PHARMACY BASED NEEDLE EXCHANGE SCHEME

POLICY DOCUMENT

The following policy was originally set up for West Surrey Health Authority in 1996. The latest update isAugust 2010.

Pharmacists who wish to join the Scheme will be required to sign an agreement committing them to run a needle exchange scheme as laid out within the following policy.

Aims

  • To reduce transmission of HIV and other blood-borne viruses associated with injecting drug use
  • To reduce the spread of HIV infection within Surrey
  • To encourage community pharmacists to distribute clean injecting equipment, to provide advice and information on the safe disposal of injecting equipment
  • Distribute appropriate literature advising harm reduction, safer sex and local services to ALL injecting drug users.

Objectives

  • To reduce the amount of shared injecting equipment by providing accessible, free sterile injecting equipment.
  • To provide free disposal for used injecting equipment, to encourage the safe disposal of contaminated waste.
  • To provide information on health issues, harm minimisation, and local services (counseling & advice) using both appropriate literature and advice.
  • To facilitate referral of clients to other agencies where specialist advice and treatment for problem drug use may be obtained
  • To provide citric acid powder
  • To provide sterile cups and filters
  • Information for pharmacist Appendix 2
  • To determine the level of need through monitoring and evaluation.

Confidentiality

Pharmacists and their staff should maintain absolute anonymity of clients using the service. Unless they have the consent of the client, a pharmacist must not disclose information about clients in the scheme to anyone. The Code of Ethics of the Royal Pharmaceutical Society provides guidance on confidentiality.

Training

It is a requirement that all pharmacists have training prior to taking part in the Scheme. Free training is provided for all participating community pharmacist and for their staff teams. It is a contractual requirement that all pharmacist participate in the needle exchange scheme annual training programme. Pharmacists and support staff will be given the opportunity to discuss problems and access up to date information. Pharmacist will be expected to work through the CPPE on line learding tool ‘Substance Use and Misuse’ and a copy of the certificate received from CPPE mustbe sent to the Scheme Manager at The Outreach Team.

Pharmacists wishing to deliver a needle syringe programme (NSP), need to familiarize themselves with the contents of the NICE Public Health Guidance 18 (February 2009). See summary printed below:

Needle and syringe programmes: providing people who inject drugs with injecting equipment

Summary

This guidance is for anyone who provides or commissions a needle and syringe programme, including those working in pharmacies and drug (and alcohol) action teams. Needle and syringe programmes provide sterile injecting equipment to people who inject illicit drugs. They may also support adults who i ...

Read the complete summary

This guidance is for anyone who provides or commissions a needle and syringe programme, including those working in pharmacies and drug (and alcohol) action teams.

Needle and syringe programmes provide sterile injecting equipment to people who inject illicit drugs. They may also support adults who inject non-prescribed performance and image-enhancing drugs.

The aim is to reduce the harm caused, particularly the spread of viruses such as hepatitis and HIV.

NICE recommends that local strategic partnerships (LSPs) – including local authorities – and NHS organisations should offer a range of services for people over 18.

All programmes should, as a minimum:

  • encourage people who inject drugs to use the services on offer
  • provide as many needles and syringes and other injecting equipment as someone needs
  • provide sharps bins and advice on how to dispose of equipment safely
  • provide advice on safer injecting and ways to get help to stop using drugs or switch to non-injecting methods.

More specialist programme services should include:

  • advice and services to help service users stop injecting
  • treatment of infections and other health problems, vaccinations and housing and benefits advice (or help to access to such services).

The guidance complements and supports, but does not replace, NICE guidance on drug and substance misuse. See NICE website:

Locum pharmacists must be made aware of the service and the operational procedures in advance of their providing locum cover for participating pharmacists.

It is important that all staff involved with clients have a positive attitude towards the scheme. It is the responsibility of the pharmacist to ensure that any staff they employ are fully advised of the occupational health and safety procedures, especially with regard to the risk of infection.All pharmacy staff should be aware of the policy and adhere to it.

Hepatitis B Vaccination

The Department of Health recommends that the pharmacists and their staff participating in such schemes have a course of Hepatitis B vaccine. General Practitioners should vaccinate people in high risk categories. This is optional but it is important that you are aware of the recommendations. Any pharmacist wishing to be vaccinated will be reimbursed the cost incurred for having the course of the vaccine.

Payment

Participating pharmacists will be paid on a quarterly basis. Payments will only be made if record sheets are returned on a quarterly basis to the Needle Exchange Manager at the Outreach Team, Sheerwater. If no exchanges have taken place, the sheet must still be returned marked ‘NO EXCHANGES’. The current fee is dependent on the level of exchanges taking place annually at the pharmacy.

  • Pharmacies exchanging less than 50 packs per year will receive a £100 annual retainer.
  • Pharmacies exchanging between 50-200 packs per year will receive a £500 retainer plus £1 per pack distributed over 50 per quarter and £0.50 per bin returned over 50 per quarter.
  • Pharmacies exchanging over 200 packs per year will receive a £200 annual retainer plus £1 per pack given out and £0.50 per bin returned.

To be eligible for all payments the pharmacist must operate the needle exchange service as specified within this operational policy, attend training and keep clear records of each transaction.

Records are also vital to produce an accurate annual report and secure funding for the continuation of services and future services.

Termination

Pharmacists may at any time give one months notice in writing that they no longer wish to participate in the scheme.

Surrey PCTmay at any time give notice in writing to pharmacists that they are terminating the involvement of that pharmacy in the Scheme.

Publicity and Logo

This pharmacy based scheme will be widely publicised with leaflets exhibiting contact numbers of agencies, which will then pass on the addresses of participating pharmacists.

Publicity will also take place by word of mouth amongst clients.

All pharmacists taking part in the Scheme will be required to display the logo on the door or in the window of their premises (available from the Needle Exchange Manager at The Outreach Team, Parkview Centre for the Community, Blackmore Crescent, Sheerwater, Woking Surrey, GU21 5NZ. Tel: 01932 355533).

Exchanges

  • Counter staff are the first point of contact but all enquiries should be referred to the pharmacist.
  • Exchanges should only take place when the pharmacist is on duty and in his/her presence.
  • Discretion should be employed in all transactions.
  • The complete pack should be issued to the client. The information is not aimed merely at the client but also at contacts of the client.
  • If a client is collecting more than one pack, please remove excess literature. This can be given to the Needle Exchange Manager at her next visit.
  • Up to a maximum of five packs may be issued at any one time, at the discretion of the pharmacist. Clients requiring greater quantities of paraphernalia should be directed to a member of the Outreach team (see Useful Contacts Section)
  • Used needles and syringes from the clients must be placed in the sharps container by the client and NOT handled by the pharmacist or any member of staff. At their discretion pharmacists may handle works returned within a personal sharps container, properly sealed and physically clean.
  • When the pharmacy sharps container is filled to the ‘full’ line it should be sealed ready for collection.
  • Each pharmacy will be provided with two sharps containers initially, which will be replaced on demand when one is full. Contact the Primary Care Support Service (0208 335 1329). Pharmacists should ensure that a spare container is available at all times.
  • The pharmacy sharps container, when not in use should be stored in an area away from public access. It should be brought to the client when needed.
  • Clients should be encouraged to return their ‘works’ in the personal sharps containers provided by the scheme, or in some way enclosed. Works returned in any other way should not be refused, but pharmacists must get the client to put the works into the sharps container personally.
  • Clients should be encouraged to return used works but failure to do so does not disqualify them from being issued with new needles and syringes. However, enquiries should be made as to how the client is disposing of the equipment. Attempts should be made to ensure safe disposal is occurring e.g. at another exchange facility.
  • Pharmacists may wish to plan the timing of exchanges with clients.
  • Normal standards of hygiene must be employed throughout the transaction.

Exchange Packs

Six different packs are available - see Appendix 1

Ordering & Delivery of Exchange Packs

Packs can only be ordered from the Primary Care Support Service (PCSS) by post or fax using the order forms provided in the ‘Resource Pack’. If you require order forms please contact the PCSS on 0208 335, 1422or the Needle Exchange Manager on 01932 355533.

The PCSS request 10 days notice when ordering packs.

Standing Orders

If you are making regular exchanges, you may wish to set up a standing order for the needle/syringe packs. The standing orders will bedelivered once or twice a month depending on your usage and storage space.

To set up a standing order please contact the Needle Exchange Manager, at Surrey Harm Reduction Outreach Team, Parkview Centre for the Community, Blackmore Crescent, Sheerwater, Woking, Surrey GU21 5NZ. Tel: 01932 355533, Fax: 01932 350963.

Records

Good record keeping is good practice and is important for evaluation. Pharmacists are therefore asked to maintain a record of exchanges on the record sheets provided by the Needle Exchange Manager. This basic register should include:

  • Date of visit
  • Clients initials or nickname - if client is reticent, a description of the client will suffice
  • Approximate age
  • Sex i.e. M or F
  • Ethnic Origin
  • Number and type of packs issued e.g. 2x 1ml pack
  • Number of bins returned - DO NOT OPEN THE CONTAINER
  • Any additional information sought by the client
  • Please write in the comments column if the client is ‘NEW’ or ‘REGULAR’ as well as any other comments the pharmacist wishes to make

Written guidelines for the completion of the record sheets are provided (Appendix 3)

Sharps Containers

Each participating pharmacy is provided with at least two 22 litre sharps containers initially, which will be replaced on demand. The Primary Care Support Service should be contacted to arrange collection and replacement of the containers using the form provided in the ‘Resource Pack’. When one of the large sharps containers is full complete a ‘Sharps Collection Form’ and fax it to the PCSS on 0208 335 1401. The pharmacist should ensure that a spare container is available at all times.

The sharps containers for collection should be fully sealed using the appropriate fastening for that container.

The same form can be used for ordering new sharps bins

Health & Safety

It is the responsibility of the pharmacist to ensure that all pharmacy staff are fully advised of the occupational health and safety procedures. A copy of the Medical Association publication (1993) “A Code of Practice for the Safe Use and Disposal of Sharps” should also be available for reference.

Useful Equipment:

  • Disposable gloves
  • Disposable aprons
  • Sodium hypochlorite granules
  • Sodium hypochlorite 2.5g tabs
/
  • Dustpan and brush
  • Yellow clinical waste bags
  • 2 pairs disposable forceps
  • Goggles

  • Spillage Kits containing the above can be obtained from Needle Exchange Manager.

General Precautions

1The pharmacist should check the physical integrity of the pharmacy sharps container prior to use.

2All cuts and abrasions to pharmacist and staff should be covered with a waterproof dressing.

3Needle Stick injuries

3.1In the event of a needle stick injury the wound should be encouraged to bleed and then washed thoroughly with soap and cold water, but without scrubbing. Splashes of blood in the eyes or mouth should be irrigated by copious amounts of water, preferably running water. Please ensure that contact lenses are removed before this procedure.

3.2The person injured should then report immediately to their General Practitioner or to their local Accident and Emergency Department.

Enter the incident in the ‘Pharmacy Incident Book and inform the needle exchange Manager.

4Spillage of Sharps

4.1In the event of spilt sharps, cordon off the area from the public and staff. Wear strong household gloves and a disposable apron should be worn. Sharps should not be handled but picked up using forceps and placed directly in the pharmacy sharps container.

4.2The area should then be washed with 1% sodium hypochlorite solution, using a disposable cloth.

4.3Rinse the area with clean water and allow to dry.

4.4Gloves, aprons and forceps should be disposed of into a yellow bag for clinical waste or if necessary into the sharps container.

4.5Wash hands in soapy water and dry thoroughly.

5Spillage of breakage from the Pharmacy Sharps Container

5.1In the unlikely event of used syringes becoming spilled or accidentally released a dustpan and brush and gloves should be used to carefully collect the spilled sharps. These should then be emptied into a spare sharps container or into a suitable temporary receptacle, i.e. one that is durable enough not to be pierced by the sharps and can be closed. Any works lodged in the bristles of the brush should be removed with forceps.

5.2The procedure for spillage should then be carried out (see section 4).

6Spillage of Body Fluids

Cordon off the area from the public and staff.

6.1Wearing disposable gloves and an apron, treat the area with sodium hypochlorite granules. Sprinkle the granules evenly over the fluid so that the whole surface is covered. Leave for 2 minutes.

6.2After 2 minutes if any of the fluid still remains sprinkle more granules to cover it and leave for a further 2 minutes. This ensures complete disinfection.

6.3When all the fluid has been absorbed wipe up with disposable cloths or scoop and place in the pharmacy sharps container.

6.4The area should then be washed with a 1% sodium hypochlorite mixture using a disposable cloth. (10,000 ppm available chlorine).

6.5The surface should then be rinsed with clean water and dried.

Dispose of gloves, apron, cloths and towels into a yellow clinical waste bag and then wash hands in soapy water and dry thoroughly.

7Document Review

This Operational Policy will be subject to review in January of each year. The payment and contractual arrangements for participating community pharmacists will also be reviewed in April of each year.

8Children and Young People under the age of 18 years

Children and young people under the age of 18 years are protected by a comprehensive framework of powers and responsibilities set out in the Children Act 1989 and associated regulations and guidance. The provision of needle exchange services to those under 18 years requires a careful consideration of all health and legal aspects and a full assessment. Needle exchange should only be offered to children and young people as part of a planned care package.

Pharmacists participating in this scheme are unlikely to be able to undertake the level of assessment and care planning required to ensure a safe service to children and young people. It is therefore, recommended that this service is not provided to those under 18 years.

Children and young people should be referred to the local specialist young people’s drug agency (Catch 22, 24/7 service on 01372 832888) and the Scheme Manager informed.

In all cases, the welfare of the child is paramount. Further information and guidelines are provided in the Pharmacists’ Resource Pack and training will be given as part of the Annual Training Programme.

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Last edited August 2010

Appendix 1

Needle Exchange Packs

Pack Type / Code / Description / No. of Packs
1 ml Pack
RED STRIPE / X360C / 10 x 1ml Integrated NEEDLE/SYRINGES, (B-D)
10 x Sachets Sterile Citric Acid
1 x Frontier Sharpsafe Bin 0.2L
10 x Exchange Stericup with Filter
2 x Durex Gossamer Condoms Scheme card
1ml Pack
WHITE PACK / X430C / 10x1ml integrated clear never share NEEDLES/SYRINGES
10x Sachets Sterile Citric Acid
1x Frontier Sharpsafe Bin 0.2L
10xExchange Stericup with Filter
2x Durex Gossamer Condoms Scheme card
2 ml Pack
BLUE STRIPE / X361C / 10 x 2ml SYRINGES
5 x B-D ORANGE NEEDLES
5 x 1” B-D BLUE NEEDLES
10 x Sachets Sterile Citric Acid
1 x Frontier Sharpsafe Bin 0.45L
10 x Exchange Stericup with Filter
2 x Durex Gossamer Condoms Scheme Card
5 ml Pack
ORANGE DOT / X362C / 5 x 5ml Terumo SYRINGES
5 x B-D ORANGE NEEDLES
5 x B-D 1¼ BLUE NEEDLES
5 x Sachets sterile Citric Acid
1 x Frontier Sharpsafe Bin 0.45L
2 x Durex Gossamer Condoms Scheme Card
10 ml Pack
YELLOW STRIPE / X363C / 5 x 10ml Terumo SYRINGES
5 x B-D ORANGE NEEDLES
5 x B-D 1¼ BLUE NEEDLES
5 x Sachets Sterile Citric Acid
1 x Frontier Sharpsafe Bin 0.45L
2 x Durex Gossamer Condoms Scheme Card
2ml Steroid Pack
GREEN STRIPE / X364C / 10 x 2ml SYRINGES
10 x B-D 1½ GREEN NEEDLES
10 x B-D 1¼ BLUE NEEDLES
1 x Frontier Sharpsafe Bin 0.45L
2 x Durex Gossamer Condoms Scheme Card
Pharmacist Signature
Date

EACH PACK ALSO CONTAINS A RANGE OF INFORMATION LEAFLETS AND A NEEDLE EXCHANGE SCHEME CARD.