Child Resistant Caps

[admin]

Child Resistant Lids

It has come to our attention that on Friday 17th Feb a pharmacist checked, and gave to the mother of a young child, a bottle of paracetamol suspension 120mg/5ml and one of amoxicillin 125mg/5ml. The mother put the amoxicillin in the fridge. The bottle had a top on it, that at a glance looked like a child resistant lid, but was in fact not one. The paracetamol suspension did have a child resistant lid on it.

The child went into the fridge, opened the bottle of amoxicillin and drank the whole bottle full. This led to a trip to the local [email protected] department and resulted in a child with diarrhoea and vomiting for most of the night. Obviously the parents were very worried and angry. If the child had drank the paracetamol, then obviously the consequences could have been a lot more serious.

Looking at the two brands of amoxicillin in the pharmacy where I worked today, neither had child resistant lids on them. It is good practice to remove these lids, after re-constituting the liquid, and fit a proper child resistant lid. It is however very easy to miss this, especially when run off your feet, so beware!

I would urge all dispensers and pharmacists to be extra vigilant when using the original containers for anti-biotics. Always change the lid, if it is not the correct type, and make sure it is secure.

REMEMBER NO LID IS CHILD PROOF !!!

[admin]

Child Resistant lids

This is a good topic, especially during these times when the "no win, no fee" culture is amongst us.

I once had a woman who said she had left her bottle of anti-depressants in the middle of the lounge's coffee table. She said her toddler had got the top off and had taken some. She said the usual, trip to hospital stuff etc and I had left the lid loose, so obviously it was my fault and she was going to sue me.

I ponited out that of course these lids are not child proof, and maybe leaving drugs in the middle of a low level table was not the best place for them, and it does say on all labels keep out of the reach of children.

At this point she did something I have never encountered before, she leant over the counter and said "give me a hundred quid and you'll keep your f*****g job". I was stunned at this, and told her to go away, and complain if she felt the need to. I never heard anything else about it.

I was telling this to a friend of mine this, and she had a similiar thing, but this time it was "if you buy my kids a Playstation.....etc".

Unbelievable you might think, but in our Society today all too common. The sad thing is, if they go to the Pharmaceutical Society, they will take their side, not yours.

So to all you youngsters thinking of becoming a pharmacist, "write off" the £267 yearly Pharm Soc fee - that's just dead money you have to pay I'm afraid, but shell out another £150 per year for some decent insurance.

[Web Ferret]

Re: Child Resistant Caps

Does anyone know of any generic antibiotic liquids that have child resistant caps already on them???

[johnep]

Re: Child Resistant Caps

This thread must be ancient, for £267 read £425.
johnep

[Jeff]

Re: Child Resistant Caps

Does anyone know of any generic antibiotic liquids that have child resistant caps already on them???

Risk minimisation begins before the dispensary - with the buying power of the biggest multiples - if they insisted on generic antibiotics being supplied with child proof caps it would happen.

Jeff

[Web Ferret]

Re: Child Resistant Caps

I'll take that as a No then.

It amazes me how some packaging gets past the MCA. The methotrexate loose in 28s with no CRC forces us to re-bottle them. Madness when everyone knows the problems with handling it.

[Pharmanaut]

Re: Child Resistant Caps

I'll take that as a No then.

It amazes me how some packaging gets past the MCA. The methotrexate loose in 28s with no CRC forces us to re-bottle them. Madness when everyone knows the problems with handling it.

Still waiting for a response from NAPP about DHC Continus in an original container that was a non-crc securitainer.

They were probably too busy looking at their distribution model in the UK to be bothered with patient safety.

[Pharmanaut]

Re: Child Resistant Caps

I'll take that as a No then.

It amazes me how some packaging gets past the MCA. The methotrexate loose in 28s with no CRC forces us to re-bottle them. Madness when everyone knows the problems with handling it.

Read somewhere that the pack size of MTX is to be limited to 24.
Hope they start using strip packs now.

[howe928]

Re: Child Resistant Caps

is CRC (child resistant caps) only a recommendation not compulsory??

you may need to check the SOP of the company you work for to find out what it says in there

how about
peptac liquid? gaviscon liquid?
medicine labeled with 'store in the original container'? e.g. Asasantin Caps, Clopixol
Duraphat toothpaste, hydrogen peroxide, Corsodyl Mouthwash
Calamine lotion?

[Mac]

Re: Child Resistant Caps

CRC are not a legal requirement. They are, however, a professional requirement. Thus with medicines that need to be stored in the original container, you have to weigh up the risk of not giving a CRC against the risk of the medication being less effective due to repackaging.
Different places have different protocols. My previous hospital would dispense things like Madopar in the original container with no CRC but my current one repackages them into a CRC and gives them a 4 week expiry date (from company info).

I do think there should be pressure on the companies to package in CRC. You would then have to use professional discretion whether to repackage in particular cases eg patients with arthritis who cannot open such lids.

If you do give out a medicine in the original packaging with no CRC the Society do recommend that extra counselling is given regarding keeping out of reach of children.

[pharmatron]

Re: Child Resistant Caps

The Society used to recommend in the MEP that all solid dose and all oral and external liquid preparations were dispensed in reclosable child resistant containers unless:
(i) the medicine is in an original pack or patient pack such as to make this in advisable
(ii) the patient has difficulty in opening child resistant containers
(iii) a specific request is made that the product shall not be dispensed in a CRC
(iv) no suitable CRC exists for a particular liquid preparation
(v) the patient is assessed as requiring a compliance aid.
However, this guidance does not feature in the latest edition of the MEP.

In one pharmacy I worked, staff were told not to place a CRC onto antibiotic liquids as the original bottle and top were classed as a complete system and the child-resistant lids weren't approved tops for the bottles.

When I questioned the manager about this I was referred to an article in the PJ (Child-resistant packaging).

So, what do we do...replace the non-CRC lid with a clic-loc type...or leave the original closure...or pour the mixture into an amber glass dispensing bottle with a CRC. If you choose the latter option - what happens to the patient leaflet...these are usually attached to the bottle and trying to remove them usually rips them.

It's so complicated...why don't they just make them with child-resistant tops!?!?!

[Jeff]

Re: Child Resistant Caps

It's so complicated...why don't they just make them with child-resistant tops!?!?!

All it takes is for the major purchasers is to insist on CRC closures for the products they choose to order.
The RPSGB probably can't get involved because it's a commercial decision, however a new representative body for pharmacist could perhaps do so.

Jeff

[pharmagirl]

Re: Child Resistant Caps

I have tried to fit crc on generic antibitoics and they have leaked so i dont anymore.
I recently had a patient complain because his tablets where supplied in amber bottle with a crc. The tablets often come in blisters but this time the only ones we could get were supplied in a bottle with out a child resistant closure so the pharmacist that day transfered them to a bottle with a crc and he wasnt happy. He wanted them in an original pack and was talking about contamination. I tried to explain the reasons for it and we wouldnt in future for him but he did not want to listen.

[happy_bunny]

Re: Child Resistant Caps

The RPSGB probably can't get involved because it's a commercial decision, however a new representative body for pharmacist could perhaps do so.

Jeff

Sorry if this is a little off-topic, but all I seem to hear about lately is issues where the RPSGB cannot get involved for one reason or another - is there anything they actually can be involved in? Other than punishing pharmacists that is

[Sir_Dispensalot]

Re: Child Resistant Caps

I have tried to fit crc on generic antibitoics and they have leaked so i dont anymore.
I recently had a patient complain because his tablets where supplied in amber bottle with a crc. The tablets often come in blisters but this time the only ones we could get were supplied in a bottle with out a child resistant closure so the pharmacist that day transfered them to a bottle with a crc and he wasnt happy. He wanted them in an original pack and was talking about contamination. I tried to explain the reasons for it and we wouldnt in future for him but he did not want to listen.

'the customer is always right...'

This particular situation also being more commonly known as 'the customer is a moany git with too much free time and an overinflated sense of self-worth'.