Empowering you to meet regulatory and best practice requirements

This month, our Patient Safety activity is focused on the successful completion and implementation of the compulsory eLearning, ‘Our Just Culture: Part 2’, for all pharmacy team members and store leaders. This eLearning explores how to complete the ‘Learn’ and ‘Demonstrate Change’ elements of Our Just Culture in a way that helps to ensure that an error does not reoccur, that team members’ skills constantly improve, and that patient safety is continually strengthened.​

All pharmacy team members should complete this eLearning by the end of June and your Patient Safety Champion will help you to embed the knowledge you have gained through your one-to-one or team huddle discussions.

From 7 June 2022, the sale of solid tablet and capsule forms of paracetamol-containing products in Boots UK stores will no longer be permitted to anyone under 16 years of age, except by a pharmacist. This measure has been taken in response to the known detrimental effects of the COVID-19 pandemic on many young people’s mental health and wellbeing and as a step to reduce the inappropriate and unsafe usage of this drug by a minority of individuals in this group.

If a young person who is, or may be, under 16 years of age presents at the pharmacy to purchase a solid dose paracetamol-containing product, a pharmacist should establish whether the sale is safe and appropriate. If the sale can proceed, the pharmacist (only) should override the till restriction to authenticate the sale. This till override is only permissible (by a pharmacist) as the new age restriction is not one that is legally bound.

The full details of this new age restriction were communicated to stores via a BootsLive Calendar Task on 25 May. Please ensure all pharmacy team members have been briefed and that non-healthcare trained team members in store are familiar with the content that is relevant to their role.

Pharmacy team members are reminded that it is illegal to sell certain other products to people under a specified age, e.g. electronic cigarettes to people under 18 years of age, and selling an item with a legal age restriction to someone under the specified age is a criminal offence that would risk personal prosecution.

PGDs provide a legal framework for the supply and/or administration of particular medicines by specified healthcare professionals to a carefully-defined group of patients, without a prescription. In defining this group of patients, any to whom the medicine cannot be supplied safely under the terms of the PGD will necessarily be excluded. It is essential that, whenever a medicine is supplied to a patient via a PGD, the wording of the exclusion criteria (which may direct the supplying pharmacist to a specified reference source), along with all other aspects of the PGD, is adhered to strictly.

The British National Formulary (BNF) and the Stockley’s series (Stockley’s Drug Interactions, Interactions Checker (online only) and Herbal Interactions) provide robust and authoritative information about drug interactions and are available to you via the Medicines Complete website.

We have become aware, however, that pharmacodynamic interactions (those between drugs which have similar, or antagonistic, pharmacological effects or side-effects and may arise due to action, or competition, at particular receptor sites or between drugs acting on the same physiological system) are currently more extensively covered in the BNF than they are in the Stockley’s series. These types of interactions are often predicted from the known effects of the drugs involved rather than having been reported in the literature.

There may be circumstances in which it is therefore appropriate to refer to more than one source (e.g. both the BNF and Stockley’s Drug Interactions) to check whether drugs can be used together safely.

Martindale’s Adverse Drug Reaction (ADR) Checker, also available on Medicines Complete, can provide useful information about certain pharmacodynamic interactions as it can show the frequency and severity of specified side effects that are common to particular drugs.

The skills covered in the Children’s Medicines course are critically important when dealing with children’s prescriptions. However, many of the skills covered, such as dosage calculations and counselling the patient or their care-giver on how to take their medicine(s), are also key in wider pharmacy practice.

All pharmacy team members should be familiar with the content of this course and the associated dose calculations video. It is essential that whenever the dose of a liquid medicine is prescribed in milligrams (mg) for a patient of any age, the appropriate calculation is performed, and checked, and the dosage instructions on the dispensing label are presented clearly and unambiguously as the volume of liquid in millilitres (ml) that the patient should take. It is also vital that, for liquid medicines, patients are provided with an appropriate device to measure the dosage volume and that counselling is provided to ensure the patient or care-giver is clear about the dose and how the device should be used.

The Children’s Medicine Course, including a dose calculations video, can be accessed on BootsLive:  https://nsp.bootslive.co.uk/sites/bootslive/AllUKNonOpticiansUsers/Pages/The-Children%E2%80%99s-Medicines-Course.aspx

There are two different salts of zuclopenthixol available for injection: zuclopenthixol decanoate (a slow release preparation used for maintenance treatment of schizophrenia and paranoid psychoses); and zuclopenthixol acetate (an immediate release preparation used for the short-term management of an acute episode). In practice, zuclopenthixol decanoate has been confused with zuclopenthixol acetate; however, they are not interchangeable. When clinically checking a prescription for zuclopenthixol injection, the pharmacist needs to be confident that the correct preparation has been prescribed.

Please ensure that all members of the pharmacy team are aware that Epilim^® (sodium valproate) boxes now have a perforated pregnancy prevention warning card. The card should be flipped up or removed to reveal a space for the pharmacy dispensing label; it’s important not to put the dispensing label on the card. Make sure the card is given to the patient with the dispensed medication.

Further to a reminder published in the Medicines and Healthcare products Regulatory Agency (MHRA) March 2022 Drug Safety Update regarding the risks of treatment with amiodarone and the need for patient monitoring and supervision, the MHRA has noted that a patient card is available for all patients taking amiodarone. This card includes important information on the most serious and potentially life-threatening side-effects (and their symptoms) that may occur during treatment with amiodarone and also reminds patients of the potential for drug to drug interactions.

The card can be accessed at: https://www.gov.uk/drug-safety-update/amiodarone-cordarone-x-reminder-of-risks-of-treatment-and-need-for-patient-monitoring-and-supervision

IMA Matters

Our Travel Service consultation format allows pharmacists to talk to travellers about their trip and understand the individual’s trip-specific and personal risk factors. Some travellers choose to pre-populate their trip on the knowmalaria app prior to their consultation. When a traveller presents with their trip details, medical information and vaccination history pre-populated, it is important that the pharmacist familiarises themselves with the information that has been entered. This includes checking the itinerary is correct and reviewing the responses the traveller has entered. It is important to confirm the information in each section has not changed since it was entered, to ensure any recommendations and scheduling of vaccinations are accurate.