Community pharmacy practice

Aimed to assist Pharmacy staff (Techs, Pre-reg’s and Pharmacy Students) in ‘getting it right’ in practice and for exams.

Covers: Appliances, Dressings and Other non-medicinal products, and provision of services outside of the pharmacy).

1. Community Pharmacy Practice (UK) 15/07/2014 Ravina Barrett 1 Aimed to assist Pharmacy staff ( Techs, Pre- reg’s and Pharmacy Students ) in ‘getting it right’ in practice and for exams.

2. Aim and purpose This unit provides the knowledge required to assist in: The supply of appliances , Dressings and Other non-medicinal products , and The provision of services outside of the pharmacy . 15/07/2014 Ravina Barrett 2

3. Unit introduction This unit delivers knowledge and understanding that can be used by learners involved with the provision of community specialist services to colleagues, clients and other healthcare professionals. The impact of the role of pharmacy within the community healthcare environment is also considered . 15/07/2014 Ravina Barrett 3

4. So…..What? Following completion of this unit, learners will know how medication is supplied to care homes and the equipment and documentation involved. Learners will acquire knowledge to assist in the supply of appliances, dressings and other non-medicinal products using standard operating procedures, ensuring that payment for the product is processed as appropriate . The unit highlights the importance of correctly preparing for the delivery of services outside the pharmacy, including health and safety requirements, as well as the importance of working at all times within the limits of one’s own role . 15/07/2014 Ravina Barrett 4

5. Learning outcomes ( LO1 , LO2 , LO3 ) Understand how to assist in the provision of appliances, dressings and other non-medicinal products Understand how to assist in the provision of services outside of the pharmacy Know the national and local regulations and policies regarding supply of medicines to patients in care. 15/07/2014 Ravina Barrett 5

6. Prescriptions format and content We will cover: Rx FP10 Rx FP10 MDA Rx FP10 Token Exemptions By the end, you should be able to populate an empty Rx template. Homework: Find the blank copy of the Rx in your print-outs and then fill it out for one pair of hosiery. 15/07/2014 Ravina Barrett 6

7. ( LO1 ) The provision of appliances, dressings and other non-medicinal products Wound management: Features of commercial wound dressings; Primary and secondary dressings; External factors involved in wound healing; Unconventional methods to aid wound healing e.G. Maggot therapy, leeches, herbal remedies Maggot therapy - http ://upload.wikimedia.org/wikipedia/commons/9/97/Maggots.jpg http:// ewma.org/fileadmin/user_upload/EWMA/pdf/EWMA_Projects/Debridement/EWMA_Debridement_Document_JWCfinal.pdf 15/07/2014 Ravina Barrett 7

8. Some topical stuff… 15/07/2014 Ravina Barrett 8 http:// ewma.org/english/publications/position-documents/all-documents.html#c319 http://ewma.org/? id=243 *http :// ewma.org/fileadmin/user_upload/EWMA/pdf/Position_Documents/2006/English_pos_doc_2006.pdf *

9. Group Homework on Wounds  Groups to give a 5 min presentation (with hand-out's which I can reprint for peers) on 1 of th e following 7 types of dressing and bandages Describe the structure and function of each & Give one example of the following: Alginate dressings Foam dressings Hydrocolloid dressing Hydrogel dressings Vapour permeable films Odour absorbent dressings Cohesive bandages Deadline: Next Class Individual Homework on Wounds Identify and describe the physiological and external factors that need to be considered when assessing wound healing. 15/07/2014 Ravina Barrett 9

10. Task: Label these Dressings using the types of dressing and bandages category (slide 9). 15/07/2014 Ravina Barrett 10

11. Task: Label these Dressings using the types of dressing and bandages category (slide 9). 15/07/2014 Ravina Barrett 11 Bring in samples if you can so that we can share it with peers in the class room

12. Case Study Mrs Nom-Nom-Nom, a 65 year old lady has a leg ulcer that is producing medium amounts of exudate and is covered in a thin layer of sloughy tissue. She has swollen legs, has difficulty walking and is overweight. When you enter the PMR records you also discover that she is taking Metformin 500mg tabs . Explain what type of wound management product and/or other bandage you would expect to be prescribed and why giving an example of specific product(s).   What aspects of this case do you consider relevant to the healing process? Explain how you would counsel this patient to ensure effective use and ongoing management . 15/07/2014 Ravina Barrett 12

13. ( LO1 ) The provision of appliances, dressings and other non-medicinal products Surgical hosiery We will cover: Therapeutic use; Varicose veins; Measurement and fitting; Care and maintenance of products Take a look at the following link and watch the demo video http ://www.activahealthcare.co.uk/compression-hosiery/ 15/07/2014 Ravina Barrett 13

14. Endorsements and Prescription Pricing of Hosiery To price your prescription, NHSBSA Prescription Pricing Division processing staff need sufficient information about the product being dispensed. As a general rule, prescriptions for hosiery should include information on the Compression Class, Article style, Quantity and Knit. < compression class > <article style> <quantity> <knit> If appropriate < made to measure > 15/07/2014 Ravina Barrett 14

15. Task: what is…? Made to measure Elastic hosiery, explain how this is different to regular Elastic hosiery. Measured and Fitted , explain how this is different to regular Elastic hosiery Drug Tariff Part IXA - what characteristics of the product does it detail? 15/07/2014 Ravina Barrett 15

16. Elastic (Knee) Support Elastic Support is not the same as Surgical hosiery This is effectively a ‘tubular bandage ’ Rx’s can look as basic as this one 15/07/2014 Ravina Barrett 16

17. Surgical hosiery: Be able to identify what is essential info necessary on an Rx and what bits of info you can deduce/find out. What needs to be endorsed? Remember correct endorsement is essential to your job! 15/07/2014 Ravina Barrett 17

18. Drug Tariff Technical Specification No 40. (The number increments with the latest current version) Below (slide 19 – 22) we discuss relevant parts of the DT. You need to know (or at least be able to look-up when asked) the different classes of hosiery, their indication, level of compression and style. What needs to be on Rx – see slide 17. Check out the accessories that can assist disabled or elderly patients. Be able to recommend a product and demonstrate its use/application. 15/07/2014 Ravina Barrett 18

19.   ELASTIC HOSIERY Graduated Compression Hosiery, Specification 40 Explanation of Garments     N.B. The "Class" can be expressed either with roman or arabic numerals. Class I Light (Mild) Support       Compression at ankle 14mm Hg - 17mm Hg   Indications - Superficial or early Varices. Varicosis during pregnancy.   Styles - Thigh length or below knee with knitted in heel (reciprocated). Class II Medium (Moderate) Support       Compression at ankle 18mm Hg - 24mm Hg   Indications - Varices of medium severity       - Ulcer Treatment and prevention of recurrence. Mild oedema     - Varicosis during pregnancy     - Anklets and kneecaps: for soft tissue support   Styles - Thigh length or below knee with knitted in heel (reciprocated) Class III Strong support         Compression at ankle 25mm Hg - 35mm Hg   Indications - Gross varices     - Post Thrombotic Venous Insufficiency     - Gross Oedema     - Ulcer Treatment and prevention of recurrence     - Anklets and kneecaps: for soft tissue support   Styles - Thigh length or below knee open or knitted in heel (reciprocated) 15/07/2014 Ravina Barrett 19

20. 15/07/2014 Ravina Barrett 20 General Notes Prescribing Before the prescription can be dispensed the following details must be given by the prescriber. 1. Quantity - single or pair 2. Article including any accessories 3. Compression Class I, II or III Constructional Specification The complete structural specification, as well as performance requirements are contained in Drug Tariff Specification No. 40.

21. 15/07/2014 Ravina Barrett 21 Specially Made Garments       1. In cases where stock sizes are not suitable for patients owing to irregular limb dimensions, surgical stockings in the prescribed compression class, to be made to the patient's individual measurements, should be specified. 2 . All such garments are specially shaped during manufacture and may have a knitted in or open heel and open or knitted in toe. Sizing       All articles must conform to BS 6612:1985 with regard to size designation.   Labelling         All articles must state clearly on the packaging that they conform with Drug Tariff Technical Specification No 40. The packaging should also provide clear washing instructions in conformity with handwashing at 40°C as defined in BS 2747 and washing instructions should be durably and clearly marked on each garment. The packaging should clearly define the garments percentage and fibre content. DESCRIPTION OF ARTICLES AVAILABLE     Compression Class  (See  253 ) Type of Garment Standard Stock Sized Garments * Made-to- Measure Garments     Knit Style Price per pair in pence Price per pair in pence CLASS I Circular Thigh 799 4230       B. Knee 730 2646     Lt. Wt Elas . Net Thigh   2140     B. Knee   1671 CLASS II Circular Thigh 1188 4230       B. Knee 1067 2646     Net Thigh   2140       B. Knee   1671     Flat Bed Thigh   4230       B. Knee   2646 CLASS III Circular Thigh 1408 4230       B. Knee 1210 2646     Flat Bed Thigh   4230     B. Knee   2646            

22. 15/07/2014 Ravina Barrett 22 All such garments are specially shaped during manufacture and many have a knitted in or open heel and open or knitted in toe with the following exceptions: Class II/III  - Flat Bed Knit can only be supplied with closed heel and open toe. For Above Knee Stockings - see Thigh Length.       Accessories     Price per item in pence Acti -Glide       1428 Additional Price for Fitted Suspender   69 Arm Butler       800 Easy-Slide (application aid for open toe stockings) (S,M,L,XL) 1211 Easy-Slide Caran (application aid for closed toe stockings) (S,M,L) 1404 EZY -As compression hosiery applicator   3240 EZY -As compression hosiery applicator handles     1525 Foot Butler       800 Magnide     (M, L) 1404 Mediven 2 in 1       1233 Sockaid       1288 Spare Suspender for thigh stockings     69 Suspender Belt Drug Tariff Specification No. 13   532

23. Case Study: Mrs Kankles Mrs Kankles brings a prescription into the pharmacy for two pairs of thigh length, class II stockings. She tells you that this is the first time she has had a prescription for these items. Mrs Kankles has to pay for her prescriptions . 15/07/2014 Ravina Barrett 23

24. Task : Mrs Kankles Identify two conditions for which thigh length stockings could be prescribed . State the information you would give to Mrs Kankles about her prescription charges . Describe how you would measure Mrs Kankles to establish whether standard size hosiery could be used by this patient. Explain when would be the most appropriate time of day to take these measurements . Give two reasons why it is important to take accurate measurements . According to the Drug Tariff, state what information is required on the prescription before elastic hosiery can be dispensed? 15/07/2014 Ravina Barrett 24

25. Task : Mrs Kankles Describe how you would correctly fit Mrs K's stockings. This link may help https :// www.youtube.com/watch?v=Cvuziq5qS0U Explain how you would ensure that Mrs Kankles has fully understood the information given to her about her stockings Explain any additional advice you would give concerning care and maintenance of the hosiery and any other problems a patient may encounter. Explain how to endorse Mrs Kankle’s prescription Explain how to submit the prescription to the appropriate authority at the end of the month. 15/07/2014 Ravina Barrett 25

26. ( LO1 ) The provision of appliances, dressings and other non-medicinal products Stoma care: Reasons for use of urostomy, Ilieostomy and colostomy; Care and maintenance; Management and supply of ostomy products and accessories 15/07/2014 Ravina Barrett 26

27. Accessories Cleansing Solutions Disposal Bags 15/07/2014 Ravina Barrett 27

28. Urostomy A urostomy is a stoma for the urinary system. A urostomy is made to avail for urinary diversion in cases where drainage of urine through the bladder and urethra is not possible, (e.g . after extensive surgery or in case of obstruction). http:// en.wikipedia.org/wiki/Urostomy Extra Reading (even if you look at the pix ) http:// www.cancer.org/acs/groups/cid/documents/webcontent/002931-pdf.pdf Images: http:// tinyurl.com/qar76w8 15/07/2014 Ravina Barrett 28

29. Catheter 15/07/2014 Ravina Barrett 29

30. Urine Bag Urinary Collection Bag - Front Urinary Collection Bag - Back 15/07/2014 Ravina Barrett 30

31. Ben & Jerries , Strawberries & cream… Catheters &…? Male Catheter …….. Lubricating Jelly 15/07/2014 Ravina Barrett 31

32. Ilieostomy / Ileostomy noun : ileostomy; plural noun: ileostomies A surgical operation in which a damaged part is removed from the ileum and the cut end diverted to an artificial opening in the abdominal wall. Video: http://www.nhs.uk/conditions/Ileostomy/Pages/Introduction.aspx 15/07/2014 Ravina Barrett 32

33. Colostomy A surgical operation in which the colon is shortened to remove a damaged part and the cut end diverted to an opening in the abdominal wall . Video ( End Colostomy ): http :// www.youtube.com/watch?v=zXjQ7MjinTQ Images: http:// tinyurl.com/qglhfab 15/07/2014 Ravina Barrett 33

34. Colostomy Rx & Product Moderma flex colostomy bag 42300 http://www.hollister.com/anz/news/news_display.asp?newsid=5&id=1 15/07/2014 Ravina Barrett 34

35. http:// www.hollister.com/anz/news/large_photo.asp?id=1&photo=4162012171038.jpg How the AF300 Ostomy Filter works: Gas build up and ballooning are reduced through enhanced airflow of the filter. Better odour control occurs through the use of a exclusive, activated carbon that also extends the effective life of the filter. Provides continuous venting, allowing gas and air to escape unnoticed. Liquid cannot penetrate the filter from the inside or outside as it is protected by a specially designed film barrier. No more filter covers mean you can confidently wear any Moderma Flex or New Image pouch while bathing, swimming or taking part in other forms of active lifestyle. Available on all Closed and Drainable Pouches with Lock ‘n Roll Closure. The filter gives you confidence and convenience. 15/07/2014 Ravina Barrett 35 Hollister AF300 Filter The filter includes an impressive 300 mm2 surface area that promotes enhanced air flow. In addition, a patent pending configuration, GORE* Medical Membranes and activated carbon make the Hollister AF300 filter a durable filter.

36. Homework Produce a table listing a range of products and accessories suitable for a new ostomy patient either colostomy, ileostomy or urostomy. Identify at least two conditions that may have resulted in the patient requiring the ostomy . State the information needed by your patient regarding prescription charges . From your table above, describe the function of at least two types of ostomy bags and three of the accessories you have identified for this patient . Explain how the patient obtains further supplies of these products. Explain any advice you could give to this patient to prevent problems with sore skin around the stoma area, including any advice on diet, taking medication and other relevant lifestyle issues . Explain how the pharmacy could review and advise this ostomy patient about their needs and the importance of maintaining information on PMR . 15/07/2014 Ravina Barrett 36

37. ( LO1 ) The provision of appliances, dressings and other non-medicinal products Continence care ( http://www.patient.co.uk/health/urinary-incontinence-leaflet ): Causes of incontinence Stress incontinence - when the pressure in the bladder becomes too great for the bladder outlet to withstand. Caused by weak pelvic floor muscles ( childbirth ). Sudden extra pressure (stress) inside the tummy (abdomen) and on the bladder. Pelvic floor muscles are often weakened by childbirth. Stress incontinence is common in women who have had several children, in obese people and with increasing age. Stress incontinence can occur in men who have had some treatments for prostate cancer. This includes surgical removal of the prostate (prostatectomy), and radiotherapy. http :// www.patient.co.uk/health/stress-incontinence 15/07/2014 Ravina Barrett 37

38. ( LO1 ) The provision of appliances, dressings and other non-medicinal products Continence care Causes of incontinence Urge incontinence/idiopathic urge incontinence (unstable or overactive bladder) is the second most common cause. Urgent desire to pass urine, which leaks before you have time to get to the toilet. The bladder muscle contracts too early and the normal control is reduced. Cause: problems with the nervous system (the brain, spinal cord and other nerves in the body). Illnesses or diseases affecting the nervous system are called neurological disorders. Some people with certain neurological disorders may experience urge incontinence. Examples are Parkinson's disease, multiple sclerosis (MS), spinal cord injury and after a stroke. http :// www.patient.co.uk/health/urge-incontinence http://www.patient.co.uk/health/overactive-bladder-syndrome 15/07/2014 Ravina Barrett 38

39. ( LO1 ) The provision of appliances, dressings and other non-medicinal products Continence care ( http://www.patient.co.uk/health/urinary-incontinence-leaflet ): Causes of incontinence Mixed incontinence (stress and urge). 15/07/2014 Ravina Barrett 39

40. ( LO1 ) The provision of appliances, dressings and other non-medicinal products Continence care Treatments, (non-medical) http ://www.patient.co.uk/health/urinary-incontinence-leaflet 15/07/2014 Ravina Barrett 40

41. ( LO1 ) The provision of appliances, dressings and other non-medicinal products Continence care Treatments (medicinal, Available products) Medicines called antimuscarinics ( anticholinergics ): Oxybutynin ( Cystrin ®, Ditropan®, Lyrinel ® XL and Kentera ®) Solifenacin ( Vesicare ®) Tolterodine ( Detrusitol ®) Trospium chloride ( Flotros ®, Regurin ®, Uraplex ®) Propiverine ( Detrunorm ®) Flavoxate hydrochloride ( Urispas 200®) Darifenacin ( Emselex ®) Fesoterodine fumarate ( Toviaz ®) 15/07/2014 Ravina Barrett 41

42. NHS Repeat Dispensing See other notes Also known as: Repeat Dispensing Repeat Prescription Service Batch Dispensing Not to be confused with ‘ Repeat Prescription Collection Service’ or PCS which is a free service provided by pharmacies to build ‘regular business’ and secure their business. 15/07/2014 Ravina Barrett 42

43. Homework What is a repeat prescription service? Give two examples of patients who might benefit from these services giving your reasons. 15/07/2014 Ravina Barrett 43

44. Home Delivery Service There are professional and practical considerations that are important when deciding whether or not to deliver medicines or whether or not to post medicines (prescribed or sold) to patients. Consider the following when making a professional judgment (The list is not exhaustive ) Patient consent for delivery or posting Patient confidentiality during the delivery or posting process Whether it is necessary for face-to-face contact with the patient to ensure that the medicine can be safely, effectively and appropriately used 15/07/2014 Ravina Barrett 44

45. Home Delivery Service Whether it is necessary to interview the patient Whether the patient has been assessed or directly interviewed by the prescriber An adequate audit trail for delivery and receipt from the point at which the medicine leaves the pharmacy and is received by the patient (or returned to the pharmacy in the event of delivery failure) Storage requirements during transit When posting – will the postal carrier agree to transport the medicinal product (check terms of carriage, prohibited and restricted goods) 15/07/2014 Ravina Barrett 45

46. Delivery of sch 2 or 3 controlled drug Legislation requires that a requisition in writing must be obtained by the supplier before delivery of any schedule 2 or 3 controlled drug to most recipients including practitioners, hospitals, care homes, ship and offshore installation personnel, supplementary prescribers, senior registered nurses in charge of wards, theatres and other hospital departments. Some recipients (such as other registered pharmacies) are not included in this legal requirement. However, for audit purposes, and as a matter of best practice, we would advise that supplies should only be made after receiving a written requisition. 15/07/2014 Ravina Barrett 46

47. Delivery of sch 2 or 3 controlled drug Therefore, where one registered pharmacy supplies another registered pharmacy, as a matter of good practice, a requisition written on a standardised form should be obtained. A representative, including a delivery driver, can sign on behalf of a patient. However, a robust audit trail should be available to confirm successful delivery of the medicine to the patient 15/07/2014 Ravina Barrett 47

48. When posting abroad When posting abroad – are there legal restrictions in the destination country which would prevent you from posting? For example , guidance produced by the U.S. Food and Drug Administration ( FDA ) makes it clear that it is illegal or a foreign pharmacy to ship prescription medicines that are not approved by the FDA to the United States) „„ When posting abroad – are there UK legal restrictions which would prevent you dispensing in the first instance? ( e.g. is the prescriber recognised as an appropriate practitioner (see 3.3.1) for the medicinal product in the UK?) 15/07/2014 Ravina Barrett 48

49. Case Study Mr Cough-a-lot is 55 years old is an asthmatic and regularly visits the local pharmacy to obtain his prescriptions. His usual prescription includes inhalers, blood pressure tablets and cholesterol tablets. He has discussed using the repeat dispensing service with his GP and would now like to use this service Explain to Mr Cough-a-lot the information you need from him to implement this service and explain what he needs to do next time he needs more medication. Explain what records need to maintained by the pharmacy of this service. Explain the patient safety issues that might be identified by the pharmacist concerning patient’s medication or condition that could suggest that it was unwise to dispense the repeat prescription . 15/07/2014 Ravina Barrett 49

50. Homework What is a delivery service? Give two examples of patients who might benefit from these services giving your reasons . Mr Cough-a-lot has arranged for his medication to be delivered to his home in future. If Mr Cough-a-lot was not at home to receive delivery of his prescription and the delivery personnel asked if the package could be posted through the letterbox or left with a neighbour, explain what you would instruct them to do. Give reasons for your instructions, stating your professional and legal responsibility when providing medicines via a delivery service. 15/07/2014 Ravina Barrett 50

51. ( LO1 ) The provision of appliances, dressings and other non-medicinal products Inhaler devices: Technique to use; Care and maintenance 15/07/2014 Ravina Barrett 51

52. Inhalers (MDS) Source: http://www.asthmasymptoms86.com/asthmainhaler.html#. UrMTmNJdV44 15/07/2014 Ravina Barrett 52

53. Different potencies of CFC-free beclometasone inhalers Qvar and Clenil Modulite ▼ are CFC-free pressurised metered-dose inhalers that contain beclometasone diproprionate . They have different potencies because of their different formulations, which may have implications for both safety and efficacy. Qvar has extrafine particles, is more potent than traditional CFC-containing inhalers, and is about twice as potent as Clenil Modulite ▼. Advice for healthcare professionals: Prescribe CFC-free beclometasone metered-dose inhalers by brand name to reduce the risk of dosing errors Pharmacists are reminded that for any generic prescription for beclometasone , they should establish whether a CFC-free product is required and if so, which brand should be dispensed Clenil Modulite ▼ may be used in children (with the Volumatic spacer device) and adults; Qvar is not recommended for use in children MHRA (Drug Safety Update) http :// www.mhra.gov.uk/Safetyinformation/DrugSafetyUpdate/CON085179 15/07/2014 Ravina Barrett 53

54. CFC-free beclometasone and formoterol Fostair ▼ is a CFC-free, fixed-dose combination of beclometasone and formoterol , which is licensed for the management of asthma in patients aged 18 years or older. Similar to Qvar , Fostair ▼ contains an extrafine formulation of beclometasone and is more potent than traditional CFC-containing beclometasone inhalers. Advice for healthcare professionals : The inhaled-corticosteroid component of Fostair ▼ is about twice the potency of traditional CFC-containing inhalers, which should be taken into account when switching patients from a non-ultrafine preparation. The dose of beclometasone dipropionate in Fostair ▼ should be lower than non- extrafine formulations of beclomethasone dipropionate and will need to be adjusted to the individual needs of the patient . MHRA (Drug Safety Update) http :// www.mhra.gov.uk/Safetyinformation/DrugSafetyUpdate/CON085179 15/07/2014 Ravina Barrett 54

55. Handihaler (Spiriva only ) Video: http ://www.youtube.com/watch?v=bXHHFmZ_DRI 15/07/2014 Ravina Barrett 55

56. Spacer Device Source: http:// www.daaat.org/inhaler-devices.html 15/07/2014 Ravina Barrett 56

57. Spacer Device Spacers should not be regarded as interchangeable: patients who use a spacer with their inhaler should use the spacer device named in the Summary of Product Characteristics (where specified by name) Patients whose asthma is well-controlled and who are using a spacer should always use the same type of spacer and not switch between spacers. Different spacers may deliver different amounts of inhaled corticosteroid, which may have implications for both safety and efficacy MHRA (Drug Safety Update) http://www.mhra.gov.uk/Safetyinformation/DrugSafetyUpdate/CON085179 15/07/2014 Ravina Barrett 57

58. FURTHER INFORMATION RPS Support Medical Devices – quick reference guide. 2012. (www.rpharms.com) MHRA . Information on regulation of Medical Devices (www.mhra.gov.uk) 15/07/2014 Ravina Barrett 58

59. ( LO1 ) The provision of appliances, dressings and other non-medicinal products Compliance aids: Available products and their use e.g. Dossette boxes 15/07/2014 Ravina Barrett 59

60. ( LO1 ) The provision of appliances, dressings and other non-medicinal products Correct documentation and record keeping: Electronic and paper; Patient medication records (PMR’s ); Endorsement, Processing payment 15/07/2014 Ravina Barrett 60

61. ( LO1 ) The provision of appliances, dressings and other non-medicinal products Use of resources: drug tariff, products allowed on prescription; appropriate endorsement; different types of prescriptions ; prescriber formularies 15/07/2014 Ravina Barrett 61

62. ( LO2 ) Understand how to assist in the provision of services outside of the pharmacy Communication skills: Identifying the needs of others; Confidentiality; Questioning, Listening, Sensitivity 15/07/2014 Ravina Barrett 62

63. ( LO2 ) Understand how to assist in the provision of services outside of the pharmacy Services : Collection and delivery service, Collection of prescriptions; Delivery of dispensed items; Domiciliary visits; Standards operating procedures (SOPs); Guidelines in code of ethics; Legal and ethical requirements for patient safety 15/07/2014 Ravina Barrett 63

64. ( LO2 ) Understand how to assist in the provision of services outside of the pharmacy Health and safety: Personal and product safety Correct documentation and record keeping: Manual, Electronic 15/07/2014 Ravina Barrett 64

65. MDS - Homework State two types of patients who would benefit from having their medication dispensed in a monitored dosage system. State two benefits the patient would receive from this service. State one reason for implementing a monitored dose system in a care home . Identify and describe two different dosage monitoring systems currently available. Describe five practical problems of using a monitored dosage system in a care home and difficulties that may arise with storage of some medications within these systems . 15/07/2014 Ravina Barrett 65

66. ( LO3 ) Know the national and local regulations and policies regarding supply of medicines to patients in care Monitored dosage systems: Different products available; Purpose for use; Dispensing and labelling; Difference between compliance aids and MDS 15/07/2014 Ravina Barrett 66

67. ( LO3 ) Know the national and local regulations and policies regarding supply of medicines to patients in care Documentation : Medication Administration Records ( MARs ); Manual and electronic record keeping; Prescriptions; Endorsement 15/07/2014 Ravina Barrett 67

68. ( LO3 ) Know the national and local regulations and policies regarding supply of medicines to patients in care Regulation and policy: National Standards; Medicines , Ethics and Practice guidance; Audit (external , internal ); SOPs 15/07/2014 Ravina Barrett 68

69. ( LO3 ) Know the national and local regulations and policies regarding supply of medicines to patients in care Unused medication: Returned medication; Registered nursing homes, Residential care homes The Handling of Medicines in Social Care http ://www.rpharms.com/support-pdfs/handling-medicines-socialcare-guidance.pdf 15/07/2014 Ravina Barrett 69

70. Nomad Boxes (Nomad® Concise ) Saves more space More effective if using less than 5 items. Manage your medication more effectively. One tray per week. Each day has four separate times for medication including morning, afternoon, evening and night time so taking your medicine is easier NOMAD Backing Sheet explains the medicines in the box/tray Tamper evident Reduces the ingress of moisture Can be Compliant to some standard (e.g. US Pharmacopoeia grade B ) 15/07/2014 Ravina Barrett 70

71. BENEFITS OF MDS IN CARE HOMES Significantly reduce the time taken for administering the medication ( Blister Packed medication) It can hold up to 7 days’ worth of medication for up to 6 doses per day The Nomad® system can be easily rendered tamper evident The combination of insert tray and seal protects the medication One compact unit means that storage is easy Image search: nomad system medication 15/07/2014 Ravina Barrett 71

72. ‘P’, ‘M’, ‘D’ questions below represent the level of ‘Pass’, ‘Merit’ and ‘Distinction’ score each question can attain. Prepare for this exam! This unit separates the noobs from the grafters. Why? because having to look-up every little detail will cost you time and marks on the day of the exam. Know your stuff and you will breeze the exam AND dispensary life like a PRO! 15/07/2014 Ravina Barrett 72 Exam Preparation

73. Exam Preparation P1 explain how to prepare for the supply of appliances, dressings, and surgical hosiery, meeting individual and prescriber requirements P2 explain the information required by an individual or healthcare professional when supplying appliances, dressings and surgical hosiery M1 categorise different types of dressings and surgical hosiery D1 explain factors to be considered when choosing an appropriate product 15/07/2014 Ravina Barrett 73

74. Exam Preparation P3 explain how to prepare for and deliver a service to individuals that are unable to attend the pharmacy P4 describe health and safety risks when delivering services outside of the pharmacy M2 discuss how risks to personal and product safety can be minimised when delivering a service outside of the pharmacy D2 evaluate a service delivered outside of the pharmacy including the suitability of clients 15/07/2014 Ravina Barrett 74

75. Exam Preparation P5 describe the regulations and policies for the supply of medicines to care homes M3 explain the responsibilities of individuals involved in the supply of medicines to care homes M4 compare different types of Monitored Dosage Systems P6 describe the use of Monitored Dosage Systems D3 explain how to plan for the supply of medicines to a care home 15/07/2014 Ravina Barrett 75