Hospital Pharmacist
Vol 9 No 1 p4
January 2002

Review of circulars and official publications
by Alex Bower, MRPharmS

The "National guidance on the safe administration of intrathecal chemotherapy" was issued on 6 November, 2001, as HSC 2001/022. Action to rectify any non-compliance should have been completed by the end of December, but hospital pharmacy managers and other relevant staff will need to consider the continuing implications of the guidance. This includes arrangements to maintain a register of designated personnel, update training and provide input into regular reviews of protocols by ward staff.

The circular is silent on the frequency of competency testing and future use of the checklist as an audit tool, but these aspects need to be considered

"Withholding treatment from violent and abusive patients in NHS Trusts" was issued as Health Service Circular (HSC) 2001/18 on 2 November, 2001.

By April, all NHS trusts are required to develop local policy in this area and introduce safer working conditions. The policy should state clearly how staff are expected to deal with aggression and violence. This includes situations where staff are subject to verbal abuse that makes them feel unsafe, and significant threats or risk of injury. Withholding treatment is a last resort, and it raises difficult clinical and managerial dilemmas. However, the circular claims that there is evidence that appropriate policies can act as a deterrent to potentially violent patients and visitors.

The extent to which hospital pharmacy staff are subject to violent and abusive behaviour is not clear and there may be a need to initiate arrangements, either nationally or locally, to assess the full extent. In the meantime, the potential risk is such that hospital pharmacy managers will be well advised to review arrangements locally and consider any further action that should be taken to protect staff. This includes the provision of suitable training, which might be provided on a multidisciplinary basis in a trust, on coping with violent and abusive patients or visitors.

"Good practice in consent — achieving the NHS Plan commitment to patient-centred consent practice" was issued as HSC 2001/023 on 22 November, 2001. This circular lists a range of associated documents regarding consent to treatment. These can be viewed on the internet. There are four model forms for consent to treatment, covering the following groups of patients:

1. Patients able to consent for themselves

2. Those with parental responsibility consenting on behalf of a child or young person

3. Patients able to consent for themselves and those with parental responsibility consenting on behalf of a child or young person, where the procedure does not involve any impairment of consciousness. The use of this form is optional

4. Adult patients unable to consent to investigation or treatment

NHS trusts are required to introduce the new consent to treatment forms and accompanying patient information by 1 April, and a model consent to treatment policy by 1 October. These requirements will be of particular interest to hospital pharmacists who serve on ethical committees. These pharmacists need to ensure that the new arrangements are applied for patients who are entered into clinical drug trials.

HSC 2001/025, issued on 27 November, 2001, was entitled "Care Standards Act 2000 — guidance on continuing responsibilities of local authorities and health authorities following the transfer of registration and inspection to the National Care Standards Committee on 1 April 2002".

From 1 April, health authorities and local authorities will no longer be responsible for the registration and inspection of private and voluntary health and social care. These roles will be undertaken by the National Care Standards Committee (NCSC), which will have powers to cancel registration in respect of the services it registers.

Local authorities and health authorities (and their successor primary care trusts) will remain as purchasers and providers of the services and should agree a procedure for local action to be taken in the event of a cancellation of registration, including cases of urgent cancellation. It is recognised that there will be circumstances in which it is appropriate to share information between the bodies responsible for registration, inspection, purchasing and providing. Locally agreed protocols and procedures, which have been subject to legal advice, need to be developed to govern arrangements for information-sharing.

Hospital pharmacists who currently undertake inspections as part of registration arrangements for private nursing homes will need to consider the implications of these changes at the local level. Health authority pharmaceutical advisers and others who have been involved in developing policy documents on the safe custody and administration of medicines for private nursing and residential homes will also need to consider any implications arising from the change. This may present an opportunity to review current advice and put in place an updating process to include the development of a common policy, wherever possible, covering private nursing and residential homes.

Mr Bower is assistant director of strategic development at Wakefield Health Authority