pharmacy laws and regulations

[Rafael]

Hey guys, I have started my training at a local pharmacy a week ago. and i have got some concerns and would like to hear your opinions;
1- Destructing of CD drugs, which one does need to be witnessed from an authorizing officer? the ones from the pharmacy stock or the returned CD drugs from patients? or both? I am asking about what is LEGALLY REQUIRED.

2- when supplying a CD product, is it LEGALLY REQUIRED to ask for the patient ID( even if you know him) or its just GOOD PRACTICE?

3- i noticed some drugs we dispense as complete packs ie 2 packs of 30 tablets even that the Rx says 56 tablets. a)which drugs are dispensed in this way? b)how do we know or we just have to learn them? c)plus the reason behind providing some extra tablets please?

4- how many of you use electronic CD registering system? pharmacy i work at does not use an electronic version but i used a similar one at university few weeks ago while sitting for my dispensing module exam.
does it make things easier ie automatic balancing of methadone calculations? does it has the option to modify spelling errors or quantity registering errors?
5- who should I contact to learn more about ECLIPSE programe electronic registering and electronic prescription dispensing. Any links or advices if you used this tool? If not what dispensing tool do you guys use.

thank you for reading, I hope you read it all to enlighten me.

[Titch]

Re: pharmacy laws and regulations

1. Authorised officer needs to destroyed pharmacy stock. Pharmacist can destroy patient returns - good practice to have a member of staff witness you doing this and NPA has a book for recording the process.

2. It is a legal requirement to check who is collecting the medication but you do not have to see ID to hand it out. If person collecting is a healthcare professional - the pharmacist MUST ask for ID but has discretion to supply if person has no ID.

3. I presume you mean drugs that are classed as "calender or special packs" The Drug Tariff displays a symbol next to each drug in part VIII that it recognises as a calender or special pack. This means that payment is automatically based on multiples of that pack size and whilst you can split them up to give the exact amount, common practice is to just give the complete pack to avoid cutting up the strips.
PSNC produce a list of all special containers/calender packs - up to you if you choose to learn them! Probably easier to be familiar with the common ones.

4. No experience of electronic CD register yet - don't think they are common practice yet.

5. Eclipse - I'm assuming you are meaning ETP, not sure if Eclipse can do ETP. I would ring Eclipse helpline and ask them for any info as from memory it does not have a help function built into it so very much depends on trial and error to find out how to do things!!

[Rafael]

Re: pharmacy laws and regulations

thank you for your reply, i will read your post in an hour and reply you back as i just got back from the pharmacy, i had a busy day, the pharmacy i work at dispensed around 500 items today" not sure if this is a lot but for me it seems a lot" and i am still on my 3rd day of the summer training, the pharmacist is going to a new shop tomorrow and we will have 2-3 locums coming weekly so i dont think things will get better!! but well i hope they all teach me more things as i am still new.
anyways gotta eat something and will get back to you
cheers

[Web Ferret]

Re: pharmacy laws and regulations

Titch is correct in his replies.
I have only used a methadone electronic measure "Meathameasure". It was difficult to use once it went wrong but I managed to get one of my locum placements to arrange some training so I now have a better understand of why it goes wrong and what to do about it! This one does everything (and more) that you can do with a paper version.

500 is pretty average nowadays. There are a lot of shops that do less and a lot that do more. A good place to learn though as you will see a lot in a busy dispensary.

[Titch]

Re: pharmacy laws and regulations

Titch is correct in his replies.

HER replies, please!!

[Pharmanaut]

Re: pharmacy laws and regulations

HER replies, please!!

The way the balance has shifted we will have to assume that all pharmacists are women.

[Rafael]

Re: pharmacy laws and regulations

1- even if the returned drug was CD sch 2, authorused officer does not need to witness the distruction?
2- for example, lets say for methadone patients , you already know them, is it legally required to ask for their ID? when recording it in the CD register, the pharmacy were i work at write NO for both spaces when it ask you was the ID asked for and was it shown? i told the pharmacist that at uni they told us we shoul ALWAYS ask for ID and record it as YES prove of ID was aske for, but we do not need to see the ID.
what do you think?
3- yes calender packs, thank you for the clarification, i checked the drug tariff book today looking for the symbol anyways the dispensing systems tells us by itself i.e when trying to label 56 tablets the ECLIPSE system itself notified me that dispensing to the nearest pack size is required which is 60
4- yes was wondering about electronic CD registering and how helpful it could be? anyways today i learnt that its ILLEGAL to cross or make any ammendments to the CD register record, specialy crossing a wrong quantity. was blamed for doing so but well this is how we learn.
5- dunno my pharmacist was wondering about it, the electronic Rx systems.


okay another busy day, but things went better at my 4th day here, as i managed to put on my trainers not the SHOES! less feet pain.
a learnt more new stuff and would like to share it with you all( i know you all know these things but well i feel like talking about it).
1- a patients come with a Rx for salmol-salbutamol 100mcg inhaler and others products, we did not have any remaining as we gave around 20 this morning, the guy barely could inhale and we could tell from the sound coming out from him( u know what i mean). the pharmacist decided to provide him with Easy-breath inhaler, he told me he has to justify it to PPA to be paid for it. what do u think?
2- never dispense from the bloody label, always from the script, gave out ramipril 10mg capsules rathern than tablets, u know capsules are more commenly prescribed.
3- methadone patients who miss more 3 doses are not allowed to get their next dose, tho dunno what we should do about it when they come the next day or who should we contact? can someone enlighten me here?
4- why cloramphenacol 1% eyes drops can be proved without the need for Rx while chloramphenacol 1% ointment need a Rx? any reason behind it? also i noticed that an emergancy supply was made for the ointment few weeks ago as it is shown on ECLIPSE, page 6 in BNF says we can do ES for INSULIN cream or ointment ONLY, does this mean its illegal to make ES of chloramphenacol ointment?
5- provided some needle exchange for patients.
6- witnessed the denaturation of some CD returned tablets and signed the register. what do we do after leaving them for 24 hours in the little box provided for their denaturation? can we simply get rid of them?

finally we managed to dispense 580 items today, from which around 100 as delivery service.

this is was my day for today, if the admin does not mind, i will be using this topic as a daily diary
thanks for reading

[Steve G]

Re: pharmacy laws and regulations

why give an easy-breathe inhaler (I assume you mean the Salamol easy-breathe, which is breath actuated) to some one who can hardly inhale? Breath-actuated inhalers require an inspiratory effort to use, so would have made more sense to give a ventolin if you had any.

You can do an E/S of any drug, apart from sch 2 or 3 CDs (only exception is phenobarbitone for epilepsy). chloramphenicol ointment is a P now, so don't know why an E/S would be done, unless the GP requested it.

[Rafael]

Re: pharmacy laws and regulations

MEP says the ointment is POM, will check the product itself tomorrow.
not sure if we had ventolin, will check with the locum when he get back again. the thing is we will be having different locums working every week for 2-3 days, will make sure to ask him next time.
thanks steve

[Steve G]

Re: pharmacy laws and regulations

Two problems with the printed MEP - it's not always up to date, and the terminology and exemptions are not always clear. The society's web site has up to date information on the legal classification of medicines - Rpsgb.org: Search legal classification of medicines

Chloramphenicol 1% eye ointment (POM) exceptions: but containing 1% chloramphenicol, for the treatment of acute bacterial conjunctivitis in adults and children aged 2 years and over, maximum length of treatment 5 days, and pack size 4g; please refer to proprietary names for the classification granted under the marketing authorisation.

[Rafael]

Re: pharmacy laws and regulations

"please refer to proprietary names for the classification granted under the marketing authorisation."
what does it actually means? check whats found on the product itself?

[Rafael]

Re: pharmacy laws and regulations

the ointment is POM i double checked today.

[Rafael]

Re: pharmacy laws and regulations

ok guys, here is the summary of my day
1- should be starting at 9:00, but went to work around half eight, so prepared all the methadone scripts for today, double checked yesterday's scripts were registered. then the pharmacist prepared the methadone" around 30 patients". had a new locum in the pharmacy today, he is quite nice but a bit slow when checking Rx. my day was as usual doing a mix of paper work, recieving the stocks and arranging them on the shelves, labeling...etc

2-anyways what was new today is i had to order a specific brand product for amlodipine and liperone" not sure about the name" which we had them both but in a different brand than what the patient requested. could someone explain to me the reason behind it?
3- why do we keep sildenafil and cialas in the cupboard? i know they are SLS medicines and i do understand why as they are expensive and NHS wont be happy to prescribe it for all ppl! i double checked with the locum but he was not aware why other drugs ( another 10 or so) are also SLS, and i am actually confused what does SLS drug mean and why the other drugs are SLS? anyone willing to enlighten me?

4- sad news is i will be working tomorrow with a another new locum and its gonna be em only in the dispensary with another girl workin on the till. jesus christ, i hope things go alright, dunno how i will cope with labeling and getting the items for the pharmacist to check i am still new into this thing, have not finished 1 week training and i feel i am given a big responsibility that i would not be able to handle! i mean if the permenant pharmacist is around he would understand that, but a new locum coming tomorrow and expecting to have trained stuff while the other 2 trained guys aint turning up tomorrow! i can imagine him screaming from now

5- i noticed pharmacist barely councel patients on the use of their medications, I DO UNDERSTAND WHY AS THE PHARMACY IS BLOODY BUSY ALL THE TIME! but this contradicts what those lecturers have been telling us at uni since year 1! i mean how they should councel if the patient himself does not ask for help and the pharmacy is very busy? on the other side, when some patients come asking for some medicine to use for a minor illness, he responds well to the enquirey.

anyways that was all what came into my mind during this day.
i hope if someone read and enlighten me more about today's and yesterday's Qs.
cheers

[Steve G]

Re: pharmacy laws and regulations

the ointment is POM i double checked today.

Most of the available chloramphenicol ointments are POM, but some are P - there's an Optrex one, and I think Numark have one. It's the same with the eye drops.

[SolomonQ]

Re: pharmacy laws and regulations

2. dont know wat u mean by leperone, but some patients prefer the taste of certain brands over others, most common preference to brands occurs with soluble co-codamol or paracetamol effev. (also the amlodipine required could have been the besilate form, pharmacies normally keep the maleate form???)

3. SLS means that these medicines are not allowed to be prescrbed on the NHS unless they are for certain group of patients e.g. one of the groups tadalafil and sildenafil can be given to is a diabetic patient, the SLS needs to be on the rx because i think it indicates the Doctor/prescriber knows this about the restriceted use of this medicines under NHS, also im surprised why you asked this as out of 500-odd items you mustav had quite a few green rx for these, and also alot of people get these prescribed privately, cost about £35 for 4 tabs but people are willing to pay, expect these sorta rx on friday or around the weekened.

4. unfortunately thats the truth these days, thats how pharmacies run. locums and untrained staff(no offence to you). would never happen in say a doctors or dentist surgery.

5. unfortunately the uni "lied", it would be your duty to counsel patients about their medicines but does the pharmacist get time to do this, like you said "no", HOWEVER majority of the work as a HOSPITAL pharmacist is clinical checking, counselling and everything else you were thaught at uni, in community pharmacy its more about dispensing, knowing multiples of 28 etc... the pharmacy owners get their money from the rx dispensed they would be happy if the pharmacist waste his/her time counselling patients (which would atleast take 5 minutes)

*about the chloramphenicol ointment, like most nwly "pom to p" "switched" medicnes the P medicine is only for ceratin brands e.g. you cant sell patients dispensing packs of naproxen, only feminax ultra (naproxen 250mg) is allowed similarly you cant sell just any chlorampheicol eye drops to the public they must have that license, which is normally obtained by brands e.g. optrex chloramphenicol,

*&^also note paracetamol 500mg tablets or capsules are POM technically, but if sold in pack size max of 32 they are P, and max pack size 16 they are GSL, go check in the pharmacy next time largest pack size being sold would be 32 and the max quantity that can be supplied is 100, also go and check say tesco/asda normal store or poundshop, they sell paracetmol in packs of 16, I havent tried this out but they arent allowed to sell more than 100 tablets to any one person at one time. (NOTE: this does not apply to dispersable tablets.)