Transcript Question 1 - pharmacyunisa wiki

Forensic Pharmacy
Small group questions: March 09
Question 1
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You receive the
following prescription
at your pharmacy for
a regular patient.
Dr. R.Kimble
All night Clinic
Glenroy 3046
15/03/09
Samuel Gerard
Marshall St.
Broadmeadows
Ordine 10
Ordine 10
Take 8ml by metric measure q6h prn
8 (eight) ml q6h prn
Qty 200ml
two hundred ml
No repeats
no repeats
Signed
Dr R.Kimble
Dr. R Kimble
Question 1
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You are familiar with Dr.Kimble’s
handwriting and this appears to have
been written by him.
According to your records Samuel has
not had Ordine in the past
He infrequently fills prescriptions for
Panadeine Forte
His history shows a course of Bactrim
last week
Dr.Kimble is his regular doctor
According to his wife, he has been
prescribed this medication as he has
severe mouth ulcers caused by a
reaction the doctor called “Steven
something syndrome”.
He is having a great deal of difficulty
swallowing tablets and is in an
amount of pain
Dr. R.Kimble
All night Clinic
Glenroy 3046
15/03/09
Samuel Gerard
Marshall St.
Broadmeadows
Ordine 10
Ordine 10
Take 8ml by metric measure q6h prn
8 (eight) ml q6h prn
Qty 200ml
two hundred ml
No repeats
no repeats
Signed
Dr R.Kimble
Dr. R Kimble
Question 1
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What do you need to
consider before
dispensing this
script?
Dr. R.Kimble
All night Clinic
Glenroy 3046
15/03/08
Samuel Gerard
Marshall St.
Broadmeadows
Ordine 10
Ordine 10
Take 8ml by metric measure q6h prn
8 (eight) ml q6h prn
Qty 200ml
two hundred ml
No repeats
no repeats
Signed
Dr R.Kimble
Dr. R Kimble
Answer… question 1
Your answer should cover..
 Requirements for DD scripts
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Aside usual particulars, presence of Dr’s handwritten verification of
quantity and number of repeats.
Acknowledgement that for computer generated prescriptions all
particulars other than date and patient’s name and address to be
handwritten
Assessment of validity of prescription (with consideration to
forgery) acknowledging familiarity with handwriting and signature of
doctor.
Consideration of potential for abuse with this drug - no previous
history of supply within 8 weeks / increasing quantities or frequency
of supply / no evidence of doctor shopping.
Answer… question 1
 Appropriateness and safety of medication
prescribed
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Ordine may be most appropriate pain killer as in
liquid form but STRENGTH!!! 10mg/ml would give
patient 80mg as a single dose. Given he is opioid
naïve… this dose is too high.
Prescription would not be dispensed if doctor was
unavailable
Note: Schedule 3 of Health Professionals Act: Part 9(a) “medicines are
dispensed in accordance with an order or prescription as far as the
dispensing is consistent with the safety of the person who is to use the
medicines”.
Question 2
“A pharmacist made alterations to the dispensary of their pharmacy to
facilitate the development of the compounding side of the pharmacy. The
alterations were made without the necessary application to the Board. On
inspection on another matter about six months later the alterations were
discovered. The alterations were found to be totally unsatisfactory for
compounding in that walls, floor and fittings in the compounding room
were not adequately sealed to prevent contamination of the medicines
compounded. The pharmacist concerned was aware that the Board
approval process should have been followed but did not do this owing to
the difficulty in finding a suitable tradesperson to complete the job.
The panel found that the pharmacist had engaged in unprofessional
conduct and that the pharmacist be reprimanded”.
From PBV Circular Nov 2006
Question 2
What is “unprofessional conduct” ?
 In what way is this unprofessional
conduct?
 What actions could the Board have taken
on discovery of the alterations?
 What processes could have been
followed?
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Answer… question 2
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Some definition of “unprofessional conduct”
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Actions the Board could have taken
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Eg. As defined in Health Professionals Act: Part 1.
(s.3)
Notification and commencement of investigations
Hearings
Penalties
Process which should be followed..
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Appendix 14 of PBV Guidelines- Approval of
premises flow chart
Guidelines 628-633 Application Procedures
Answer… question 2
Note: Schedule 3 of HPR Act 2005
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“Part 1. “The premises are to be a)
b)
c)
d)
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Laid out in a manner consistent with safe
pharmacy practice
Maintained in a clean and hygienic manner
Maintained at a suitable temperature and humidity
Equipped with the necessary equipment and
reference material
The different parts of the premises are
properly situated and are secure and suitable
for the purposes for which they are to be
used”
Question 3
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A pharmacy technician can be a valued
asset in your pharmacy, able to assist
with many dispensary duties that do not
require “professional judgment”. One of
these is control of stock - filling shelves,
ordering (etc) in the dispensary.
Question 3
Are there any special requirements with
respect to S8 medications?
 Can a dispensary technician be allowed
access to the safe?
 May a tech fill scripts for S8 medications?
 Can a dispensary technician fill out the
DD book?
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Answer… question 3
Answer could include references to..
 DPCS Act and Regs
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“authorised persons”
Storage of S8 medications
Records of S8 medications
PBV circular Sep 06
Suggests pharmacists should personally carry out the following (in addition to their usual role):
“personally check the authenticity of the prescription, selects the item fro the DA safe and
records the transaction in the DA register” , “pharmacist should ensure that they undertake
all transactions involving S8 medications and that pharmacy technicians are not involved “
(following some recent cases of diversion) and also “Pharmacists are personally
responsible for all aspects of the dispensing process involving dispensary assistants and
the supervision of pharmacy technicians is a legal obligation”.
Answer… question 3
Note: HPR Act schedule 3 (AGAIN!!)
7. A registered pharmacist must oversee the area
of the pharmacy or pharmacy department
where pharmacy services are provided.
8. A registered pharmacist appointed to act as the
pharmacist in charge must oversee, supervise
and monitor all registered pharmacists
providing pharmacy services in the pharmacy or
pharmacy department and any other staff who
assist in the provision of pharmacy services.
Question 4
Regarding faxed prescriptions…
“A doctor prescribed lisinopril with
hydrochlorothiazide. A fax of the prescription was
sent to a mail order pharmacy. The pharmacist
interpreted the strengths as 20mg and 25mg,
respectively but what had been written was
20/12.5mg. A subtle vertical gap in the faxed copy
had obliterated the “1” in the 12.5mg and the
decimal dot between the “2” and the “5” in the
“12.5” had been interpreted as one of many stray
marks on the faxed prescription”
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From PBV circular Sep. 2006
Question 4
What are the specific guidelines regarding
faxed prescriptions?
 What procedures must pharmacist
dispensing mail order / internet
prescriptions have in place in order to
comply with the law?
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Answer… question 4
Should cover…
 PBV Guidelines 463-464 re: fax prescriptions
 PBV Guidelines 458 re: distance dispensing
 And again! Schedule 3:
“a) medicines dispensed in accordance… with safety of
the person”
Also
f) Distance dispensing is carried out according to good
pharmaceutical practice”
Question 5
“The Board recently considered a report of a person
(who was previously a registered pharmacist)
practising for nearly three years without being
registered. This person worked as a locum for a
number of pharmacists and for a number of locum
services. The Board considers practising as
pharmacist when not registered to be a very serious
matter, as a non-registered person practising as
pharmacist may put the public at risk.”
PBV Circular Sep 2006
Question 5
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As PRUIC of your pharmacy one of your
responsibilities is to ensure that at all times the
pharmacy is supervised by a pharmacist.
When employing a new pharmacist how do you
ensure this occurs?
If you employ a pharmacist who is unregistered
are you responsible?
How and why are pharmacists deregistered?
What requirements does the PBV have for
registration of pharmacists who have
undertaken their traineeship in Victoria?
Answer… question 5
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CHECK for current Board Registration Card!!
Yes, you are liable!
Deregistration occurs: if a pharmacist is
suspended or has had registration cancelled as
a result of proceedings against him/her ; if the
annual fee is not paid up and registration
renewal not received prior to closing date
Registration requirements in Guidelines (201202) and HPR Act Part 2
You want more???
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Where must pseudoephedrine products be
stored?
May a doctor prescribe for a family member?
What about for themselves?
Can we fill prescriptions from overseas?
Can you sell cigarettes in a pharmacy?
Can a GP prescribe Ritalin?
Can you sell more than one box of a
psuedoephedrine containing product?
Can we return scheduled medicines?
 Can you send DD’s with a delivery boy?
 Can you ever give more than 3 days
emergency supply?
 Can a shop girl fill a dosette?
 Can a pharmacy depot sell S3 items?
 Who can destroy S8 medications?
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Can we supply any medications to podiatrists?
Can you supply 2 days on a DD script if you
unsure if it is forged?
Can you drink your coffee in the dispensary?
Do C & A labels need to go on Webster Paks?
Can you sell Acetone over the counter?
How is it labelled?
What schedule(s) are:
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Hydrocortisone 0.5%?
Hydrocortisone 1%?
Iron ?
Folic Acid ?
Nicorette microtabs?
Doxylamine ?
Salbutamol?
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Dihydrocodeine?
Paracetamol ?
Ketoconazole ?
Pseudoephedrine?
Cocaine?
Codeine?
Fluvax?
Neo-Cytamen?
And just when you thought we
were finished…
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Does a parent have access to their child’s
health information?
Do the police have access to prescription
records?
Can you refuse to supply an individual with their
own health information?
Can you divulge concessional benefit
information to another pharmacy?
Can you divulge medical information to a
hospital pharmacist?
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What medical information can you supply to an
individual’s doctor?
What do you need to obtain prior to divulging
information?
Can you write patient notes such as “cranky
woman” on an individual’s file?
What about “doctor shopper”?
How do you satisfactorily destroy health
records?