WELSH HEALTH CIRCULAR

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1 WELSH HEALTH CIRCULAR WHC (2002) 71 Parc Cathays Caerdydd CF10 3NQ Cathays Park Cardiff CF10 3NQ Title: MEDICATION SUPPLY TO HOSPITAL PATIENTS Issue Date: 17 June 2002 Status: Action For Action by: Chief Executives, NHS Trusts; Chief Executives, Health Authorities Action required See paragraph(s) : 6, 11, 12, 13, 15, 18 For Information to: See Distribution list Sender: John Sweeney, Director, Primary and Community Health, National Assembly for Wales National Assembly contact(s) : Carolyn Poulter ( ) or Gavin Parry ( ) Pharmaceutical Services Branch, Primary and Community Health Enclosure(s): Tel: GTN: 1208 Llinell union/direct line: Ffacs/Fax: Minicom:

2 Distribution List Chief Executives, Health Authorities Directors of Pharmaceutical Public Health, Health Authorities Directors of Public Health, Health Authorities Directors of Finance, Health Authorities Directors of Contractor Services, Health Authorities Medical Advisors, Health Authorities Chief Executives, NHS Trusts Medical Directors, NHS Trusts Local Health Groups Chairs Local Health Groups General Managers Health Solutions Wales Health Promotion Wales NHS Confederation in Wales Association of Welsh CHCs BMA (Wales) GPC(Wales) Welsh Medical Committee BDA (Wales) Welsh Dental School British Orthoptic Society Royal College of Midwifes, Welsh Board British Dietetic Association Society of Chiropodists & Podiatrists Royal College of Nursing (Wales) Royal College of General Practitioners Society of Radiographers NHS Staff College Wales Senior Officer, Chartered Society of Physiotherapists Audit Commission Welsh Medicines Resource Centre UWCM Therapeutics and Toxicology Centre Committee on Safety of Medicines (Wales) Welsh Medicines Information Centre Welsh Executive of the Royal Pharmaceutical Committee Community Pharmacy Wales Welsh Pharmaceutical Committee Chief Pharmacists, NHS Trusts Welsh Committee for the Professional Development of Pharmacy Welsh Centre for Post-Graduate Pharmacy Education Celtic Dimensions ABPI WIG British Generics Manufacturers Association Medicines Control Agency Department of Health Scotland, NI Assemblies

3 WHC(2002)71 ANNEX Introduction 1. This guidance is intended to update and amplify the earlier guidance contained in WHC(91)94 whilst preserving its basic principles. Hospital medication supply Use of Manufacturers Original Packs ( Patient Packs ) 2. Previously issued guidance (WHC(91)94) recommended that a minimum of 7 days worth of medication should be supplied on a patient s discharge from hospital. This figure was deemed to provide sufficient time to enable patients to obtain further supplies of their medication from their General Practitioner following discharge from hospital. 3. Provisions made under Directive 2001/83EC (formerly 92/27/EEC) require that all medicines dispensed to patients should be accompanied by an explanatory patient information leaflet (PIL) and should bear the product s batch number and expiry date. Supplying medication in manufacturers original packs is the best means of fulfilling these requirements and preserving the product s licensed status. 4. Hospital pharmacy departments should therefore move towards using manufacturers unopened original packs as standard practice within the dispensing process. The routine use of manufacturers original packs for dispensing will: - aid the efficiency of the dispensing process - reduce the risk of dispensing errors - provide the patient with a patient information leaflet on their medication in line with Directive 2001/83EC - increase the time period between the patient s discharge and his/her need for a further supply of medication. This will ensure that the GP will have received the patient s discharge information before a further supply is required. - facilitate the automation of the dispensing process 5. Experience from NHS Trusts, where original pack discharge medication has been introduced, has demonstrated significant financial savings for the local primary care economy Jeffrey L. 28 day patient pack discharge medication Pharmacy Management 17 No 2 April 2001 Pg Barker A. 28-day Outpatient Dispensing Only a simple step? Pharmacy Management 18 No 1 January 2002 Pg Longer TTOs save money for Derby Hospital Pharmacist (8) Audit Commission. A spoonful of sugar medicines management in NHS hospitals Audit Commission, December 2001

4 Action 6. Directors of Finance for Health Authorities, Local Health Groups and Trusts should establish mechanisms to enable prompt implementation of original pack dispensing. Funding should be transferred from primary to secondary care to facilitate the process. This should be implemented Local Health Groups/Board and Trusts by April Use of patients own drugs in hospital 7. Redesigned medicine supply services for hospital patients, that enable the appropriate use of patients own medication in conjunction with original pack dispensing, have realised significant benefits for patients, hospital staff and General Practitioners. 8. As part of the re-engineered process, patient s own medication is assessed as suitable for use and stored in an individual medication locker at the patient s bedside. Manufacturers original packs, pre-labelled for the patient s discharge (if appropriate), are dispensed if additional or subsequent supplies of medication are required to supplement the patient s own supply. 9. This redesigned supply process, - reduces prescribing and medication administration errors - facilitates patient understanding of their medication - reduces medication waste - increases the efficiency of the medication supply process - reduce delays in discharge resulting from dispensing of discharge medication - makes better use of pharmacy staff skills mix by developing the role of the pharmacy technician in the supply process, releasing pharmacists time for clinical work - can be extended, where appropriate, to enable self-administration of medication by patients 10. Such re-designed services are described in greater detail in the Task and Finish Report on Prescribing 5 and in the Audit Commission s document, A spoonful of sugar. 4 Action: 11. Local Health Groups, Health Authorities and General Practitioners (GP) should not discourage patients from taking their medication into hospital for use during their stay within the hospital service. 12. Trust Boards should review their pharmacy staffing establishment and make funding available to facilitate the introduction of redesigned medication supply processes 5 Task and Finish Group for Prescribing in Wales. Report to the Minister for Health and Social Services March 2001

5 13. Trust Chief Executives should approach Welsh Health Supplies with a view to establishing a Welsh contract for the supply of patients medicine lockers. 14. The National Assembly for Wales will issue a national poster in the Autumn 2002 to encourage patients to bring in their medicines on admission to hospital. Prescribing at the primary / secondary / tertiary care interface Outpatients and Day Case patients 15. Hospital outpatients should only receive their initial supply of medication from the hospital when there is an urgent clinical need. The consultant should request that the General Practitioner considers initiating or continuing treatment. In order to facilitate a General Practitioner s compliance with local prescribing formularies, consultants should, wherever appropriate, recommend a class of drug to be prescribed by the General Practitioner, rather than a specific individual drug or brand. 16. The consultant should give the GP notification in adequate time of the patient s diagnosis so that any on-going treatment can be maintained. 17. In the event that information about the patient cannot be transferred from hospital to GP within the time-scale or when a consultant feels that there is a clinical need to initiate immediate treatment to an outpatient, the consultant should prescribe the necessary medication. The supply should be made as an original pack. Accident and Emergency Patients 18. Patients discharged from an Accident and Emergency Unit should receive a 5-7 day supply of medication or less if drugs are not required for that length of time. Original pack dispensing, or pre-packed medication produced for Accident and Emergency purposes, should be used wherever appropriate. The decision to use original packs or pre-packed medication in this area should be left to the discretion of the Trust Chief Pharmacist. Prescribing of original packs in primary care 19. Local Health Boards will need to facilitate the move towards original pack dispensing in primary care on a clinical governance, patient safety and risk management basis. The All Wales Medicines Strategy Group, soon to be established, will consider how best to implement this move.

6 To: NHS Trusts - Chief Executives, Trust Boards, Directors of Finance, Consultants, Chief Pharmacists Health Authorities - Chief Executives, Directors of Finance, Directors of Pharmaceutical Public Health l l h B d G l 17 June 2002 Dear Colleague MEDICATION SUPPLY TO HOSPITAL PATIENTS 1. Guidance on the following subjects is attached as an annex to this circular: use of manufacturers original packs (sometimes referred to as patient packs ) the use of patients own medication in hospital redesign of medicines supply services for hospital patients prescribing at the primary / secondary / tertiary care interface 2. This guidance, which should be brought to the attention of all prescribing doctors and NHS Trust Chief Pharmacists, supplements the previous Welsh Office circular WHC(91)94 and updates the advice on the minimum quantities to be supplied on discharge. 3. The additional guidance reflects the recommendations of the Task and Finish Group Report on Prescribing 6 and the Audit Commission s report, A spoonful of sugar; Medicines Management in NHS Hospitals 7. 6 Report to the Minister for Health and Social Services Task and Finish Group for Prescribing in Wales. March A spoonful of sugar medicines management in NHS hospitals Audit Commission. December 2001

7 4. Copies of the Audit Commission s report on medicines management are available from: Audit Commission Publications, PO Box 99, Wetherby, LS23 7JA. Telephone: Enquiries about this letter and requests for copies of the Task and Finish Group Report on Prescribing should be addressed to: Carolyn Poulter Head of Pharmaceutical Services Branch Primary and Community Health Division National Assembly for Wales Cathays Park CARDIFF CF10 3NQ Yours sincerely John Sweeney Director Primary and Community Health

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