Nelson Bays Primary Health Caroline Allen Pharmacy Facilitator

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Nelson Bays Primary HealthCaroline Allen
Pharmacy Facilitator

• Cornerstone
• 7th May 2009

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Indicator A.2.4

• Prescribing in the absence of direct patient
  contact is accurate, appropriate and timely.

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Questions to ask the patient

• Have you been admitted to hospital since your
  last repeat?
• Have you seen a specialist since your last
  repeat?
• Have any of your medicines been altered?
• Have you purchased any medicines from a Pharmacy?
• Have you taken any alternative or complimentary
  medicines?
• How are you feeling now?
• Has your condition changed?

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Disease Specific Questions

• This area will need developing further, but here
  are a few suggestions
• Lipids CK and LFTs and frequency required for
  monitoring
• Asthma frequency of use or reliever and
  preventer / peak flow
• NSAIDs side-effects re indigestion
• Levothyroxine TSH

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Check list

• Alerts
• Messages
• Tests due or results need consideration
• If seen a Dr within the last 12 months
• If Special Authority number is still valid or if
  Close Control is required for the patient
• If drug brand is required or if can be written
  generically
• If Care Plus patient link the issue of repeats
  with the quarterly practice visit

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Procedure

• Tell patient when to expect the prescription to
  be ready for collection from the surgery (refer
  to the Practice Policy for time-frame)
• Check the destination if the patient requests the
  prescription to be faxed to a Pharmacy
• Tell the patient when the next repeat is due, and
  if any tests are required before then, or book
  Care Plus visit at the same time as the next
  repeat

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Check the Prescription

• Right patient details current address etc,
  correct co-payment code
• Written generically where possible, has a Special
  Authority number, Close control or Certified
  Condition where appropriate and is signed by the
  prescriber

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Audits

• Any audits undertaken must review protocols for
  prescribing, accuracy and efficacy
• Cornerstone A 2.4-4
• Regular checking of prescriptions ordered to
  identify whether they have been collected and
  actions taken.

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Right 4, Code of Health Disability Service
Consumers Rights 1996

• Prescribing in the absence of a consultation
• Reasonable care and skill
• Complies with legal, professional, ethical and
  other relevant standards
• Provided in a manner consistent with needs
• Minimises potential harm and optimises the
  quality of life
• Cooperation among providers to ensure quality and
  continuity of services

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Indicator B.4.6

• Practice security is maintained to ensure there
  is only authorised access to medications and
  pharmaceutical products

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Secure storage

• Out of sight
• Practice security and precautions ensure no
  access by unauthorised people
• Not low open shelves or in GPs desk
• Low level cupboards should be lockable

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Misuse of Drugs Regulations 1977

• Regulation 28 Storage www.legislation.govt.nz/
  regulation/public/1977/0037/ latest/DLM55389.html
• Regulation 37 Register
• www.legislation.govt.nz/regulation/public/1977/003
  7/
• latest/DLM55389.html

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Controlled Drugs Storage

• Locked cupboard, constructed of metal and or
  concrete and is of an approved type
• Securely fixed to, or is part of, the building
• Key kept in a safe place when not in use
• (If the building is left unattended the safe
  place shall not be within the building - If
  fitted with a combination lock of an approved
  type this does not apply)

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Controlled Drug Register

• Applies to a practitioner or a person who is
  licensed to supply Controlled Drugs on a
  prescription
• A Controlled Drug Register
• bound
• pages consecutively numbered
• one form of controlled drug per page
• Entries no later than the next business day
• Legible and indelible. No crossing out.
• Twice yearly balance checks 30th June 31st Dec

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A Prescription Book

• A Prescription Book
• bound
• record of every prescription dispensed including
  repeats
• Patient details surname, initials and address
• Prescriber details surname, initials and address
  
• The proportion and total amount of the controlled
  drug dispensed
• The date of the dispensing

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CD Prescription Requirements

• Misuse of Drugs Regulations 29 and 31
• Form H572 (or H572M for methadone)
• Legibly and indelibly written
• Prescribers own handwriting
• Signed and Dated must be dispensed within 7
  days of writing
• Prescriber details address of prescriber

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CD Prescription Requirements

• Patient details surname, initials and address
• Age in years and months if patient under 12 years
• Name and total amount of CD to be dispensed and
  the number of occasions for dispensing
• Dose and frequency of use
• Quantity not more than 1 months treatment (28 or
  30 days?)

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Indicator B.5.1

• Medical equipment and resources are available and
  maintained

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Audit Trail for Servicing

• All medical equipment tested and serviced
  according to relevant regulations
• Maintenance and operating instructions performed
  correctly (date and personnel)
• Manuals available
• Training for staff staff know how to use
  equipment

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Equipment

• Adequate and appropriate for circumstances of the
  practice
• Safe
• Well maintained
• Functioning well

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Doctors Bag

• Emergency off site care
• Not necessary for all practices
• If ergometrine is used it should be stored in the
  refrigerator

22
Medical Equipment Protocols

• System for maintenance and checking of expiry
  dates of all drugs
• System to check and maintain the emergency
  equipment/bag
• Designated person audits and maintains stock
• All stock should be in date
• Monthly audit

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Further information

• RNZCGP Assessment Visit Module Contents of the
  Doctors Bag 2000
• Standards New Zealand Technical Management
  Programs for Medical Devices AS/NZS3551 224 and
  Amendment 1 2005

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Caroline Allen

• Pharmacy Facilitator
• Nelson Bays Primary Health Organisation
• PO Box 1776
• Nelson 7040
• Ph 03 5391651 or 0800 731 317
• Mobile [phone]
• Fax [phone]
• www.bewell.org.nz
• e-mail Caroline.Allen_at_nelsonpho.org.nz