CLINICAL POLICY
Medicines Code
Issued: July 2006
For Review: July 2008
Reviewer: Clinical Governance Directorate
Medicines Code for North Lincolnshire Primary Care Trust – The safe and secure handling of Medicines
Introduction
This policy provides guidance to North Lincolnshire Primary Care Trust staff on all aspects of the safe and secure use of medicines.
Policy Statement
Medicines are an important part of modern healthcare and, when used properly, reduce illness and improve health. They all, however, carry inherent risk, particularly when they are used inappropriately.
This policy provides staff with guidance on minimising this risk and is constructed to reflect current legislative requirements and best-practice advice. The application of this policy will allow the PCT to meet the requirements of the Medicines Management elements in Standards for Better Health.
Aims
This policy contains guidance on the following areas of medicines management:
Ordering
Prescribing
Supply
Administration
Storage
Destruction
Ordering
Staff should only order medicines from appropriate suppliers. For North Lincolnshire PCT the principal supplier of medicines is the Pharmacy Department at Scunthorpe General Hospital (SGH). Dressings and appliances must also be ordered from appropriate suppliers: the principal supplier of dressings and appliances is Supplies Department at SGH. Staff should only use other suppliers when they have received confirmation from their line manager of the suitability of the supplier.
Staff must maintain a written record of the medicines or dressings and appliances that they order. They should decide whether this should be maintained at an individual practitioner level or at a team level and seek clarification from their line manager if they are uncertain.
Orders for medicines can only be made by appropriately qualified nursing staff and those staff groups who are exempted from the controls of the Medicines Act 1968 unless they have specific written approval from the Director of Primary and Community Care.
Storage
Security
All medicines and dressing/appliances should be stored in a lockable cupboard or room. Access to the cupboard or room should be restricted such as to prevent unauthorised accessed. This is particularly important in areas where premises are not manned 24 hours per day. If a clinician/team has concerns about the security of their site they should arrange for stocks to be held at a secure site or ensure that stocks are maintained at minimal levels. This is particularly important for products that are known to be abused.
Staff should have a policy on key holding for the store room/cupboard. It should identify the principal key holder(s) and the procedure to follow if a key is lost or misplaced.
Products sensitive to light or temperature
A number of medicines and some dressings require storage in specific conditions. Staff should be aware of the requirements of any stocks they hold and ensure that they monitor any necessary environmental factors that might influence the stability of the product e.g. avoiding direct exposure to sunlight by storing. For items that require storage below room temperature a lockable medicines refrigerator should be used. Staff should keep a written record of the maximum/minimum temperatures of medicines refrigerators on a daily basis (working days). If the temperature in the refrigerator breaches either the upper or lower limit of any product stored in the refrigerator advice should be sought on the use of such products. In many cases the product will still be usable but it is likely that its shelf life will be greatly reduced. Advice can be obtained from the Medicines Information Department at
Supply
Staff may only supply medicines to patients/carers in accordance with written Trust policies or if they are exempt from the controls of the Medicines Act 1968. Supply, other than as a consequence of prescribing, will usually be authorised by the production of a Patient Group Directions (PGDs). Advice on the development of PGDs is available from the PCT’s Clinical Governance Directorate.
Staff should not supply manufacturers’ samples to patients/cares.
Prescribing
The PCT has a policy that provides comprehensive details on prescribing by nurses and other non-medical prescribers. The policy covers independent nurse prescribing from the Community Practitioners’ Formulary and Nurses Independent Prescribing along with Supplementary Prescribing. In addition advice on Good Prescribing Practice can be found starting on page1 of the British National Formulary (BNF) and via the National Prescribing Centre (NPC) website at
http://www.npc.co.uk/nurse_prescribing/pdfs/signpostsvol1no1.pdf
Administration
Staff may only administer medicines to patients in accordance with written Trust policies or if they are exempt from the controls of the Medicines Act 1968. Administration, other than as a consequence of prescribing, will usually be authorised by the production of a Patient Group Direction (PGD). Advice on the development of PGDs is available from the PCT’s Clinical Governance Directorate.
Medicines should only be administered with the full consent of the patient (see Consent policy). Covert (hidden) administration should only take place in exceptional circumstances following an open and broad discussion among the multi-professional clinical team and the patient’s carer(s). All such discussions should be carefully documented. Further guidance can be found on the Nursing and Midwifery Council’s website http://www.nmc-uk.org/nmc/main/publications/covertAdministrationOfMedicines.pdf.
Because of the nature of care with in Mental Health a separate policy on covert medicines administration exists and should be referred to as necessary.
Staff involved in the administration of medicines should, wherever possible, involve a second member of staff or competent adult in checking that they are administering the correct medicine.
Staff should only administer prescribed medicines in accordance with dispensing label or the written directions of the responsible prescriber. Only in exceptional cases should staff administer prescribed medicines on verbal instructions alone.
Destruction
Medicines or dressing and appliances prescribed to a patient become their property. Staff should ensure that they only prescribe or supply a sufficient quantity to meet the patient’s needs. They should encourage patients/carers not to hoard medicines and dressing or appliance that are no longer needed and advise them to return surplus supplies for safe destruction to the pharmacy or dispensing practice that made the supply.
Staff should only agree to act as “agents” in the disposal of medicines or dressing and appliances if they believe that the consequences of not doing so would be to place the public at danger. In such circumstances staff should keep a record of the medicines they dispose of and ask the pharmacist or dispensing practice to sign the record confirming that they have returned the products for safe disposal.
Staff should return any intact out-of-date stock items to the Pharmacy Department at
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