Warwickshire LPC

Medicine Management and Prescribing during Covid-19

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Returned/Unwanted Medicines

NPA Guidance

Guidance Document

Check List

Flow Chart

Palliative Care / EOL

Priority medicines

Medicines reuse in care homes

Palliative Care Pharmacy List

Dental Care

GDP Prescribing Flowchart

Electronic Repeat Dispensing

eRD Announcement

eRD in Response to Covid-19

LPC eRD Resources

Controlled Drugs Guidance

Government Legislation

RPS Guidance

MHRA

Drug Safety Newsletter May 2020

Covid-19 Yellow Card Reporting

During the COVID-19 pandemic, there is a need to adapt clinical practices and procedures to respond to the situation and ensure patient care guidelines are consistent, safe and appropriate. This page contains guidance on various contingency plans and procedures that were put in place in response to the pandemic.


Frequently Asked Questions and Additional Support


  • Is the pharmacy obliged to accept returned medicines during Covid-19?
  • How can I make sure that unwanted medicines returned to the pharmacy pose no risk to the staff?
  • What is the purpose of the medicine reuse scheme in care homes?
  • How does the medicine reuse scheme work?
  • What’s the LPC Guidance on Palliative Care / EOL provisions?
  • How does the GDP emergency prescribing work?
  • What’s the eRD advice following the COVID-19 outbreak?
  • What are the patient consent requirements for eRD during Covid-19?
  • What are the CD regulations for pandemic supply?
  • When should I use the Coronavirus Yellow Card reporting site?
Is the pharmacy obliged to accept returned medicines during Covid-19?

Community pharmacies routinely accept unwanted/out-of-date/waste medicines for disposal from patients and households, as this is an NHS contractual requirement. It is important to note that this service has not been suspended during the current coronavirus (COVID-19) pandemic.

For patient safety reasons, it is important that patients and households remain able to return unwanted medicines to the pharmacy for disposal during the COVID-19 pandemic, to avoid the potential risk of accidents, overdoses and misuse. Community pharmacy teams have understandably expressed concerns about the potential for infection from unwanted medicines returned to the pharmacy for disposal, where the patient may have/had coronavirus (COVID-19).

The pharmacy also has a duty of care to support patient safety and accept unwanted medicines back for disposal in as safe a manner as possible. Safeguarding patient/public safety and that of the pharmacy team is of paramount importance. Both factors need to be considered when making a decision about whether your pharmacy can safely accept unwanted medicines for disposal at any specific point in time.

https://www.npa.co.uk/news-and-events/news-item/superintendent-update-guidance-on-returned-unwanted-medicines/

How can I make sure that unwanted medicines returned to the pharmacy pose no risk to the staff?
What is the purpose of the medicine reuse scheme in care homes?

Under usual circumstances, the re-use or recycling of another patient’s medicine is not
recommended by the Department of Health and Social Care (DHSC) as the quality of any
medicine that has left the pharmacy cannot be guaranteed. Any unused medicines would
normally be disposed of by returning them to a contracted external company or
community pharmacy.

However, there are increasing concerns about the pressure that could be placed on the
medicines supply chain during the peak of the COVID-19 pandemic. A medicines re-use
scheme for care homes and hospices could potentially ease some of that pressure in the
coming weeks.

How does the medicine reuse scheme work?

The guidance states that when medicines are out of stock and there is an immediate need for them, an alternative preparation should be prescribed and dispensed, as is usual practice where possible.

Where there is no suitable alternative or a prescription cannot be written for the alternative medicine (e.g. out of hours), the community pharmacy team that supplies the care home or hospice should ask the care home or hospice whether they run a medicines re-use scheme and whether they have any stock of the required medicine.

If stock of a re-used medicine is available in the care home or hospice, the community pharmacy team must share a copy of the prescription for that medicine with the home. Where the care home or hospice do not have a procedure in place to allow interim additions or amendments to MAR charts in their possession, the pharmacy could issue a new MAR chart for the product that is to be re-used.

A copy of the prescription could potentially be shared by sending an image of the prescription via NHSmail, where the care home has access to NHSmail. The supply of the medicine by the care home or hospice will need to be in accordance with that prescription; they cannot rely on a report of its contents.

https://www.gov.uk/government/publications/coronavirus-covid-19-reuse-of-medicines-in-a-care-home-or-hospice

What’s the LPC Guidance on Palliative Care / EOL provisions?

Palliative Care / EOL:

Each LPC geography has pharmacies signed up to support the provision of end of life (EOL) medicines and a list is available from the CCGs and on the LPC websites. You may also have heard about the possible increase in requirements due to Covid19 in hospices and care homes. If stock shortages occur with some key lines some care homes may have held back some stock to be reused. This will only come into play should a specific item or alternative be unavailable within timeframe needed. If you receive a prescription for EOL and cannot fill it within timeframe required you should contact one or more of the pharmacies holding stock as part of the CCG service to try and meet the requirements. Failing this, alternatives in stock should be suggested. If still some items outstanding you need to contact the home / hospice and check if they have a medicine reuse scheme in place and share a copy of the prescription as per guidance.

1. Where there is no available stock (Community Pharmacy contacted during opening hours) and a prescription cannot be written for the alternative medicine (e.g. out of hours or no alternative available), the community pharmacy team with responsibility for the prescription should ask the care home or hospice whether they run a medicines re-use scheme and whether they have any stock of the required medicine.

2. If stock of a re-used medicine is available in the care home or hospice, the community pharmacy team must share a copy of the prescription for that medicine with the home, this may be done by email or physical collection or delivery of the prescription. The supply of the medicine by the care home or hospice will need to be in accordance with that prescription. They cannot rely on a report of its contents.

3. Where possible the pharmacy should provide a new corresponding MAR chart, as necessary. If it is not possible to provide a new MAR sheet, and the patient resides in a residential home where there are no registered healthcare professionals on site, the registered healthcare professional authorising re-use should ensure that the MAR chart has been updated correctly, this may be done virtually.

In order to manage additional demand for end of life medicines, and ensure safe, equitable and compassionate care for patients, we have worked with the Association of Palliative Medicines, Royal College of GPs, Hospice UK and the Association of Supportive and Palliative Care Pharmacy to publish Priority medicines for palliative and end of life care during a pandemic. This clinical guidance for essential end of life medicines, which sets out the first and second choices for these medicines, will enable the NHS to conserve supplies, switch to alternative drugs when required and minimise
waste. This is also being used to guide the purchasing of medicines for the UK. It aims to support healthcare professionals working in palliative and end of life care, including GPs and pharmacists, across hospital, community, social care and hospice settings to work together in managing additional demand for end of life medicines due to COVID-19. This should be read alongside the recently published DHSC standard operating procedure on how to run a safe and effective medicines reuse scheme in a care home or hospice during the coronavirus outbreak.

http://www.coventrylpc.co.uk/wp-content/uploads/2020/05/LPC-Update-May-18th-2020.pdf

How does the GDP emergency prescribing work?

We have been working closely with our Local Pharmaceutical Committee and Local Dental Committee representatives, to implement a system in which dental practices can send electronic copies of prescriptions to community pharmacy. 

The aim is to minimise the volume of  paper FP10Ds being handed over to community pharmacy directly by patients. In the absence of a national system, we have therefore been pragmatic and are recommending a process based upon the principles of Emergency Supply at the Request of a Prescriber (see Medicines, Ethics and Practice Edition 43 July 2019 https://www.rpharms.com/publications/the-mep/mep-viewer-member).

We have agreed with LPC\LDC colleagues that dentists should scan an electronic copy of the prescription and send it to the community pharmacy’s NHS.net email account.  Dentists using this process have agreed that they will provide a written FP10D prescription within 72 hours. Dentists will also advise patients to inform their community pharmacy that a scanned copy of the prescription has already been emailed by the dental practice. Community pharmacies should process the emailed request in line with the legal requirements of the Emergency Supply at the Request of a Prescriber.  A summary of the process is attached (Appendix A).

This process of electronic communication has already been implemented in certain parts of the region during the COVID-19 pandemic and is working well. We therefore recommend that you note the contents of this update and support any dental patients who need a supply of medicines requested via this mechanism. Please could you send any enquires regarding this communication to england.pharmacypaymentswm@nhs.net with the subject header containing the words “GDP Prescribing”.

Thank you once again for your hard work, effort and commitment to providing pharmaceutical services during these challenging times. 

Kind Regards,

The Pharmacy Team
NHS England and NHS Improvement – West Midlands

What’s the eRD advice following the COVID-19 outbreak?

As part of the preparations to prioritise work and help manage an increased pressure on the health service, NHS England and NHS Improvement are advising that practices should consider putting all suitable patients on electronic repeat dispensing as soon as possible.

The whole repeatable prescription can be set up for as long as a year but each repeat should not be for longer than the patient has now.

For example, if the patient has prescriptions for a month’s supply now, then the repeat dispensing should be set up as up to 13 x 28 days’ supply.

https://www.nhsbsa.nhs.uk/pharmacies-gp-practices-and-appliance-contractors/prescribing-and-dispensing/electronic/electronic-repeat-dispensing-erd#jumplink0

https://psnc.org.uk/our-news/gp-practices-helped-to-identify-patients-eligible-for-erd/

What are the patient consent requirements for eRD during Covid-19?

Patient consent requirements for electronic Repeat Dispensing (eRD) have been temporarily suspended to encourage wider use of the system during the COVID-19 pandemic.

https://psnc.org.uk/our-news/temporary-changes-to-erd-consent-model-to-encourage-uptake/

What are the CD regulations for pandemic supply?

On 30th April 2020 changes to the Misuse of Drugs Regulations 2001 came into force to provide Ministers with emergency powers for the supply of Controlled Drugs (CDs) in specific circumstances during a pandemic. The regulations are enabling so may be used only if ‘activated’ by Ministers and apply in very limited circumstances.

The purpose of the changes is to ensure community pharmacies can continue to supply patients with essential medicines at critical times during a pandemic, such as the COVID-19 outbreak.

There are three changes which are briefly: emergency supply of a CD without a prescription; emergency supply of a CD against a Serious Shortage Protocol (SSP); and an emergency change to a CD instalment direction with the agreement of the prescriber – all only apply during a pandemic and are subject to various conditions. PSNC will give more details of the legislative changes and conditions shortly.

https://psnc.org.uk/our-news/cd-regulations-amended-for-pandemic-supply/

https://psnc.org.uk/our-news/rps-guidance-issued-on-new-cd-regulations-for-pandemic-supply/

When should I use the Coronavirus Yellow Card reporting site?

Use the new dedicated COVID-19 Yellow Card reporting site to report:

  • all suspected side effects associated with any medicine used in patients with confirmed or suspected COVID-19, including medicines to manage long-term or pre-existing conditions, and unlicensed medicines or medicines used off-label
  • medical devices incidents related to COVID-19

(for non-COVID related side effects from medicines please continue to report through the standard Yellow Card website, which can also be used for defective or falsified medicines and medical devices, including fake COVID-19 testing kits).

Source: MHRA



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