East Sussex Downs and Weald
JIC – Use In Practice
1. Algorithm
1.1 Deciding that pack is required – by GP and D/N (+/- Specialist Pall Care Nurses) in consultation at one of Pall Care meetings (LES) or a home visit. Usually 4-8 weeks before anticipated need. D/N or GP will have to assess likely-hood of abuse by family / visitor to home.
1.2 GP/DN has a face-to-face consultation with the patient and carer explaining (via pre-printed sheet – need for and what each drug does) what the JIC drugs are for and obtains written consent and agreement for storage, use and return of box and informs patients that only pharmacies / dispensaries on a PCT-approved list will be able to supply them. It is stressed that the JIC box is to stay at home – even if the patient is admitted to hospital / hospice.
1.3 GP prescribes from standard list → computer system → generates script and confirms the use of the JIC box in patients records.
1.4 GP countersigns Palliative Care Folder Anticipatory Prescribing Form, (usually filled in by District Nurse).
1.5 GP (PPCL – Practice Palliative Care Lead) updates OOHS and H@H that JIC is in patient’s home via fax.
1.6 PPCL or D/N displays JIC in use on whiteboard.
1.7 Patient / Carer picks up script (or JIC box from dispensing practice) and (pre-prepared) letter addressed to Pharmacist together with the names of the Pharmacies participating in the scheme and takes this to Pharmacist on JIC list. Patient/Carer informs surgery which Pharmacy the script will be taken to and this is noted in patient’s records.
1.8 Pharmacist dispenses packs and signs inventory for contents. The outside of the box should also have label with patient’s name, address and drug content with earliest expiry dates (which should be at least 6 months from the date of dispensing). Patient/Carer signs on back of script in CD box and shows ID.
1.9 Patient/Carer keeps box at home
1.10 The box and its contents (expiry dates and security seal) are checked monthly by D/N or GP when visiting.
1.11 Box is used by D/N or H@H nurse or OOHS doctor who checks all drugs present and signs inventory to say which has been used and how many left.
1.12 On resumption of normal hours D/N or H@H or OOHS contacts GP/surgery and asks for appropriate amounts of commenced drugs to continue infusions. JIC box now left with patient but not topped up as adequate prescribing should now happen on a rolling basis.
1.13 After death of patient, carer returns JIC box containing any unused drugs and the inventory to Pharmacist/dispenser who checks it before putting CDs aside for destruction.
1.14 PPCL contacts Pharmacy to check whether box has been returned and then informs OOHS/DN/H@H/GP.
2. New Forms to Be Used.
2.1 Explanation letter for JIC and what each drug does – kept in
JIC Box.
2.2 List of pharmacies participating in JIC.
2.3 Letter to pharmacist re: JIC.
2.4 Inventory of JIC controlled drugs to be inserted into JIC box.
2.5 Labels for outside of JIC box – can be standard label which has expiry dates written on (a separate label for drug box and Outside of JIC – can be printed at time of dispensing)
Notes
1. Dispensing practices can all apply to be on PCT Pharmacy LES (for JIC) above under contestability rules (please substitute dispensaries of participating GP dispensing practices where appropriate in all documentation
2. The box of ‘CD’s’ - if started – will be used up before newly dispensed drugs are opened.
3. Each box will have a plastic tamper-proof seal applied to the lid at time of dispensing. It is expected that this seal will only be broken by the professional teams involved.
4. Each participating pharmacy will carry at least 2 JIC boxes initially and will re-order when they are down to one box.
5. The participating pharmacies/dispensaries have been signed up to the Pharmacy LES for stocking the Specialist Palliative Care drugs and some of them offer an extended hours service.
6. Urgent / emergency drugs in the out of hour’s period are still obtained by contacting the OOHS who will liaise with a local chemist.
7. The CDs will need to be written in the form of the range of quantity to be given (similar to the folder form) and not ‘as directed’.
8. Drugs should have at least 6 months before expiry date and be supplied in the minimal size of unbroken ‘original packs’ if possible).
9. There will be 6 (2 sizes of water for injections) items in all – see list.
10. The JIC box concept will be linked to LCP / End of life care but it will be made clear that it is to be considered well in advance of the last few days.
11. An algorithm for use of the JIC will be on HARMLESS / GRACE together with a copy of all forms
Items for JIC Box.
1. DIAMORPHINE ampoules – 10x10mg/amp.
2. HYOSCINE HYDROBROMIDE ampoules (600mcg/1ml) -10x1ml.
3. MIDAZOLAM ampoules – 10x (10mg/2mls).
4. HALOPERIDOL ampoules – 5mg/amp x 10
5. CYCLIZINE ampoules – 10x 50mg/amp.
6. WATER FOR INJECTION ampoules – 10x10ml and 10x5ml.
Glossary.
JIC just in case
OOHS out of hours service
D/N district nurse
H/H hospice at home
CD controlled drug
June 2010
Version 1.1