The Pharmaceutical Journal
Vol 268 No 7200 p789
1 June 2002

An occasional feature, prepared in the Royal Pharmaceutical Society's Professional Standards Directorate, to highlight problems and inquiries currently being handled

• Professional responsibility when dispensing
• Supervision of CDs within the pharmacy
• Spare dispensing labels for homes or carers
• Sale of strychnine for the killing of moles

Professional responsibility when dispensing

Pharmacists have a professional duty to assess every prescription to determine its suitability for the patient. Pharmacists must ensure that they are familiar with the products they are supplying, ensure their pharmaceutical knowledge is up to date and be alert to potential adverse drug reactions and interactions. A pharmacist who has concerns regarding a prescribed medicine must take all reasonable steps to contact the prescriber to discuss the medicine and must only dispense the medicine if satisfied that it will be safe to use.

It is not sufficient for a doctor to confirm that what is written on the prescription is what he or she intended to prescribe and that he or she will take full responsibility. The pharmacist must be satisfied as to the product and dosage to be supplied and that it will not harm the patient. If there is any doubt, the pharmacist may have no option but to refuse to dispense the prescription and refer the patient back to the doctor. However, pharmacists should be careful not to undermine the patient's confidence in the doctor.

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Supervision of CDs within the pharmacy

The Royal Pharmaceutical Society's Professional Standards Directorate has been advised of an incident in which Controlled Drugs were stolen from a box in a dispensary, where they were awaiting supervised dispensing. Although the pharmacist believed that the CDs were adequately supervised, the systems in place failed, and this failure resulted in two Schedule 2 CDs being stolen.

The Misuse of Drugs (Safe Custody) Regulations 1973 provide an exemption from the stringent storage requirements for Controlled Drugs when the CDs are "under the direct personal supervision of a pharmacist". Supplementing the word "supervision" with the words "direct" and "personal" indicates a high degree of control. The directorate therefore believes that pharmacists must be able to exercise continual supervision of Controlled Drugs at all times and that CDs should only be out of the CD cabinet while they are actually being dispensed.

It is not acceptable for a CD to be left on a dispensary bench during pharmacy opening hours because, as the above incident demonstrates, the presence of the pharmacist at all times to supervise the stock cannot be assured.

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Spare dispensing labels for homes or carers

The Royal Pharmaceutical Society advises against pharmacists issuing spare dispensing labels to care homes or carers to assist with the administration of prescribed medication. Pharmacists have no control over how the spare label will be used once it has been supplied by the pharmacy and it is possible that the label could be reused by the home. An incident has been reported to the Society in which a medicine bottle was overlabelled with another patient's name with handwritten alterations. On investigation, it transpired that the home had used spare labels issued for the medicine administration record charts.

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Sale of strychnine for the killing of moles

The sale of strychnine is controlled under the Poisons Act 1972. It may be sold or supplied only to a person producing a written authority, in the form set out in Part II of Schedule 12 of the Poisons Rules 1982, authorising its purchase for the killing of moles. Written authorities are issued in England by persons duly authorised by the Department for the Environment, Food and Rural Affairs and in Scotland or Wales by persons duly authorised by the Secretary of State.

The Royal Pharmaceutical Society has been informed by DEFRA that permits are being issued for larger amounts than usual — between 50g and 100g — because of the large amount of farmland to be treated after the foot and mouth disease outbreak in 2001. The Poisons Rules state that the licence is valid for three months and the quantity sold does not exceed 100g.

In addition to the requirements of the Poisons Rules, purchasers of strychnine are required by the Control of Pesticides Regulations 1986 to supply the pharmacist with an additional "authority to purchase" permit. The permits are issued by the same authorities that issue the Poison Rules permits. Other requirements are set out in the section on non-medicinal poisons in 'Medicines, ethics and practice: a guide for pharmacists'.