are we allowed to?

[howe928]

1) dispense Methadone in its original stock container by just sticking a dispensing label on e.g take 100ml daily

2) dispense Calcichew in its original container without transferring it to child resistant clic-lock

3) cross out the word 'tablets' on a dental script written as Rx amoxicillin caps 250mg qds 18 tablets

4) give amoxicillin oral syrup in its original container powder form to patient's carer?

5) order prescription for patients every month without them ringing the pharmacy every time to say they want to order their prescription?

6) give patient's details over the phone to somebody claimed they are ringing from the hospital without getting into trouble?

[DavidS]

1) dispense Methadone in its original stock container by just sticking a dispensing label on e.g take 100ml daily

Yes. Why not?

2) dispense Calcichew in its original container without transferring it to child resistant clic-lock

Yes. You take responsibility for a kid ODing on them, but I just don't see that happening with these

3) cross out the word 'tablets' on a dental script written as Rx amoxicillin caps 250mg qds 18 tablets

yes, do this all the time.

4) give amoxicillin oral syrup in its original container powder form to patient's carer?

If you can justify it as being in the patient's best interest.

5) order prescription for patients every month without them ringing the pharmacy every time to say they want to order their prescription?

legal but risky

6) give patient's details over the phone to somebody claimed they are ringing from the hospital without getting into trouble?

No. Why would they be phoning us?

[minisini]

Some answers....

1) dispense Methadone in its original stock container by just sticking a dispensing label on e.g take 100ml daily

Correct! As with every liquid medicine, the manufacturer usually includes an overage. This overage can be up to 15ml, so if you were to dispense 500ml to a patient they may actually receive 515ml. Every medicine should be dispensed in exact quantities, especially CD's therefore it would contravene the medicines act to do otherwise!

2) dispense Calcichew in its original container without transferring it to child resistant clic-lock

All dispensed medicines should be in a suitable child resistant container. Imagine that a child got access to these medicines and then had an allergic reaction to the lactose in the tablet the liability would lie with the pharmacy. However, practically, this is a waste, it maybe prudent to ask the patient if they have any children or if any minor could possibly have access to the medicines.

3) cross out the word 'tablets' on a dental script written as Rx amoxicillin caps 250mg qds 18 tablets.

??? Im not sure what you mean by this, actually change the Rx without prescriber permission? Big no, no...

4) give amoxicillin oral syrup in its original container powder form to patient's carer?

You cannot give out powdered form of an antibiotic. This not only would contravene the licence of the product but would also jeopardise the patients care as the added water maybe an inaccurate quantity or of poor quality. In practice I know of some pharmacists who would measure the water into a separate container and give the patient specific instructions. In this case this would contravene the product license as it should be the pharmacist who does this.

[paul2008]

6) give patient's details over the phone to somebody claimed they are ringing from the hospital without getting into trouble?

If you can confirm it is the correct patient and it is in the patient's bestt interests, for example:

Does Mr. X get a Dosette box here what is in it? and made suitable arrangements for continuing care of the patient who may not be able to provide this information him/herself.

Does Mrs Y get Z from you (for example a 3 monthly injection) when was it last collected? Is she due/overdue for a dose? Perhaps she has been refusing it and not told her GP, in which case information from the pharmacy would be necessary to provide safe treatment if the patient could not remember or was confused.

You should be satisfied that they are calling from the hospital and not somewhere else. One way of doing this is to ask where they are calling from (ward or extension) and ring them back using number from the phone book or pharmacy records before providing any information.

You could also ask whether the patient has given permission, but usually the patient and their GP will be approached before calling the community pharmacy as in many cases they are not a good source for medication histories.

[DavidS]

In practice I know of some pharmacists who would measure the water into a separate container and give the patient specific instructions.

Strangely, I won't do this! Water can go off - try it if you don't believe me, just bottle a few up for a fortnight and give them a sniff. I ensure that the carer can measure the water themselves.

Most are parents with children who have cystic fybrosis, who are adept at assessing the child's condition and have suitable measuring equipment (a tared bottle, for instance, and in several cases, A level sciences or BSc's).

[bobbin]

Strangely, I won't do this!

I don't do it either. The water is supposed to be fresh tap water. Most people are quite capable of measuring water themselves provided that they have an appropriate measuring cylinder. If their measurement is not 100% accurate it won't make any difference anyway eg. does it matter if amoxicillin is 121mg/5ml or 129ml/5ml? No - it's not clinically relevent. Patients on long-term antibiotics should not be forced to come back to the pharmacy each time they need the next 100ml! Of course, some people will want to but many won't.

[mandy]

1, yes unless the px say dispense in daliy dose bottles.

2, yep, with the patients consent,

3, Never, ring the practice and inform the dentist how to write a script and have a new one faxed and and have the original sent in the post.

4, yep we have a mum of a very ill child that gets 8 bottles a month for her son, it was her that asked for the unconstituted antibiotic

5,Never do that, why would you?? (what if the patient is dead)

6, never give patient information out unless they can say were they are ringing from and giving there full name, e.g....hello my name is staff nurses Larr larr and ringing form lar lar land,

I'm only a trainee dispenser on the NPA thingy
but its all common sense really is it not?

[medical6969]

For all newbie's, please be aware there are 2 types of pharmacists.The first follow the letter of the law, the second use their common sense. Many pharmacist begin as type 1, then after a few years change to type 2.

1) dispense Methadone in its original stock container by just sticking a dispensing label on e.g take 100ml daily

Yes, fine. There may be slight overage or underage, but nothing too significant. If someone is having 100 mls daily they are really not going to notice they have had 3mls extra or under. Also you will not be exact if you measure out 100mls anyway.

Its of no clinical significance.

2) dispense Calcichew in its original container without transferring it to child resistant clic-lock

Yes, fine. It takes 5 minutes to transfer them into new containers! Just tell the patient there is no click lock on there, so now its their responsibility that little johnny does eat them all.

3) cross out the word 'tablets' on a dental script written as Rx amoxicillin caps 250mg qds 18 tablets

From an earlier reply 'Making a change to a script is a big No No'. (You can tell which type of pharmacist this is).

Anyway. Yes, fine. Obviously the prescriber meant capsules and they don't come as tablets anyway. Why would you even hesitate to change the script?

You have a masters degree which took 4 years to complete. And you cant even do a simple thing like this! How unprofessional.


4) give amoxicillin oral syrup in its original container powder form to patient's carer?

Yes, fine. If they have a good reason e.g. going on holiday tomorrow. Just get 2 empty same size bottles. Fill one up with the exact quantity of water e.g. 84 mls. Leave the other empty. When they want to make up the powder they simply add water the empty bottle to the same level as the one you filled. Again a few mls here or there is not clinically significant.


6) give patient's details over the phone to somebody claimed they are ringing from the hospital without getting into trouble?

Yes hospital pharmacist's call all the time to check PMRs.
Just get them to confirm a few details e.g. D.O.B address full name. Alternatively ask them for the hospital switch board number and their extension. Tell them you will ring them back in a few minutes. That way you confirm that its genuine call.

Finally, this is not a personal attack at any individual pharmacists.
Thank you to the newbies for their questions. Keep them coming.

[howe928]

5) order prescription for patients every month without them ringing the pharmacy every time to say they want to order their prescription?

5,Never do that, why would you?? (what if the patient is dead)

I'm only a trainee dispenser on the NPA thingy but its all common sense really is it not?

an example is: a lot of the pharmacies order prescriptions for their nomad or tray (MDS) patients on their behalf every month because patients always not ordering them on time (normally ordered prescription very late, not give enough time for pharmacy to order stocks and plan workflow) and creating lots of problem, the other problem is patient or carer (agreed to inform pharmacy if there is any changes) failed to inform pharmacy either when the patient is hospitalized or moved home or deceased, only found out when something gone wrong

[Prawnlaksa]

So is it alright to dispense zineryt unmixed at the patients request? They would have had 3x30ml bottles on the script and know its short shelf life once made up.I have done this many times, always reminding the patients about writing their expiry dates on the bottle after mixing. Hadnt realised it is outside the product licence for the patient to mix up their own.