The Pharmaceutical Journal
Vol 270 No 7230 p32
4 January 2003

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

Law and Ethics Bulletin, 1992 to present

• Covert administration of medicines
• Stolen registration certificate
• Revised forms authorising the purchase and use of strychnine

Covert administration of medicines

Pharmacists are reminded that covert administration of medicines must only be undertaken in accordance with a locally written policy. The policy must have the best interests of the patient or client in mind and the medicine to be administered must be considered essential for the patient's or client's health and well being, or for the safety of others.

The decision to administer a medicine covertly should not be considered routine, and should be a contingency measure. Each patient's or client's need must be assessed individually.

Before the covert administration of a medicine there must be involvement with the multiprofessional clinical team and the supporters of the patient or client and an agreement that this approach is required in the circumstances. Those involved should include carers, relatives, advocates and the multidisciplinary team, which should include the pharmacist. A further consideration must be made as to whether or not the patient or client has indicated consent or refusal at an earlier stage, while still competent, in the form of a living will or advance statement.

Pharmacists asked to dispense products for covert administration must consider whether alternative licensed products are available, such as the same drug with a different formulation or a different drug for the same indication. Pharmacists should be aware that if a formulation is crushed, dissolved or otherwise tampered with then the product will be rendered unlicensed. Pharmacists must consider and advise on the potential for distortion in the bioavailability profile of the medicine and whether there is a need for reduction or increase in dose and how or whether this can be quantified.

Pharmacists must consider the risks and benefits for patients of administering in altered form against not administering.

Any nurse who wishes to covertly administer a medicine should be advised to approach the Nursing and Midwifery Council for advice (tel 020 7333 6564).

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Stolen registration certificate

The Royal Pharmaceutical Society has learnt that a pharmacist's registration certificate has been stolen, with a photocopy of the certificate being left in its place.

The name on the certificate is that of Mrs Gurdeep Kaur Kenth, registration number 93332. Pharmacists are asked to be vigilant during the course of their work, especially when recruiting a new locum pharmacist or pharmacy manager.

If a pharmacist becomes aware of a person presenting with these details, they are asked, as a matter of urgency, to contact the Society's Professional Standards Directorate on 020 7572 2308.

Pharmacists are reminded that they should not make photocopies of their registration certificates except where required for identification purposes, for example, when approaching a locum agency or a new employer.

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Revised forms authorising the purchase and use of strychnine

Pharmacists in England are advised of a change to the forms giving authority to purchase and use strychnine for killing moles.

The Department for Environment, Food and Rural Affairs intends to replace the existing authority documents, LP10 (authority to purchase) and STRYCH 3 (authority to use), which are currently manually typed or handwritten, with new computer generated forms. The signature of the authorising officer and the DEFRA stamp (currently being developed) will authenticate the new documents.

DEFRA plans to introduce the new forms early in 2003. In the meantime pharmacists in England should continue to accept the existing documents, as referred to previously in this bulletin (PJ, 1 June 2002, p789) and described in detail in the section on non-medicinal poisons in the current edition of 'Medicines, ethics and practice: a guide for pharmacists' (p55).

The Scottish Parliament and the National Assembly for Wales have no plans to change the existing forms used in Scotland and Wales.