Guidelines for Pharmacists in Supervising the Daily Dosing of Oral Methadone Mixture To

Bexley, Bromley & Greenwich Health Authority

Supervised Administration of

Methadone (SAMs)

Community Pharmacists.

Scheme.

Procedures Supervised Administration of Methadone (SAMs) By Community Pharmacists. The procedures enclosed have been agreed with BAIS

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1. Coverage and Definitions

1.1 This document outlines the procedures for providing the service and has been split into pharmacist, client and prescriber responsibilities.

1.2 For the purposes of this document the pharmacist is the nominated pharmacist lead whom has undertaken training provided by the Health Authority on supervised administration of methadone, or a locum pharmacist who is fully conversant with these procedure.

1.3 For the purposes of this document, the client is the individual who has been included in the SAMs scheme and will have his/her dose of methadone witnessed by the pharmacist.

1.4 For the purpose of this document BAIS has responsibility for prescribing methadone for all clients that are included on the Bromley SAMs scheme.

2. BAIS Responsibilities

2.1 BAIS must reach an understanding with the client that methadone will be dispensed at a designated community pharmacy where administration and consumption of the methadone will be supervised by the pharmacist.

2.2 BAIS must negotiate the most suitable/convenient pharmacy, which is part of the scheme, with the client. The pharmacy must be contacted in advance by a representative of BAIS to gain agreement from the pharmacy and to discuss the dispensing arrangements for the client.

2.3 If the pharmacy accepts the client, the clinic must inform the pharmacy of the name and address of the client, the methadone dose, start and expiry date of the prescription and any other information relevant to the dispensing, e.g. client wants sugar-free

2.4 The maximum number of clients that any one pharmacy should be witnessing at one time will be agreed between the pharmacist, pharmaceutical adviser, BAIS representative and LPC representative following an on-site meeting between the parties. This is important so as to provide a manageable workload for the community pharmacist.

1All clients are to receive methadone daily, with a take home dose for Sundays and Bank Holidays.

2.5 Each client will have a nominated BAIS key worker. They will be responsible for liaising and co-ordinating the client’s care programme and will be the first point of contact for the pharmacist

3. Pharmacist Responsibilities

3.1 When the client arrives, the pharmacist must check the details of the introductory letter and register the client on the Patient Medical Record (PMR) system. The client should be given a PMR identification card, which they should be encouraged to show when collecting their methadone (where these are available).

3.2 Methadone should not be dispensed to clients who are intoxicated with drugs and/or alcohol. If the pharmacist suspects the client is intoxicated, he/she should telephone BAIS to inform them. If this occurs on a Saturday, then the pharmacist must dispense two take home doses for Saturday and Sunday and tell the client to consume the methadone as late as possible after they have “sobered up”. A report of the incident should be forwarded to BAIS and the client’s key worker for information.

3.3 Methadone must not be dispensed to any client who has missed three consecutive doses. BAIS should be notified of clients in this position. They must be referred back to BAIS (as their tolerance to methadone may have fallen.)

Where a daily dose of methadone has not been dispensed and supervised, the pharmacist must indicate this on the prescription as ‘not dispensed’ next to the relevant date. Entries should be made on the relevant data collection form(s). A missed dose should be reported to the BAIS key worker.

3.4 Where the dispensing service has been terminated for a client for whatever reason, the pharmacist should indicate “not dispensed” for any remaining days on the current prescription. Any prescriptions, which have not yet been started, should be returned to BAIS.

3.4.1 The pharmacist should go through the agreement form with the client and sign it in the space provided. The main issues to be covered are:

 time of day for supervision  missed doses cannot be dispensed at a later date  methadone will not be dispensed if client has missed three or more instalments  methadone will not normally be dispensed if the pharmacist suspects there is evidence of drug and/or alcohol intoxication (client to be referred back to the clinic for assessment.  client should come in alone

 acceptable behaviour

3.5 The pharmacist should introduce the client to key members of staff.

3.6 When a prescription is presented it should be checked to see if it is legal and if the quantities and patient details are correct for that client and that the prescription is signed.

3.7 Supervision should never take place in the dispensary. A designated area offering suitable privacy will be selected in each pharmacy and should be used for this purpose.

3.8 Doses of methadone should be made up in advance each day (assuming the pharmacist is in possession of a current prescription). Methadone should be dispensed into an appropriate child resistant container labelled in accordance with the requirements of the Medicines Act, and must be stored in the CD cabinet until the client arrives at the pharmacy.

3.9 Only methadone mixture 1mg/1ml purchased ready made, or methadone mixture 1mg/ml extemporaneously prepared, to an approved specified formulation, may be used.

3.10 When the client arrives, the pharmacist must ensure that the client is correctly identified and receives his/her dose of methadone.

3.11 The methadone may be consumed directly from the bottle or may be poured into a cup, as agreed by the pharmacists and client.

3.12 The pharmacist must observe the consumption of the methadone by the client and provide a glass of water for the client to drink and engage in conversation with the client. This is to ensure that the methadone has been swallowed.

3.13 All labels must be removed from the client’s dispensed containers before throwing away, to maintain client confidentiality.

3.14 Methadone may not be given to the client’s representative unless previously authorised by a member of BAIS. In this case, the dose can’t be supervised

3.15 Pharmacists should submit the data required and invoice no later than the 5th day after the end of each month. This data will consist of:

 number of patients

 number of supervisions

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3.16 Where an “incident” has occurred, the pharmacist must complete an “Incident Report Form” at the time of the incident and return it to Claire Unwin at BAIS. If the incident requires it or if you are concerned about a particular situation a telephone call should be made to BAIS.

3.17 All information and data collected specifically and only for this scheme should be treated as confidential and only passed on to authorised personnel.

3.18 The project file containing all data collection forms, details of how to operate the scheme, relevant telephone numbers, etc., should be kept in the dispensary at all times. They must not be passed on to anyone else, except those authorised to see it.

3.19 Locum pharmacists must be made aware of this service and the procedures IN ADVANCE of them providing locum cover when possible. It is essential that the service runs smoothly and all records are kept up to date. Further information for locums may be obtained from Andy Scott-Clark at Bromley Health Authority on telephone number 020 8315 8340.

3.20 Pharmacists should ensure that they have adequate insurance cover prior to commencing this service.

3.21 Pharmacists and staff who feel this scheme increases the risks of contracting Hepatitis B should make arrangements for Hepatitis B vaccinations with the Health Authority. For further information contact Andrew Scott-Clark at Bromley Health Authority (0208315 8340)

3.22 Pharmacists wishing to provide this service, must complete the training being offered by Bromley Health (two evening sessions), and make themselves available for future training sessions that may be needed for future development and update of the scheme.

3.23 It is also recommended to complete the CPPE package on Drug Dependence, although not compulsory

3.24 Minimum experience of 2 years nominated pharmacist (if less than assessment)

3.25 Pharmacists wishing to take part must also be working towards accreditation (Stage One) or already accredited. Unless exceptional circumstances, a participating pharmacy will be withdrawn from the SAMs scheme if accreditation is not achieved in a particular year.

3.26 All data and invoices should be sent for the attention of Peter Buck, HA DAT lead Bexley Bromley and Greenwich HA

4. Client Responsibilities

4.1 Clients should arrive at the pharmacy for their daily dose of methadone at the time agreed with the dispensing pharmacists. Clients should avoid presenting to the pharmacy for their daily dose of methadone within the last half hour of business.

4.2 Clients should conduct themselves in accordance with the details of the signed agreement.

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Supervised Administration of Methadone at the Community Pharmacy

Because the community pharmacists and BAIS will be sharing the responsibility for your care, this will obviously necessitate discussions between both parties. As part of their responsibility for your care and with regards to the scheme, the pharmacist will be keeping certain records about your attendance and adverse behaviour, which they will return to the clinic. If there are particular issues, which you wish to discuss with the pharmacist confidentially you must tell the pharmacist yourself.

Clients will be treated courteously and with respect by the community pharmacist and their staff. The client is expected to reciprocate and treat the community pharmacist, staff and premises with courtesy and respect. If the pharmacist feels your behaviour is unacceptable, they have the right to refuse to continue dispensing your prescription and refer you back to BAIS.

You will attend the pharmacy between the hours agreed by yourself and the community pharmacist on the specified days. At the community pharmacy you will be required to consume that day’s methadone, supervised by the community pharmacist.

You should attend alone and leave any pets outside the pharmacy.

The pharmacist will not dispense the methadone to clients who attend the pharmacy intoxicated with drugs and/or alcohol. In such circumstances the client will be required to return to the clinic for assessment.

The community pharmacist will not dispense the methadone to any client who has not attended three or more consecutive days. In such cases you will have to return to the clinic for assessment, as your tolerance may have fallen.

When you arrive at the pharmacy you should let one of the assistants/the pharmacist know and give your Patient Medication Record card. The dispensing of methadone will normally take place without delay so that you are not made to wait. However, there may be exceptional circumstances in the pharmacy when the pharmacist has to ask you to wait or return a little later. You should respect the pharmacist’s wishes under these circumstances.

All doses of methadone will be dispensed strictly in accordance with the instruction on the prescription, and may only be collected on the specified days. If a day’s methadone is missed, it cannot be collected the next day.

Methadone cannot be collected for clients by any representative unless previously authorised by a member of BAIS.

I have read and understood the above information and I agree to comply with the stipulations.

CLIENT:

Name: ______

Date: ______

Signature: ______

PHARMACIST:

Name: ______

Date: ______

Signature: ______

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Client Name: Type of incident: (tick one or more boxes)

Supervision refused  …………………………… Advice given  Contact with prescribing  Agency  Referral  Intoxication  Disruptive behaviour  Police called  Friends/family involved  Health related problem  Other 

…………………………………………….

Give full details of incident in space provided below

Please enter full details of incident and outcome in space provided.

Pharmacy Stamp Signed:______

Print Name:______

Send Copy to: Claire Unwin, BAIS, 111 Mason Hill, Bromley, BR2 9HT

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To be retained in the pharmacy and made available to locum pharmacist when necessary

Client Name

Address

Post Code

BAIS Keyworker

Contract signed YES NO circle Copy attached YES NO circle Client’s GP

Dose to be witnessed

Time agreed when witness will take place

Other information

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Supervised Methadone Monthly Claim Form

Name and Address of Pharmacy

Claim for month of:

Total Number of Clients:

Total Number of Supervisions/Witnesses: Fee per supervision/witness:

Total Claim for Month:

I confirm that my pharmacy has supervised the number above and I claim the total amount shown above.

Signed: Dated:

Pharmacist:

Please return to: TO BE AGREED

METHADONE SUPERVISION

Name of Client: Pharmacy Stamp:

Month:

Week Mon Tues Wed Thurs Fri Sat Sun Commencin g

Pharmacist to initial above on day of witness:

Signature: ______

Pharmacist: ______

D:\Docs\2018-04-14\0fdb6a597fb8e45c0498375189532db6.doc Supervised Administration of Methadone (SAMs) By Community Pharmacists. Form to returned to: Claire Unwin, BAIS, 111 Mason Hill, Bromley, BR2 9HT.

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