the care home, reinforced the legal position to the care home, and made myself very popular with everyone who is interested in keeping the care home's business. All these actions could have been done by the pharmacy manager, whether or not they were a pharmacist.

As thinks stand at the moment, having already lost the care home, I would certainly be creating as much trouble as I could!

I would then probably have gone into the back room and broken a few things.