Applied Pharmaceutical Practice APP Prelims 22/8/08 1:15 Pm Page 2 APP Prelims 22/8/08 1:15 Pm Page 3
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APP prelims 22/8/08 1:15 pm Page 1 Applied Pharmaceutical Practice APP prelims 22/8/08 1:15 pm Page 2 APP prelims 22/8/08 1:15 pm Page 3 Applied Pharmaceutical Practice Christopher A Langley Senior Lecturer in Pharmacy Practice Aston University School of Pharmacy, Birmingham, UK and Dawn Belcher Teaching Fellow, Pharmacy Practice, Aston University School of Pharmacy, Birmingham, UK London • Chicago APP prelims 22/8/08 1:15 pm Page 4 Published by the Pharmaceutical Press An imprint of RPS Publishing 1 Lambeth High Street, London SE1 7JN, UK 100 South Atkinson Road, Suite 200, Grayslake, IL 60030–7820, USA © Pharmaceutical Press 2009 is a trade mark of RPS Publishing RPS Publishing is the publishing organisation of the Royal Pharmaceutical Society of Great Britain First published 2009 Typeset by Photoprint Typesetters, Torquay, Devon Printed in Great Britain by Cambridge University Press, Cambridge ISBN 978 0 85369 746 6 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, without the prior written permission of the copyright holder. The publisher makes no representation, express or implied, with regard to the accuracy of the information contained in this book and cannot accept any legal responsibility or liability for any errors or omissions that may be made. The right of Christopher A Langley and Dawn Belcher to be identified as the authors of this work has been asserted by them in accordance with the Copyright, Designs and Patents Act, 1988. A catalogue record for this book is available from the British Library. APP prelims 22/8/08 1:15 pm Page 5 Contents About the authors ix Preface xi Abbreviations xiii 1 Introduction, medicines classification and standard operating procedures 1 1.1 Introduction 1 1.2 The layout of this book 1 1.3 Medicines classification 2 1.4 Standard operating procedures 6 1.5 Chapter summary 9 2 NHS supply in the community 1 – Prescription forms and prescribing 23 2.1 Introduction 23 2.2 NHS prescription supply 24 2.3 Supplies of prescription items via the NHS within the community 30 2.4 The Drug Tariffs 30 2.5 Items which may be prescribed on an NHS prescription form 40 2.6 Restrictions to supply on an NHS prescription form 42 2.7 Chapter summary 44 3 NHS supply in the community 2 – Prescribers and the dispensing process 45 3.1 Introduction 45 3.2 NHS prescribers 45 3.3 The dispensing procedure for NHS prescriptions 48 3.4 Patient Group Directions (PGDs) 57 3.5 Worked examples 64 3.6 Chapter summary 94 APP prelims 22/8/08 1:15 pm Page 6 vi Applied Pharmaceutical Practice 4 NHS supply within hospitals 95 4.1 Introduction 95 4.2 Supply of medication within a hospital setting 97 4.3 The dispensing procedure for hospital supply 102 4.4 Worked examples 105 4.5 Chapter summary 119 5 Non-NHS supply 121 5.1 Non-NHS (private) prescription supply 121 5.2 Written requisitions 127 5.3 Oral requests for medicines supply by practitioners 136 5.4 The dispensing procedure for non-NHS prescriptions 136 5.5 Worked examples 137 5.6 Chapter summary 153 6 Controlled drugs 155 6.1 Introduction and the history of controlled drugs 155 6.2 Classification of controlled drugs 156 6.3 Practical application of the Misuse of Drugs Act and Regulations 157 6.4 Worked examples 169 6.5 Chapter summary 179 7 Emergency supply 181 7.1 Emergency supply at the request of a practitioner 181 7.2 Emergency supply at the request of a patient 186 7.3 The urgent supply of medicines or appliances to patients via Patient Group Direction in Scotland 191 7.4 Chapter summary 193 8 Patient counselling and communication 1 – The basics of patient communication 195 8.1 Interpersonal communication 196 8.2 Questioning 200 8.3 Listening 205 8.4 Explanation 206 8.5 Case studies responding to symptoms or over-the-counter requests 208 8.6 Explaining and educating patients to improve concordance 217 APP prelims 22/8/08 1:15 pm Page 7 Contents vii 8.7 Written communication 220 8.8 Communication with other healthcare professionals 221 8.9 Chapter summary 225 9 Patient counselling and communication 2 – Product-specific counselling points 227 9.1 Ear drops and sprays 227 9.2 Eye drops 228 9.3 Eye ointments 231 9.4 Inhalers 232 9.5 Liquid oral dosage forms 237 9.6 Nasal drops 239 9.7 Nasal sprays 241 9.8 Oral powders 242 9.9 Patches 243 9.10 Pessaries and vaginal creams 244 9.11 Suppositories 245 9.12 Tablets and capsules 246 9.13 Topical applications 250 9.14 Chapter summary 253 10 Poisons and spirits 255 10.1 Poisons 255 10.2 Spirits 261 10.3 Chapter summary 266 Answers to exercises 267 Appendix 1 – Commonly encountered qualifications of healthcare professionals 273 Appendix 2 – Abbreviations commonly used within pharmacy 275 Bibliography 279 Index 281 APP prelims 22/8/08 1:15 pm Page 8 APP prelims 22/8/08 1:15 pm Page 9 About the authors Christopher A Langley BSc, PhD, Dawn Belcher BPharm, MRPharmS, MRPharmS, MRSC, FHEA FHEA Chris Langley is a qualified pharmacist who Dawn Belcher is a qualified pharmacist who graduated from Aston University in 1996 and graduated from the Welsh School of Pharmacy then undertook his pre-registration training at in 1977 and then undertook her pre-registration St Peter’s Hospital in Chertsey. Upon registra- training with Boots the Chemist at their Wolver- tion, he returned to Aston University to under- hampton store. After registration she worked as take a PhD within the Medicinal Chemistry a relief manager and later as a pharmacy Research Group before moving over full-time to manager for Boots the Chemist until 1984. Pharmacy Practice. He is currently employed as While raising a family she undertook locum a senior lecturer in pharmacy practice, special- duties for Boots the Chemist and in 1986 ising in teaching the professional and legal became an independent locum working for a aspects of the degree programme. small chain of pharmacies in the West Midlands, His research interests predominantly sur- while also working for Lloyds Chemist. round pharmacy education but he is also In 1989 she began sessional teaching with the involved in research examining the role of the Pharmacy Practice group at Aston University pharmacist with both primary and secondary which continued until she took a permanent care. This includes research into the pharma- post in 2001. She now enjoys teaching practical cist’s role in public health and the reasons aspects of pharmacy practice while still keeping behind and possible solutions to the generation an association with Lloydspharmacy, where she of waste medication. is employed as a relief manager. ix APP prelims 22/8/08 1:15 pm Page 10 APP prelims 22/8/08 1:15 pm Page 11 Preface This text is designed to guide the student pharmacist or pharmacy technician through the main stages involved in pharmaceutical dispensing. The purpose of the book is to provide students with a core reference text to accompany the compulsory dispensing courses found in all undergraduate MPharm programmes and equivalent technical training courses. Christopher A Langley Dawn Belcher Birmingham, United Kingdom August, 2008 xi APP prelims 22/8/08 1:15 pm Page 12 APP prelims 22/8/08 1:15 pm Page 13 Abbreviations ACBS Advisory Committee on Borderline Substances ACE angiotensin converting enzyme ADHD attention deficit hyperactivity disorder CD controlled drug CDA completely denatured alcohol CHI community health index CHIP Chemicals (Hazard Information and Packaging for Supply) Regulations CMP clinical management plan DEFRA Department for Environment, Food and Rural Affairs DPF Dental Practitioners’ Formulary ESPS Essential Small Pharmacies Scheme ETP electronic transmission of prescriptions FHSAA Family Health Services Appeal Authority GMC General Medical Council GOC General Optical Council GP general practitioner GSL general sale list HIV human immunodeficiency virus HPC Health Professions Council HRThormone replacement therapy HSW Health Solutions Wales IDA industrial denatured alcohol IMS industrial methylated spirit MAOIs monoamine oxidase inhibitors MDI metered dose inhaler MF Measured and fitted MHRA Medicines and Healthcare products Regulatory Agency MMS mineralised methylated spirits MURs medicines use reviews NCSO no cheaper stock obtainable NHS National Health Service NHSBSA National Health Service Business Services Authority NMC Nursing and Midwifery Council OP original pack OTC over-the-counter P pharmacy medicine PCO Primary Care Organisation PCTPrimary Care Trust xiii APP prelims 22/8/08 1:15 pm Page 14 xiv Applied Pharmaceutical Practice PGDs Patient Group Directions PIL patient information leaflet PIN personal identification number PMR patient medication record PO pharmacy only POD patients’ own drugs POM prescription-only medicine PPD Prescription Pricing Division PSD Practitioner Services Division RPSGB Royal Pharmaceutical Society of Great Britain SLS Selective List Scheme SOPs standard operating procedures SPC summary of Product Characteristics TSDA trade specific denatured alcohol TTA to take away TTO to take out ZD zero discount APP Ch-01 27/8/08 10:52 am Page 1 1 Introduction, medicines classification and standard operating procedures 1.1 Introduction .................................... 1 1.4 Standard operating procedures ........... 6 1.2 The layout of this book ..................... 1 1.5 Chapter summary .............................. 9 1.3 Medicines classification ..................... 2 Upon completion of this chapter, you should be effective medicines supply. The purpose of the able to: book is to provide student pharmacists with a core reference text to accompany the compul- • understand the layout of this book and the sory dispensing courses found in all MPharm broad contents of the different chapters programmes.