Medicine Supplies

QUICK GUIDE

TO PRESCRIBING,

MEDICINE SUPPLIES

AND SUPPORT

FROM YOUR PHARMACY

INDEX

Page
Adverse Drug Reaction / 6
Antibiotic Policies / 6
CIVAS (Central IV addictives service) / 3
Clinical Pharmacy Service / 1
Controlled Drugs / 5
Cytotoxic Service / 3
Directorate Pharmacists / 8
Discharge Medication / 5
Dispensary Opening Hours / 2
Emergency Cupboards / 2
Emergency Duty Service / 3
Formulary / 6
Free Samples / 7
IV administration by Nurses / 7
Medical Representatives / 7
Medicines Information Centre / 1
New Medicines / 6
Parenteral Nutrition Service / 3
Patients Own Drugs (POD) Service / 7
Prescribing – general guidance / 4
Prescribing for self or other staff / 7
Product Defects and Product Recalls / 6
Self Prescribing / 7

PHARMACY

Welcome to pharmacy. In addition to supplying medicines, we can offer helpful advice and guidance on their use. Access to this information may be gained by three routes:

The Regional Medicines Information Centre

The Clinical Pharmacy Service

The Dispensary

Regional Medicines Information Centre (ext. 6908/9) or Email:

Provides advice on medicines and drug therapy and has access to considerable

information resources, as well as local and national experts. Please phone or call in

if you need information on any medicine related topic such as:

Choice of therapy

Administration/Dosage

Adverse effects

Availability/supply

Identification

Interactions

Pharmacology/Pharmacokinetics

Drugs in pregnancy

Drugs in breast feeding

Alternative medicine

Substance misuse

Information on new drugs

The centre is located near the lifts to the right of the foyer on C level at SGH, and is

open 8.45a.m. - 5.15p.m. Monday – Friday. It serves all healthcare professionals in

both primary and secondary care.

Also look at our websites:

and

The service does not normally provide POISONING INFORMATION. Urgent

enquiries related to poisoning should be referred to one of the National Poisons

Centres (as listed in the front inside cover of BNF).

Clinical Pharmacy Service

Most wards have a Pharmacist who visits them each day at an agreed time. The Pharmacist checks that the prescriptions you write are clear, legally correct and safe. They are there to offer you information about any potential problem.

Dispensary

The dispensaries are open for information and supply of medicines at the following

times:

Hours of Opening

Southampton General Hospital

Monday, Tuesday, Thursday, Friday:9.00 a.m. to 5.00 p.m.

Wednesday9.30 a.m. to 5.00 p.m.

Saturday9.00 a.m. to 12.30 p.m.

Sunday (for urgent TTO’s only) 11.30 a.m. to 12.30 p.m.

Southampton Eye Unit, S.G.H.

Monday to Friday (mornings): 9.00 a.m. to 1.00 p.m.

Monday to Thursday (afternoons):2.00 p.m. to 5.00 p.m.

Southampton Oncology Centre, SGH

Monday to Friday 9.00 a.m. to 5.00 p.m.

Saturday and Sunday Closed

(for emergency supplies the main pharmacy may be used)

Royal South Hants Hospital

Monday Tuesday, Thursday, Friday 8.30 a.m. to 5.00 p.m.

Wednesday 9.15 a.m. to 5.00 p.m.

Saturday:8.30 a.m. to 11.30 a.m.

Lymington Hospital

Monday and Tuesday:8.30 a.m. to 1.00 p.m.

2.00 p.m. to 5.00 p.m.

Wednesday: 8.30 a.m. to 1.00 p.m.

Thursday and Friday:8.30 a.m. to 1.00 p.m.

2.00 p.m. to 5.00 p.m.

Emergency Cupboards

Apart from Lymington, there is no access to Pharmacies outside the hours given above, but each department has an emergency cupboard nearby, which is available to medical staff. Newly appointed medical staff are invited to seek the assistance of pharmacy staff in order to become familiar with the local arrangements for obtaining keys and the location of the emergency cupboard. It would be helpful if details of all items taken from the cupboard could be entered in the book provided, so that stock can be replaced promptly for the next emergency. The controlled drug cupboards in the Pharmacies are not accessible when the departments are closed, but adequate stock is normally available on the wards.

Emergency Duty Service

In an emergency, a Pharmacist can be contacted for information about medicines or

their supply through the hospital switchboard at Southampton General Hospital.

Parenteral Nutrition Service

Guidelines on the use of PN and other nutrition support are available on all wards

(“The Nutritional Management of your Services”). The Parenteral Nutrition (PN) service is available from the Pharmacy at Southampton General. Requests for PN solutions for adults are made through Clinical Pharmacists or the Nutrition Support Team, who agree with Pharmacy a range of standard formulations - requests must be received by 12.00 noon, at the latest, on the day on which they are required. Requests for paediatric of neonatal PN are made through the clinical pharmacists or the pharmacy PN unit. All orders for these must be received by the Manufacturing Unit not later than 2.00 pm on the day on which they are required. The service operates on five days a week only. Prescriptions for Saturdays and Sundays are prepared on Thursdays and Fridays. For further information on PN, contact the Nutrition Support Team Bleep 2082/1361 or the Technical Services Pharmacist at SGH (ext 8352 or 6090 or bleep 2599). Out of hours contact Emergency Duty Pharmacist for advice.

Central intravenous Additive Service (CIVAS)

The Pharmacy Technical Services section operates a central intravenous additive

service to the Cancer Care Directorate, Child Health Directorate, NNU, Elderly Care

and Critical Care Directorate and for patients receiving treatment at home. The service

provides a range of antibiotics in a ready to give form, ie. bag, syringe etc. This

service exists to reduce wastage on the wards, release nursing/medical staff time from

the task of reconstituting drugs, as well as ensuring this is done under aseptic

conditions. Contact Senior Technician or pharmacist on ext 6384.

Cytotoxics

A centralised oncology pharmacy service is available at SGH. This satellite unit

provides a full service to oncology by having its own dispensary and aseptic unit.

Under Trust health and safety policies, all cytotoxics must be prepared in the

specialised facilities available in pharmacy, and handled on the ward by trained and

approved staff. Drugs will be provided in the most ready use form. Prescriptions

should be sent to the pharmacy no later than 3pm on the day the drugs are required.

For dermatology and bladder instillations at the RSH, prescriptions must be faxed to

the oncology pharmacy on Fax 6762 and the original prescription taken to the RSH

pharmacy which will be released on receipt of the drugs from SOCP.

For further information contact the Service Manager on Ext 3125 or Bleep 2480. For

the Directorate Pharmacist Bleep 1128.

Out of hours contact the emergency duty pharmacist as described in Section 5.

Prescribing and the Use of Drug Administration Charts

The British National Formulary (BNF) and the BNF for Children are excellent prescribing guides. Approved names from this text should be used wherever possible. All medicines, including additives to intravenous infusions, should be prescribed on the drug chart.

Directions for Use of the Charts

Prescriptions should be written in ink in capital letters.

Abbreviations: the following are permissible:

S.C. -Subcutaneous

I.M. -Intramuscular

I.V. -Intravenous

Sub ling -Sublingual

O -Oral

All other routes of administration should be written in full, eg. intrathecal.

The dates, times and routes of administration must be explicit.

Changes in drug therapy must be ordered by a new prescription, after deleting the

discontinued drug. It is not acceptable to amend items.

Discontinue a drug by clearly crossing out the discontinued drug, and drawing a

line through the unused recording panel. Sign and date all discontinuations.

Dosage should be given in metric figures. Circle the appropriate units on the chart or write them clearly

Full Signature must be used by the doctor prescribing in addition please print your name and bleep number.

Length of Treatment if known to be limited, e.g. antibiotics should be indicated.

Controlled Drugs, eg. morphine; special regulations apply to medicines of

this type. It is essential that the total number of doses to be administered is

specified. If this is not done, only one dose can be administered by the nursing staff.

For outpatients and those going home, the prescription must be in ink or otherwise

indelible, in the prescriber’s own handwriting, signed with their usual signature and

dated by them. They must also specify:

i)The patients name.

ii)The dose to be taken.

iii)The form of the preparation.

iv)The strength of the preparation (if more than one strength is available).

v)The total number of dosage units to be supplied (in words as well as figures).

If more than one strength is required to make a dose the quantity of each must be

stated.

For example: Morphine Sulphate slow release capsules 50mg BD for 7 days.

Total quantity (14), fourteen capsules of 30mg and (28) twenty eight capsules of

10mg..

Since this is a legal requirement, Pharmacists will return to the prescriber, for

correction, any prescription which does not comply fully with the above

regulations for dispensing.

Timing of Administration: for inpatients this should be chosen (where

possible) to fit in with the nursing practices on the unit concerned. In most

instances, if it is not necessary to give a drug at 6.00 am when it will have to be

given by the night staff who are very busy at that time. For regular medication, the

appropriate time box should be ticked to indicate when the medicine should be

given. Where the dose of medicine is likely to be frequently changed, the drug

should be prescribed in the variable dose section at the bottom right hand corner of

the prescription sheet.

Discharge Medication should be prescribed on the HMR, or other

approved form. In some directorates pharmacist may write TTO’s and dispense in

advance of the doctors signature. In these instances it is the responsibility of the

doctor to check and sign the TTO prescription BEFORE the patient is discharged.

All medicines that the patient is taking must be included on the TTO form,

irrespective of whether patients have their own supplies (see also section 19 PODs)

Short Term Leave

Mental Health and Learning Disabilities services have a separate form for short term

leave.

Formulary

The Drugs Committee, at the request of the Clinical Management Group, has

produced a formulary for hospital prescribing in Southampton Hospitals.

The Formulary includes a range of medicines intended to cover the majority of

prescribing requirements. It is designed to make your choice simpler and

easier to remember. All hospital medical staff are expected to prescribe from

the formulary. If it is necessary to prescribe an unlisted drug for an individual patient, this can be arranged with the clincal pharmacist. Non-formulary drugs will not normally be held in stock and there is

often a delay in supplying them.

Antibiotic Policy

There are antibiotic policies giving details of preferred drugs for various

indications. You are asked to consult these before prescribing antibiotics.

Contact your directorate pharmacist for details.

New Medicines

Requests for new medicines to be stocked by the Pharmacies may be made by

Consultants. Forms are available from Directorate Pharmacists. Requests will

be considered by the Drugs Committee. In each case, the applicants will be

informed of the Committee’s decision, giving reasons for rejections if the

request if refused. Approved medicines are added to the Formulary. If the

addition is not approved, the product will not be stocked.

Adverse Drug Reactions

Suspected adverse drug reactions should be reported on yellow forms in the

back of the BNF. All reactions to new drugs (identified by the  sign in the BNF), and serious or unusual reactions to all other drugs, should be reported. Completed cards should be handed to the ward pharmacist or sent to the Medicines Information Centre, Southampton General Hospital. The cards will be collated and forwarded to the CSM. Confidentiality will be maintained. Note that hospital pharmacists may also report suspected adverse drug reactions to the CSM.

Product Defects and Product Recalls

All product defects should be notified to pharmacy who will investigate and take any necessary action.

Pharmacy are notified of product recalls through the national scheme administered by the Medicines and Healthcare products Regulatory Agency (MHRA). Those clinical areas affected will then be notified by pharmacy in accordance with trust policy.

Administration of Intravenous Injections by Nursing Staff

Qualified nurses with a certificate are allowed to give an approved range of

drugs by intravenous injection. A policy outlining those which have been agreed within each specialty is available on each ward.

Medical Representatives

Medical representatives must register at Main Reception and will be expected to

observe the Code of Practice for the Pharmaceutical Industry, drawn up by the ABPI.

See compendium of Data Sheets and Summary of Product Characteristics.

Samples

It is Trust policy that samples of medical products, including medicated dressings

and aerosols for use in the hospital, must never be left on wards, theatres or

departments, nor given out at promotional meetings. Pharmacies do not accept

samples.

Samples of medicinal products for the private use of doctors should be sent to

their private address or given to the doctor concerned personally on the

specific understanding that they will not be used within the hospital.

Prescribing Medicines for Members of Staff

The firm advice of the Department of Health is that staff working in the NHS

should make the same arrangements as any other member of public and, if they are

unwell or require medication, should go to their General Practitioner or to Staff

Health Clinic. Under no circumstances should the in-patient prescription chart be

used for staff medication. If self prescriptions are drawn, the normal charges will be

made and the quantity supplied will follow the current Department of Health

guidelines, ie. will be an emergency supply only.

Patients Own Drugs Scheme (PODS)

This operates in some areas. Patients are encouraged to bring their own medicines

in on admission. These are checked by pharmacy staff, or nurses, stored in either patient specific locked boxes or suitably designed trolleys and used for administration. Supplies are replenished by pharmacy, labelled with directions,

in an attempt to reduce delays in discharge. However, medication must always be checked against the discharge prescription to ensure it is current and correct BEFORE the patient is discharged.

Directorate Pharmacists

All Directorates have a Directorate Pharmacist who is responsible for co-ordinating the pharmaceutical service to the Directorate. Their functions include examining drug expenditure, providing information and advice and helping to develop guidelines for the use of medicines. The names and bleep numbers of Directorate Pharmacists are listed below.

USEFUL TELEPHONE NUMBERS

Southampton General Hospital (S.G.H.)

Dispensary / ext 4161 or 6312
Medicines Information / ext 6908 or 6909 / Email:
TPN / ext 8352
CIVAS / ext 6384
Cytotoxic / ext 8637

Southampton Eye Unit (S.G.H.)

Dispensary

ext 4836

Southampton Oncology Centre Pharmacy

Dispensary

ext 6668

Aseptic Unit

ext 3282

Directorate Pharmacists

Accident & Emergency / Jennifer Thomson / bleep 2088
Critical Care / Mark Tomlin / bleep 2221
Surgical Division / Sharron Millen / bleep 2766
Medical Directorate / Caron Weeks / bleep 2407
Neurosciences / Emyr Morgan / bleep 2404
Elderly Care / Kath Hayes / bleep 2408
Obs & Gynae Directorate / Christina Nurmahi / bleep 9038
Child Health & Neonatology / Amanda Bevan / bleep 2805
Cancer Care Directorate / Debbie Wright / bleep 1128
Cardiothoracic / Caroline Taylor / bleep 1235
Microbiology / Kieran Hand / bleep 1070
Theatres / Victoria Hutchinson / bleep 9179
Mental Health / Rebecca Henry / bleep 2842

Royal South Hants Hospital

Dispensary / ext 2348/2625

Lymington Hospital

Dispensary Manager / Linda Collins / 01590 663135 bleep 10
Community Hospitals
Elderly & Elderly Mental Health / Caroline Bowyer / pager 07659 547369
Jane Dowsett
Emma Smithson / pager 07659 535503
pager 07699 669809

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