Empowering you to meet regulatory and best practice requirements

Your Patient Safety Champion will share with you the Superintendent Pharmacist’s Office Incident Team’s insights which are featured in this month’s Patient Safety Champions’ letter. Continue to reflect, together with the rest of your pharmacy team, on the importance of reporting near miss incidents and how, by generating ideas as a team and setting SMART-ER actions, we can intelligently target key patient safety priorities to improve efficiency in the pharmacy and positively impact patient safety. Please share with your Patient Safety Champion any ideas for SMART-ER actions to support patient safety in your pharmacy.

The monthly Drug Safety Update issued by the Medicines and Healthcare products Regulatory Agency (MHRA) in June included the following information: 

Topiramate: New safety measures, including a Pregnancy Prevention Programme, has been introduced for patients taking topiramate. Please follow the ‘High Risk Medicines Supporting Guidance (E): Information for the safe dispensing and handout of topiramate’; this has been sent to stores electronically via a BootsLive Calendar Alert and a paper copy accompanies this edition of The Professional Standard.

Warfarin and tramadol interaction: Taking warfarin and tramadol concurrently can result in severe bruising and bleeding, which in some patients could be fatal. 

The full MHRA update can be accessed here. 

The Human Medicines Regulations (HMR) 2012 permit, if the pharmacist determines the supply is clinically appropriate, an emergency supply of a Schedule 4 or 5 CD, up to a maximum of five days’ treatment. The Superintendent Pharmacist’s Office team is aware of instances in which a supply of a Schedule 4 or 5 CD of a quantity lasting longer than the permitted five days has been made in error. Examples include patient referrals via commissioned services that cover the provision of emergency supplies.

Both the NHS Pharmacy First Service in England and the Clinical Community Pharmacy Service: Emergency Medicines Supply in Wales allow the provision of a Schedule 4 or 5 CD. They both do so under the HMR and therefore only a supply of up to a maximum of five days’ treatment is permitted. Supplies of Schedule 4 Part 1 CDs are not permitted under the terms of the Community Pharmacy Emergency Supply Service in Northern Ireland. However, a supply of up to a maximum of five days’ treatment under the HMR may be considered. Similarly in Scotland, if the National Patient Group Direction for Urgent Provision of Medicines, Appliances, and ACBS products does not permit the supply of a particular Schedule 4 or 5 CD, it may still be appropriate to make a supply under the HMR.

Glucagon-like peptide-1 (GLP-1) agonists (including Wegovy^® and Mounjaro™) are available via the Boots Online Doctor Weight Loss Treatment Service. It is important that patients receive appropriate counselling when receiving their weight loss medication to support with its safe and effective use. 

If a pharmacist is concerned about the clinical appropriateness for a patient, they may contact the Boots Online Doctor Helpdesk on 0800 031 8386 to discuss this. It is also advised that in such an instance this is reported on PIERS as an ‘Other Pharmacy Event’. 

During handout, team members must ensure that the following are undertaken:  

• If any member of the pharmacy team has concerns about whether the patient meets the weight criteria for the service, the pharmacist should consider whether they are an existing or new patient: 
  • An existing patient’s BMI could be under 30kg/m² and treatment would still be appropriate
  • If they are a new patient and there are concerns about whether they meet the BMI criteria for treatment, the pharmacist may be able to suggest the patient weighs themselves in store; if this is not possible, the pharmacist should contact Boots Online Doctor for advice 
• If the patient is an existing patient, ask them when they last injected a dose of this medication and ensure that this is within the last two weeks. If it has been more than two weeks since their last dose, then the pharmacist must contact Boots Online Doctor directly, as a dose change may be required.
• Give the patient a Weight Loss Treatment Service Leaflet to provide them with additional information regarding the support available to them (the leaflet also provides them with access to four free weigh-ins on Boots in-store weighing machines)

As a reminder, training on Wegovy^® and Mounjaro™, which supports patient counselling, is available for pharmacists and pharmacy technicians via BootsLearning. Information on Boots Online Doctor Weight Loss Service can be found on BootsLive.

Pharmacy professionals have an obligation to be aware of the calibration requirements of devices used in the delivery of services, and to ensure these requirements are met. To satisfy the requirements of the service specification for the NHS Blood Pressure Check Service and to ensure that they are providing accurate readings for patients, Ambulatory Blood Pressure Monitor (ABPM) devices must be calibrated every two years. When pharmacy teams are notified that their ABPM device is due for calibration, it is essential that the instructions sent via BootsLive are followed and that the device is sent for recalibration at the earliest opportunity so that the device is calibrated within two years of first use, or the last date of calibration.