Distribution of Antibiotics

1. Distribution of Antibiotics Rachel Mckay

2. Distribution of antibiotics PHARMAC wants to support and enable this important programme Solutions need to be pragmatic, easy to implement and legal PSO rule: “Practitioner’s Supply Order” means a written order made by a Practitioner on a form supplied by the Ministry of Health, or approved by the Ministry of Health, for the supply of Community Pharmaceuticals to the Practitioner, which the Practitioner requires to ensure medical supplies are: available for emergency use; teaching and demonstration purposes; for provision to certain patient groups where individual prescription is not practicable.

3. Assumptions • Want to confirm our assumptions • Are they right or wrong? • Data collection important • Patient level data important. Need to agree dataset requirements. Ideally have this updated in the patient notes if they have a primary provider. If not, then the data should be collected in spreadsheet / manually and provided to programme provider for inclusion in reporting requirements to MoH project team. • DHBs or PHOs paying patient $3 prescription co-payment

4. Delivery options • Do all providers need to use the same system? • Can different systems be used in urban and rural areas? • Systems need to be in place ASAP • Changing rules needs consultation and Board decision but very tight timeframe. Therefore need to work within the current legal framework • Suggestions for discussion only • Would value feedback.

5. Urban areas • Assumptions: • The PHO or DHB is paying for the co-payment. • The information normally provided on a prescription is required. • There is an agreement with a local pharmacy to be part of the programme. • The nurse or provider can write prescriptions under Standing Orders. • Suggested process: • The nurse/provider swabs children at school and where appropriate writes a prescription for antibiotics under Standing Orders (ideally using remote access log-ins into Medtech or other PMS). • Prescription faxed or taken to the agreed pharmacy for dispensing. Sent once daily, pre-lunchtime? • The pharmacist dispenses the medicines (including reconstituting the antibiotics) and delivers them to the school or they are collected by the nurse/provider and taken to the school. • The nurse or provider administers the initial dose to the child. • The child takes the remainder of the course home. The child is provided with a support pack of material (advice on how to store and administer the medicine; conical dispensing cup/oral syringe etc) • ? What follow-up by Medical Officer of Health or GP authorising Standing Order

6. Rural areas • Assumptions: • The PHO or DHB is paying for the co-payment. • The information normally provided on a prescription is required. • Prescriptions are not a feasible option and PSO may be the appropriate mechanism • The area meets the criteria for rural areas for Practitioner’s Supply Orders – see Section E Part II Rural Areas of the Pharmaceutical Schedule [list of rural areas] • There is an agreement with a pharmacy to be part of the programme. • The nurse or provider can write prescriptions / PSO’s under Standing Orders.

7. Rural areas – option 1 • The nurse or provider swabs children at school and where appropriate writes a prescription for antibiotics under Standing Orders (ideally using remote access log-ins into Medtech or other PMS). • The antibiotics are supplied under rural PSO rules. • The pharmacist dispenses the PSO (un-reconstituted antibiotic and diluent) and it is delivered to the school. • Where possible the nurse or provider administers the initial dose to the child. We acknowledge that in some cases the nurse will no longer be at the school and will not be able to administer the first dose. • The child takes the course home. The child is provided with a support pack of material (advice on how to store and administer the medicine; conical dispensing cup/oral syringe etc) • Follow-up by Medical Officer of Health or GP authorising Standing Order

8. Rural areas – option 2 • Have a supply of Rural PSO antibiotics dispensed in advance of the school visit • The nurse / provider takes the medication with them to the school. If the oral antibiotics need reconstituting then the nurse/provider does this at the time of prescribing for an individual patient (under appropriate cold-chain conditions, e.g. in a chilly-bin or similar) or have it delivered to the school and kept in the staff room fridge. • The nurse could dispense the first dose and provide the child with the remainder of the course and the supporting information. • There would be a need for the nurse to be able to write the patient's name, dosage instructions and date of dispensing on the bottle label. At the time of dispensing from the community pharmacy, the pharmacy should affix a label to the capsules and oral liquid container for the prescriber to complete at the time of dispensing.