Announcement

Collapse
No announcement yet.

Patches and dosage

Collapse
X
 
  • Filter
  • Time
  • Show
Clear All
new posts

  • Patches and dosage

    Traditionally no dose has been indicated for topical preparations other than drops. We used to give out Lotio Plumbi cum opio with just 'apply three times a day'.

    On Friday received script for Durogesic patches 'as directed'. Contacted surgery for new script and this had 'apply every 72 hours' . script had been dispensed many times 'as directed'.

    Theoretically I should have perhaps refused until script was amended 'Apply one patch every 72 hours'. But it was Bank Holiday Weekend and patient had no patches left from previous script.

    We could do with a ruling from 'on high' re doses for patches and then could contact local PCT CD lead to inform practices. However, it is common practice for HRT patches and nicotine patches to simply have 'apply every day/every week etc'

    Does common sense prevail?
    johnep

  • #2
    Re: Patches and dosage

    On raising this issue with local pharmacy inspector, the correct dosage should be apply one patch every 72 hours but he did state, although not in writing, that no-one would be shot if a script with apply every 72 hours was dispensed.

    We got the local practices to amend their automatic dosing on their computers to the correct terminology.

    The big worry for me is the introduction of fentanyl generic patches. We now must find an extra shelf in the safe and 4 more inserts for our registers. I cant wait for oxycontin to come off patent!!!!!!

    Comment


    • #3
      Re: Patches and dosage

      Originally posted by johnep View Post
      Does common sense prevail?
      johnep
      It does where I'm concerned.

      Jefff

      Comment


      • #4
        Re: Patches and dosage

        Originally posted by johnep View Post
        We could do with a ruling from 'on high' re doses for patches and then could contact local PCT CD lead to inform practices.
        In the Society's factsheet on 'Controlled drugs and community pharmacy' (http://www.rpsgb.org/pdfs/factsheet1.pdf) the guidance relating to Fentanyl patch prescriptions (p.30-31) clearly states that the dosage should be expressed in terms of the number of patches to be used and interval between patch applications, for example, “one patch to be applied every 72 hours”. A dose of “every 72 hours” would not be acceptable.

        However, this is the only reference that I can find that states that the dosage interval must be declared on the prescription. The MEP (http://www.rpsgb.org/pdfs/MEP31s1-2b.pdf) states that the prescription must specify the dose to be taken (NB: The Home Office has expressed the view that a dose of "as directed" or "when required" is not acceptable , but "one to be taken as directed/when required" is acceptable). Similarly, the BNF says that the instruction ‘one as directed' constitutes a dose but ‘as directed' does not.

        The MEP/BNF therefore suggests that Fentanyl prescriptions could be written as one patch to be applied as directed. Also, there is no mention in the Society's factsheet about the requirements for other CD patches e.g. buprenophine - does the dose interval need to be clearly stated for these? If so why does the section in the guidance only refer to Fentanyl?

        Even more annoying is the guidance regarding the quantity in words and figures. "The Home Office has advised that the total quantity can also be expressed as the multiplication of two numbers. However, if the total quantity has been written in this way, the quantity must be written fully in words and be completely clear and unambiguous. For instance: (2 x 30), (two times thirty); or 2 x packs of 60, (two packs of sixty)." We've had to return a couple of scripts recently because the quantity was 2 x 28 (fifty six)! Can pharmacists not be trusted to do simple multiplication?

        Common sense...I think it's long gone out of the window!

        Comment


        • #5
          Re: Patches and dosage

          Originally posted by pharmatron View Post
          We've had to return a couple of scripts recently because the quantity was 2 x 28 (fifty six)!
          I would love to be brought before the disciplinary committee for not returning those scripts. I wouldn't even think of doing so (and still wont).

          Jeff

          Comment


          • #6
            Re: Patches and dosage

            I get round the 2 x 28 (fifty six) option by adding the quantity in figures myself.

            Guidance is if words OR figures present and intention is clear then pharmacist can add the other.

            Personally cannot see a way to make the intention clearer other than for the script to be printed right in the first place.

            I have raised this as an issue with our GP software system - raised as an issue about 18 months ago so don't think it's a priority for them to fix it!
            Titch

            Comment


            • #7
              Re: Patches and dosage

              Originally posted by Titch View Post
              I get round the 2 x 28 (fifty six) option by adding the quantity in figures myself.

              Guidance is if words OR figures present and intention is clear then pharmacist can add the other.

              Personally cannot see a way to make the intention clearer other than for the script to be printed right in the first place.

              I have raised this as an issue with our GP software system - raised as an issue about 18 months ago so don't think it's a priority for them to fix it!
              Common sense would dictate that this is a logical use of the minor typographical changes procedures. However, the Society's guidance states:
              Technical Errors
              Where a prescription (for a Schedule 2 or 3 drug, except temazepam), is received which
              contains a technical error, the pharmacist is only permitted to correct the following:
              (i) a minor typographical error;
              (ii) a spelling mistake;
              (iii) Where the total quantity of the preparation of the controlled drug, or the number of
              dosage units, as the case may be, is specified in either words or figures, but not both,
              (i.e. one or the other has been omitted), either the words or the figures can be added to
              the controlled drug prescription.
              We checked with the Accountable Officer at the PCT and they confirmed that prescriptions with the quantity expressed as 2 x 28 (fifty six) could not be altered using the minor typographical amendments process as it contained both words and figures but not in the correct manner (should read 2 x 28 [two times twenty-eight]).

              What on earth is the point of the minor typographical arrangements? They are so restrictive that they are next to useless!

              Comment


              • #8
                Re: Patches and dosage

                We have the same problem with CD patches. 'Apply every 72 hours'

                I got fed up with having to send the patient back so I wrote a letter to all our local surgeries to let them know what was and wasnt acceptable. I guess only time will tell if the letter actually received the letter or it only got as far as the receptionist?????

                Another thing:

                Since we can add figures or words for total quantity if one is missing, What is the point of having it in the first place? Who benefits from it?

                G.P.s may as well just write CD script quantities exactly the same as POM scripts, as we would add the legal bit. Again whats the point?

                Comment


                • #9
                  Re: Patches and dosage

                  Originally posted by pharmatron View Post
                  We checked with the Accountable Officer at the PCT and they confirmed that prescriptions with the quantity expressed as 2 x 28 (fifty six) could not be altered using the minor typographical amendments process as it contained both words and figures but not in the correct manner (should read 2 x 28 [two times twenty-eight]).

                  What on earth is the point of the minor typographical arrangements? They are so restrictive that they are next to useless!
                  IMHO the accountable officer is wrong.
                  ....just my opinion

                  Comment


                  • #10
                    Re: Patches and dosage

                    Me too, I think the accountable officer is wrong. You have fifty six so Id be happy adding 56 to the Rx.

                    Again I think there is no point in having words and figures, if we are adding it its not for the doctors benefit, it certainly not for the patients benefit. If we are adding it its not for our benefit and Im not sure what the PPA gets out of it. Maybe the RPSGB employs a words and figures minister whose job it is to monitor words and figures on CD Rx's?????? WHo knows!!!!

                    Comment


                    • #11
                      Re: Patches and dosage

                      Just for information, if you read my previous reply, the doctors did get the letter I wrote, a drug rep from Napp told me, She was shown the letter at two surgery visits and she wanted a copy of the letter for an MUR meeting she's preparing.

                      So far all CD patch Rx's have been written beautifully. How sad is the life of a pharmacist who get excited about CD law!!!!!!!

                      Comment

                      Working...
                      X