QUICK GUIDE TO PRESCRIBING, MEDICINE SUPPLIES AND SUPPORT FROM YOUR PHARMACY INDEX Page Adverse Drug Reaction 6 Antibiotic Policies 6 CIVAS (Central IV addictives service) 3 Clinical Pharmacy Service 1 Controlled Drugs 5 Cytotoxic Service 3 Directorate Pharmacists 8 Discharge Medication 5 Dispensary Opening Hours 2 Emergency Cupboards 2 Emergency Duty Service 3 Formulary 6 Free Samples 7 IV administration by Nurses 7 Medical Representatives 7 Medicines Information Centre 1 New Medicines 6 Parenteral Nutrition Service 3 Patients Own Drugs (POD) Service 7 Prescribing – general guidance 4 Prescribing for self or other staff 7 Product Defects and Product Recalls 6 Self Prescribing 7 PHARMACY Welcome to pharmacy. In addition to supplying medicines, we can offer helpful advice and guidance on their use. Access to this information may be gained by three routes: The Regional Medicines Information Centre The Clinical Pharmacy Service The Dispensary 1. Regional Medicines Information Centre (ext. 6908/9) or Email: medicinesinformation@suht.swest.nhs.uk Provides advice on medicines and drug therapy and has access to considerable information resources, as well as local and national experts. Please phone or call in if you need information on any medicine related topic such as: Choice of therapy Administration/Dosage Adverse effects Availability/supply Identification Interactions Pharmacology/Pharmacokinetics Drugs in pregnancy Drugs in breast feeding Alternative medicine Substance misuse Information on new drugs The centre is located near the lifts to the right of the foyer on C level at SGH, and is open 8.45a.m. - 5.15p.m. Monday – Friday. It serves all healthcare professionals in both primary and secondary care. Also look at our websites: www.ukmi.nhs.uk and www.druginfozone.org The service does not normally provide POISONING INFORMATION. Urgent enquiries related to poisoning should be referred to one of the National Poisons Centres (as listed in the front inside cover of BNF). 2. Clinical Pharmacy Service Most wards have a Pharmacist who visits them each day at an agreed time. The Pharmacist checks that the prescriptions you write are clear, legally correct and safe. They are there to offer you information about any potential problem. 1 3. Dispensary The dispensaries are open for information and supply of medicines at the following times: Hours of Opening Southampton General Hospital Monday, Tuesday, Thursday, Friday: Wednesday Saturday Sunday (for urgent TTO’s only) 9.00 a.m. to 5.00 p.m. 9.30 a.m. to 5.00 p.m. 9.00 a.m. to 12.30 p.m. 11.30 a.m. to 12.30 p.m. Southampton Eye Unit, S.G.H. Monday to Friday (mornings) : Monday to Thursday (afternoons): 9.00 a.m. to 1.00 p.m. 2.00 p.m. to 5.00 p.m. Southampton Oncology Centre, SGH Monday to Friday 9.00 a.m. to 5.00 p.m. Saturday and Sunday Closed (for emergency supplies the main pharmacy may be used) Royal South Hants Hospital Monday Tuesday, Thursday, Friday Wednesday Saturday: 8.30 a.m. to 5.00 p.m. 9.15 a.m. to 5.00 p.m. 8.30 a.m. to 11.30 a.m. Lymington Hospital Monday and Tuesday: 8.30 a.m. to 1.00 p.m. 2.00 p.m. to 5.00 p.m. 8.30 a.m. to 1.00 p.m. 8.30 a.m. to 1.00 p.m. 2.00 p.m. to 5.00 p.m. Wednesday: Thursday and Friday: 4. Emergency Cupboards Apart from Lymington, there is no access to Pharmacies outside the hours given above, but each department has an emergency cupboard nearby, which is available to medical staff. Newly appointed medical staff are invited to seek the assistance of pharmacy staff in order to become familiar with the local arrangements for obtaining keys and the location of the emergency cupboard. It would be helpful if details of all items taken from the cupboard could be entered in the book provided, so that stock can be replaced promptly for the next emergency. The controlled drug cupboards in the Pharmacies are not accessible when the departments are closed, but adequate stock is normally available on the wards. 2 5. Emergency Duty Service In an emergency, a Pharmacist can be contacted for information about medicines or their supply through the hospital switchboard at Southampton General Hospital. 6. Parenteral Nutrition Service Guidelines on the use of PN and other nutrition support are available on all wards (“The Nutritional Management of your Services”). The Parenteral Nutrition (PN) service is available from the Pharmacy at Southampton General. Requests for PN solutions for adults are made through Clinical Pharmacists or the Nutrition Support Team, who agree with Pharmacy a range of standard formulations - requests must be received by 12.00 noon, at the latest, on the day on which they are required. Requests for paediatric of neonatal PN are made through the clinical pharmacists or the pharmacy PN unit. All orders for these must be received by the Manufacturing Unit not later than 2.00 pm on the day on which they are required. The service operates on five days a week only. Prescriptions for Saturdays and Sundays are prepared on Thursdays and Fridays. For further information on PN, contact the Nutrition Support Team Bleep 2082/1361 or the Technical Services Pharmacist at SGH (ext 8352 or 6090 or bleep 2599). Out of hours contact Emergency Duty Pharmacist for advice. 7. Central intravenous Additive Service (CIVAS) The Pharmacy Technical Services section operates a central intravenous additive service to the Cancer Care Directorate, Child Health Directorate, NNU, Elderly Care and Critical Care Directorate and for patients receiving treatment at home. The service provides a range of antibiotics in a ready to give form, ie. bag, syringe etc. This service exists to reduce wastage on the wards, release nursing/medical staff time from the task of reconstituting drugs, as well as ensuring this is done under aseptic conditions. Contact Senior Technician or pharmacist on ext 6384. 8. Cytotoxics A centralised oncology pharmacy service is available at SGH. This satellite unit provides a full service to oncology by having its own dispensary and aseptic unit. Under Trust health and safety policies, all cytotoxics must be prepared in the specialised facilities available in pharmacy, and handled on the ward by trained and approved staff. Drugs will be provided in the most ready use form. Prescriptions should be sent to the pharmacy no later than 3pm on the day the drugs are required. For dermatology and bladder instillations at the RSH, prescriptions must be faxed to the oncology pharmacy on Fax 6762 and the original prescription taken to the RSH pharmacy which will be released on receipt of the drugs from SOCP. For further information contact the Service Manager on Ext 3125 or Bleep 2480. For the Directorate Pharmacist Bleep 1128. Out of hours contact the emergency duty pharmacist as described in Section 5. 3 9. Prescribing and the Use of Drug Administration Charts The British National Formulary (BNF) and the BNF for Children are excellent prescribing guides. Approved names from this text should be used wherever possible. All medicines, including additives to intravenous infusions, should be prescribed on the drug chart. Directions for Use of the Charts Prescriptions should be written in ink in capital letters. Abbreviations: the following are permissible: S.C. I.M. I.V. Sub ling O - Subcutaneous Intramuscular Intravenous Sublingual Oral All other routes of administration should be written in full, eg. intrathecal. The dates, times and routes of administration must be explicit. Changes in drug therapy must be ordered by a new prescription, after deleting the discontinued drug. It is not acceptable to amend items. Discontinue a drug by clearly crossing out the discontinued drug, and drawing a line through the unused recording panel. Sign and date all discontinuations. Dosage should be given in metric figures. Circle the appropriate units on the chart or write them clearly Full Signature must be used by the doctor prescribing in addition please print your name and bleep number. Length of Treatment if known to be limited, e.g. antibiotics should be indicated. 3 Controlled Drugs, eg. morphine; special regulations apply to medicines of this type. It is essential that the total number of doses to be administered is specified. If this is not done, only one dose can be administered by the nursing staff. For outpatients and those going home, the prescription must be in ink or otherwise indelible, in the prescriber’s own handwriting, signed with their usual signature and dated by them. They must also specify: i) The patients name. ii) The dose to be taken. iii) The form of the preparation. iv) The strength of the preparation (if more than one strength is available). v) The total number of dosage units to be supplied (in words as well as figures). If more than one strength is required to make a dose the quantity of each must be stated. For example: Morphine Sulphate slow release capsules 50mg BD for 7 days. Total quantity (14), fourteen capsules of 30mg and (28) twenty eight capsules of 10mg.. Since this is a legal requirement, Pharmacists will return to the prescriber, for correction, any prescription which does not comply fully with the above regulations for dispensing. Timing of Administration: for inpatients this should be chosen (where possible) to fit in with the nursing practices on the unit concerned. In most instances, if it is not necessary to give a drug at 6.00 am when it will have to be given by the night staff who are very busy at that time. For regular medication, the appropriate time box should be ticked to indicate when the medicine should be given. Where the dose of medicine is likely to be frequently changed, the drug should be prescribed in the variable dose section at the bottom right hand corner of the prescription sheet. Discharge Medication should be prescribed on the HMR, or other approved form. In some directorates pharmacist may write TTO’s and dispense in advance of the doctors signature. In these instances it is the responsibility of the doctor to check and sign the TTO prescription BEFORE the patient is discharged. All medicines that the patient is taking must be included on the TTO form, irrespective of whether patients have their own supplies (see also section 19 PODs) Short Term Leave Mental Health and Learning Disabilities services have a separate form for short term leave. 5 10. Formulary The Drugs Committee, at the request of the Clinical Management Group, has produced a formulary for hospital prescribing in Southampton Hospitals. The Formulary includes a range of medicines intended to cover the majority of prescribing requirements. It is designed to make your choice simpler and easier to remember. All hospital medical staff are expected to prescribe from the formulary. If it is necessary to prescribe an unlisted drug for an individual patient, this can be arranged with the clincal pharmacist. Non-formulary drugs will not normally be held in stock and there is often a delay in supplying them. 11. Antibiotic Policy There are antibiotic policies giving details of preferred drugs for various indications. You are asked to consult these before prescribing antibiotics. Contact your directorate pharmacist for details. 12. New Medicines Requests for new medicines to be stocked by the Pharmacies may be made by Consultants. Forms are available from Directorate Pharmacists. Requests will be considered by the Drugs Committee. In each case, the applicants will be informed of the Committee’s decision, giving reasons for rejections if the request if refused. Approved medicines are added to the Formulary. If the addition is not approved, the product will not be stocked. 13. Adverse Drug Reactions Suspected adverse drug reactions should be reported on yellow forms in the back of the BNF. All reactions to new drugs (identified by the sign in the BNF), and serious or unusual reactions to all other drugs, should be reported. Completed cards should be handed to the ward pharmacist or sent to the Medicines Information Centre, Southampton General Hospital. The cards will be collated and forwarded to the CSM. Confidentiality will be maintained. Note that hospital pharmacists may also report suspected adverse drug reactions to the CSM. 14. Product Defects and Product Recalls All product defects should be notified to pharmacy who will investigate and take any necessary action. Pharmacy are notified of product recalls through the national scheme administered by the Medicines and Healthcare products Regulatory Agency (MHRA). Those clinical areas affected will then be notified by pharmacy in accordance with trust policy. 6 15. Administration of Intravenous Injections by Nursing Staff Qualified nurses with a certificate are allowed to give an approved range of drugs by intravenous injection. A policy outlining those which have been agreed within each specialty is available on each ward. 16. Medical Representatives Medical representatives must register at Main Reception and will be expected to observe the Code of Practice for the Pharmaceutical Industry, drawn up by the ABPI. See compendium of Data Sheets and Summary of Product Characteristics. 17. Samples It is Trust policy that samples of medical products, including medicated dressings and aerosols for use in the hospital, must never be left on wards, theatres or departments, nor given out at promotional meetings. Pharmacies do not accept samples. Samples of medicinal products for the private use of doctors should be sent to their private address or given to the doctor concerned personally on the specific understanding that they will not be used within the hospital. 18. Prescribing Medicines for Members of Staff The firm advice of the Department of Health is that staff working in the NHS should make the same arrangements as any other member of public and, if they are unwell or require medication, should go to their General Practitioner or to Staff Health Clinic. Under no circumstances should the in-patient prescription chart be used for staff medication. If self prescriptions are drawn, the normal charges will be made and the quantity supplied will follow the current Department of Health guidelines, ie. will be an emergency supply only. 19. Patients Own Drugs Scheme (PODS) This operates in some areas. Patients are encouraged to bring their own medicines in on admission. These are checked by pharmacy staff, or nurses, stored in either patient specific locked boxes or suitably designed trolleys and used for administration. Supplies are replenished by pharmacy, labelled with directions, in an attempt to reduce delays in discharge. However, medication must always be checked against the discharge prescription to ensure it is current and correct BEFORE the patient is discharged. 7 20. Directorate Pharmacists All Directorates have a Directorate Pharmacist who is responsible for co-ordinating the pharmaceutical service to the Directorate. Their functions include examining drug expenditure, providing information and advice and helping to develop guidelines for the use of medicines. The names and bleep numbers of Directorate Pharmacists are listed below. USEFUL TELEPHONE NUMBERS Southampton General Hospital (S.G.H.) Dispensary ext 4161 or 6312 Medicines Information ext 6908 or 6909 Email: medicinesinformation@suht.swest.nhs.uk TPN ext 8352 CIVAS ext 6384 Cytotoxic ext 8637 Southampton Eye Unit (S.G.H.) Southampton Oncology Centre Pharmacy Directorate Pharmacists Accident & Emergency Critical Care Surgical Division Medical Directorate Neurosciences Elderly Care Obs & Gynae Directorate Child Health & Neonatology Cancer Care Directorate Cardiothoracic Microbiology Theatres Mental Health Jennifer Thomson Mark Tomlin Sharron Millen Caron Weeks Emyr Morgan Kath Hayes Christina Nurmahi Amanda Bevan Debbie Wright Caroline Taylor Kieran Hand Victoria Hutchinson Rebecca Henry Royal South Hants Hospital Dispensary Lymington Hospital Dispensary Manager Community Hospitals Elderly & Elderly Mental Health ext 4836 ext 6668 ext 3282 bleep 2088 bleep 2221 bleep 2766 bleep 2407 bleep 2404 bleep 2408 bleep 9038 bleep 2805 bleep 1128 bleep 1235 bleep 1070 bleep 9179 bleep 2842 ext 2348/2625 Linda Collins 01590 663135 bleep 10 Caroline Bowyer Jane Dowsett Emma Smithson pager 07659 547369 pager 07659 535503 pager 07699 669809 8 D:\116107105.doc Dispensary Dispensary Aseptic Unit