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 Electronicjuice'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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