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Forensic Pharmacy

Forensic Pharmacy. Small group questions: March 09. Question 1. You receive the following prescription at your pharmacy for a regular patient. Dr. R.Kimble All night Clinic Glenroy 3046 15/03/09 Samuel Gerard Marshall St. Broadmeadows Ordine 10 Ordine 10

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Forensic Pharmacy

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  1. Forensic Pharmacy Small group questions: March 09

  2. Question 1 • You receive the following prescription at your pharmacy for a regular patient. Dr. R.Kimble All night Clinic Glenroy 3046 15/03/09 Samuel Gerard Marshall St. Broadmeadows Ordine 10 Ordine 10 Take 8ml by metric measure q6h prn 8 (eight) ml q6h prn Qty 200ml two hundred ml No repeats no repeats Signed Dr R.Kimble Dr. R Kimble

  3. Question 1 • You are familiar with Dr.Kimble’s handwriting and this appears to have been written by him. • According to your records Samuel has not had Ordine in the past • He infrequently fills prescriptions for Panadeine Forte • His history shows a course of Bactrim last week • Dr.Kimble is his regular doctor • According to his wife, he has been prescribed this medication as he has severe mouth ulcers caused by a reaction the doctor called “Steven something syndrome”. • He is having a great deal of difficulty swallowing tablets and is in an amount of pain Dr. R.Kimble All night Clinic Glenroy 3046 15/03/09 Samuel Gerard Marshall St. Broadmeadows Ordine 10 Ordine 10 Take 8ml by metric measure q6h prn 8 (eight) ml q6h prn Qty 200ml two hundred ml No repeats no repeats Signed Dr R.Kimble Dr. R Kimble

  4. Question 1 • What do you need to consider before dispensing this script? Dr. R.Kimble All night Clinic Glenroy 3046 15/03/08 Samuel Gerard Marshall St. Broadmeadows Ordine 10 Ordine 10 Take 8ml by metric measure q6h prn 8 (eight) ml q6h prn Qty 200ml two hundred ml No repeats no repeats Signed Dr R.Kimble Dr. R Kimble

  5. Answer… question 1 Your answer should cover.. • Requirements for DD scripts • Aside usual particulars, presence of Dr’s handwritten verification of quantity and number of repeats. • Acknowledgement that for computer generated prescriptions all particulars other than date and patient’s name and address to be handwritten • Assessment of validity of prescription (with consideration to forgery) acknowledging familiarity with handwriting and signature of doctor. • Consideration of potential for abuse with this drug - no previous history of supply within 8 weeks / increasing quantities or frequency of supply / no evidence of doctor shopping.

  6. Answer… question 1 • Appropriateness and safety of medication prescribed • Ordine may be most appropriate pain killer as in liquid form but STRENGTH!!! 10mg/ml would give patient 80mg as a single dose. Given he is opioid naïve… this dose is too high. • Prescription would not be dispensed if doctor was unavailable • Note: Schedule 3 of Health Professionals Act: Part 9(a) “medicines are dispensed in accordance with an order or prescription as far as the dispensing is consistent with the safety of the person who is to use the medicines”.

  7. Question 2 “A pharmacist made alterations to the dispensary of their pharmacy to facilitate the development of the compounding side of the pharmacy. The alterations were made without the necessary application to the Board. On inspection on another matter about six months later the alterations were discovered. The alterations were found to be totally unsatisfactory for compounding in that walls, floor and fittings in the compounding room were not adequately sealed to prevent contamination of the medicines compounded. The pharmacist concerned was aware that the Board approval process should have been followed but did not do this owing to the difficulty in finding a suitable tradesperson to complete the job. The panel found that the pharmacist had engaged in unprofessional conduct and that the pharmacist be reprimanded”. From PBV Circular Nov 2006

  8. Question 2 • What is “unprofessional conduct” ? • In what way is this unprofessional conduct? • What actions could the Board have taken on discovery of the alterations? • What processes could have been followed?

  9. Answer… question 2 • Some definition of “unprofessional conduct” • Eg. As defined in Health Professionals Act: Part 1. (s.3) • Actions the Board could have taken • Notification and commencement of investigations • Hearings • Penalties • Process which should be followed.. • Appendix 14 of PBV Guidelines- Approval of premises flow chart • Guidelines 628-633 Application Procedures

  10. Answer… question 2 Note: Schedule 3 of HPR Act 2005 • “Part 1. “The premises are to be - • Laid out in a manner consistent with safe pharmacy practice • Maintained in a clean and hygienic manner • Maintained at a suitable temperature and humidity • Equipped with the necessary equipment and reference material • The different parts of the premises are properly situated and are secure and suitable for the purposes for which they are to be used”

  11. Question 3 • A pharmacy technician can be a valued asset in your pharmacy, able to assist with many dispensary duties that do not require “professional judgment”. One of these is control of stock - filling shelves, ordering (etc) in the dispensary.

  12. Question 3 • Are there any special requirements with respect to S8 medications? • Can a dispensary technician be allowed access to the safe? • May a tech fill scripts for S8 medications? • Can a dispensary technician fill out the DD book?

  13. Answer… question 3 Answer could include references to.. • DPCS Act and Regs • “authorised persons” • Storage of S8 medications • Records of S8 medications • PBV circular Sep 06 Suggests pharmacists should personally carry out the following (in addition to their usual role): “personally check the authenticity of the prescription, selects the item fro the DA safe and records the transaction in the DA register” , “pharmacist should ensure that they undertake all transactions involving S8 medications and that pharmacy technicians are not involved “ (following some recent cases of diversion) and also “Pharmacists are personally responsible for all aspects of the dispensing process involving dispensary assistants and the supervision of pharmacy technicians is a legal obligation”.

  14. Answer… question 3 Note: HPR Act schedule 3 (AGAIN!!) 7. A registered pharmacist must oversee the area of the pharmacy or pharmacy department where pharmacy services are provided. 8. A registered pharmacist appointed to act as the pharmacist in charge must oversee, supervise and monitor all registered pharmacists providing pharmacy services in the pharmacy or pharmacy department and any other staff who assist in the provision of pharmacy services.

  15. Question 4 • Regarding faxed prescriptions… “A doctor prescribed lisinopril with hydrochlorothiazide. A fax of the prescription was sent to a mail order pharmacy. The pharmacist interpreted the strengths as 20mg and 25mg, respectively but what had been written was 20/12.5mg. A subtle vertical gap in the faxed copy had obliterated the “1” in the 12.5mg and the decimal dot between the “2” and the “5” in the “12.5” had been interpreted as one of many stray marks on the faxed prescription” From PBV circular Sep. 2006

  16. Question 4 • What are the specific guidelines regarding faxed prescriptions? • What procedures must pharmacist dispensing mail order / internet prescriptions have in place in order to comply with the law?

  17. Answer… question 4 Should cover… • PBV Guidelines 463-464 re: fax prescriptions • PBV Guidelines 458 re: distance dispensing • And again! Schedule 3: “a) medicines dispensed in accordance… with safety of the person” Also f) Distance dispensing is carried out according to good pharmaceutical practice”

  18. Question 5 “The Board recently considered a report of a person (who was previously a registered pharmacist) practising for nearly three years without being registered. This person worked as a locum for a number of pharmacists and for a number of locum services. The Board considers practising as pharmacist when not registered to be a very serious matter, as a non-registered person practising as pharmacist may put the public at risk.” PBV Circular Sep 2006

  19. Question 5 As PRUIC of your pharmacy one of your responsibilities is to ensure that at all times the pharmacy is supervised by a pharmacist. • When employing a new pharmacist how do you ensure this occurs? • If you employ a pharmacist who is unregistered are you responsible? • How and why are pharmacists deregistered? • What requirements does the PBV have for registration of pharmacists who have undertaken their traineeship in Victoria?

  20. Answer… question 5 • CHECK for current Board Registration Card!! • Yes, you are liable! • Deregistration occurs: if a pharmacist is suspended or has had registration cancelled as a result of proceedings against him/her ; if the annual fee is not paid up and registration renewal not received prior to closing date • Registration requirements in Guidelines (201-202) and HPR Act Part 2

  21. You want more??? • Where must pseudoephedrine products be stored? • May a doctor prescribe for a family member? • What about for themselves? • Can we fill prescriptions from overseas? • Can you sell cigarettes in a pharmacy? • Can a GP prescribe Ritalin? • Can you sell more than one box of a psuedoephedrine containing product?

  22. Can we return scheduled medicines? • Can you send DD’s with a delivery boy? • Can you ever give more than 3 days emergency supply? • Can a shop girl fill a dosette? • Can a pharmacy depot sell S3 items? • Who can destroy S8 medications?

  23. Can we supply any medications to podiatrists? • Can you supply 2 days on a DD script if you unsure if it is forged? • Can you drink your coffee in the dispensary? • Do C & A labels need to go on Webster Paks? • Can you sell Acetone over the counter? • How is it labelled?

  24. What schedule(s) are: • Hydrocortisone 0.5%? • Hydrocortisone 1%? • Iron ? • Folic Acid ? • Nicorette microtabs? • Doxylamine ? • Salbutamol?

  25. Dihydrocodeine? • Paracetamol ? • Ketoconazole ? • Pseudoephedrine? • Cocaine? • Codeine? • Fluvax? • Neo-Cytamen?

  26. And just when you thought we were finished… • Does a parent have access to their child’s health information? • Do the police have access to prescription records? • Can you refuse to supply an individual with their own health information? • Can you divulge concessional benefit information to another pharmacy? • Can you divulge medical information to a hospital pharmacist?

  27. What medical information can you supply to an individual’s doctor? • What do you need to obtain prior to divulging information? • Can you write patient notes such as “cranky woman” on an individual’s file? • What about “doctor shopper”? • How do you satisfactorily destroy health records?

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