Tact and discretion
This week could almost be dubbed Controlled Drugs Week. In addition to the pull-out guidance, ‘Changes in the management of CDs affecting pharmacists’, produced by the Royal Pharmaceutical Society's practice division (p355-8 PDF (60K)) for pharmacists in England, there is separate guidance about commissioning pharmaceutical services for drug misusers (p337) — also in England. And there is a further letter mildly berating the Council for its current advice on the extemporaneous preparation of methadone (p346).
The changes in CD management, produced in the wake of the Shipman inquiry,
will make some tasks less arduous and others more time-consuming and
potentially wearing. For example, best practice will entail a pharmacist
asking the collector of a Schedule 2 or 3 CD to sign the reverse of the
prescription form, although pharmacists will be able to use their discretion
in deciding whether or not to dispense the CD if a signature is refused.
In addition, although legislation will not require pharmacists to ask
everyone who collects a Schedule 2 CD for proof of identity, pharmacists
will have to exercise the same discretion for dispensing the CD if they
have no proof of the collector’s identity. It is at this point
that matters may become frustrating. Pharmacists will be required to
record, in the CD register, whether they asked for proof of identity
or not and what proof, is any, was seen. On the other hand, if no ID
was seen, the reason why must also be recorded. Fortunately it will not
be a criminal offence to supply the CD without proof of identity, even
when the collector is not known to the pharmacist. Nevertheless, it is
not hard to imagine circumstances where pharmacists will have to be supremely
tactful.
The second set of guidance this week is primarily for commissioners to
encourage pharmacists to develop services for drug misusers. Although
many pharmacies provide huge support for these patients, it is not necessarily
appropriate for all pharmacies. The guidance has been produced by the
National Treatment Agency for Substance Misuse (NTA), in conjunction
with the Society and the Pharmaceutical Services Negotiating Committee.
The NTA expects that 75 per cent of community pharmacies will have to
be involved in providing supervised consumption and shared-care schemes
and 25 per cent will have to offer needle exchange services if the needs
of these patients are to be met. That seems quite a tall order.
Meanwhile, there are still rumblings about the Law
and Ethics Bulletin (25 February, p245) advice on the preparation of methadone mixture and
the Council is once again asked to amend its guidance and be less prescriptive
(Letters, p346).
While procedures on handling CDs — in whatever form — needed
to be tightened up post-Shipman, they must not prove so demanding that
they compromise patient care.
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