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  • Methadone Dispensing in Whole Bottle

    Not sure if i'm posting this in the right forum, But i'm trying to seek clarification on this with the relevant evidence to support it.

    I've seen numerous comments on older post that says that

    It is alright to just give out the whole methadone off the shelves if the prescription is for the bottle such as 100mls or 500mls.

    Or would u guys measure it out accurately considering there usually is overage / (possibility of underage ) as well.

    If your giving out the whole amount say 750mls, so 500mls bottle off the shelves and measure out 250mls, evidence or guidance to say what is the right way to dispense this?

    I've had too much mixed response that no one can show any guidance except those working in (the shoe company) with their rigorous SOP measure - which states that they have to measure out the 500mls out of the 500mls bottle off the shelves and give the exact quantity.

    Those in independant seems to just give it out off the shelves (but upon asking for support on this practice - none can seems to show any sop or guidance to this).

    Just wondering if anyone have any thoughts on this?


  • #2
    I think you've kind of answered your own question.

    If there is this much ambiguity the decision relies on the individual pharmacists professional judgement.

    Personally I would measure it out as we're all aware that 500ml really means 505-520 and this particular class of patients should be managed appropriately. If a pharmacist decides to dispense full bottles it's not wrong either as they can justify that they're sticking to the manufacturers specifications and it makes their stock management easier.
    I remember when a blog was an individual boot.

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    • #3
      It would go through the standard SOP - measured and checked by a second person.
      It could be dispensed in the original bottle if it was 'spot on'.

      If we were making up several doses for other patients we could use the original bottle; dispensing the overage to make up the quantity needed for another patient.

      As you say the overage can be significant - but you don't know until it is measured.

      How carefully the patient measures it when they take the stuff is another story..

      47 BC : Julius Cesar : Veni Vidi Vici : I came, I saw I conquered.
      2018 AD : Modern Man : I shopped, I clicked, I collected.
      How times change.

      If you find you have read something that has upset or offended you an anyway please unread it at once.

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      • #4
        Dispensing in original bottle could facilitate onward sale.
        johnep

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        • #5
          Originally posted by johnep View Post
          Dispensing in original bottle could facilitate onward sale.
          johnep
          Good point but could be said of any container.
          Where there is a will there is a way - the more you do to prevent something the harder people try to work around it.
          I don't think anything could stop 'spit meth'..
          47 BC : Julius Cesar : Veni Vidi Vici : I came, I saw I conquered.
          2018 AD : Modern Man : I shopped, I clicked, I collected.
          How times change.

          If you find you have read something that has upset or offended you an anyway please unread it at once.

          Comment


          • #6
            I often reflected on this one and my conclusion is that if an OP could be supplied then that should be done to avoid possible cross contamination with other pt's medications, also ther errors that can occur with measurements on site.

            Comment


            • #7
              Originally posted by Mutley View Post
              I often reflected on this one and my conclusion is that if an OP could be supplied then that should be done to avoid possible cross contamination with other pt's medications, also ther errors that can occur with measurements on site.
              I always believed that we had to dispense what was on the script. If an OP is under or overfilled then we are not doing that. If you had a script for 28 tablets and there were 29 on the strip would you shrug your shoulders and say, they may as well have the extra one?

              Comment


              • #8
                Originally posted by sparkybw View Post

                I always believed that we had to dispense what was on the script. If an OP is under or overfilled then we are not doing that. If you had a script for 28 tablets and there were 29 on the strip would you shrug your shoulders and say, they may as well have the extra one?
                If the box was sealed by the mfr how could you know? If you break the seal to check the pt could complain that the container had been broached (had this happen).

                Come to that, how do you know that the mfr has put the right tablets in the blister pack? Goes back to the early 70's admittedly but there was an incident where Qinine was packed and labelled as Quinidine.

                Comment


                • #9
                  The answer to your question is that there is no official answer.

                  50ml, 100ml and 500ml are all in the drug tariff. So if you dispensed a 50ml bottle (as an original pack without opening it) then that is what you are going to get paid for. Thus, the NHS does not necessarily feel that there is an issue with this one for this reason (otherwise it would only pay for one pack size and expect you to measure everything from that - likely to be the 500ml).

                  Where the issue comes in is more of a professional one than anything else:

                  1) Not remeasuring can result in the overage/underage going to the patient
                  2) It is sealed so that you could prevent tampering
                  3) CD Methadone books are designed to accommodate under and overage issues

                  And I can think of others ...

                  So, there is no 'official answer' to your question. It is based on your assessment of risk. Boots obviously feel that there is a risk so they have incorporated it into their SOPs. Others may not feel the same.

                  Comment


                  • #10
                    Originally posted by Mutley View Post

                    If the box was sealed by the mfr how could you know? If you break the seal to check the pt could complain that the container had been broached (had this happen).

                    Come to that, how do you know that the mfr has put the right tablets in the blister pack? Goes back to the early 70's admittedly but there was an incident where Qinine was packed and labelled as Quinidine.
                    I always open the boxes. How else can I check them for accuracy if I don’t?

                    Have you never heard of wrong items being put in boxes? Or incorrectly dated boxes with one date on the outside and another on the strips? I know that I’m pedantic but you either do the job properly or you don’t bother.

                    Comment


                    • #11
                      Originally posted by mysteryarch View Post
                      not sure if i'm posting this in the right forum, but i'm trying to seek clarification on this with the relevant evidence to support it.

                      I've seen numerous comments on older post that says that

                      it is alright to just give out the whole methadone off the shelves if the prescription is for the bottle such as 100mls or 500mls.

                      Or would u guys measure it out accurately considering there usually is overage / (possibility of underage ) as well.

                      If your giving out the whole amount say 750mls, so 500mls bottle off the shelves and measure out 250mls, evidence or guidance to say what is the right way to dispense this?

                      I've had too much mixed response that no one can show any guidance except those working in (the shoe company) with their rigorous sop measure - which states that they have to measure out the 500mls out of the 500mls bottle off the shelves and give the exact quantity.

                      Those in independant seems to just give it out off the shelves (but upon asking for support on this practice - none can seems to show any sop or guidance to this).

                      Just wondering if anyone have any thoughts on this?
                      no as the manufacturer adds overage of sometimes 30ml to allow for wastage when pouring. Most sops request measuring it in a conical measure.

                      Comment

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