1. Consultant by letter or phone

• Do not assume that the letter/message is correct

• Check with patient’s previous notes and possibly with consultant

• Particularly check with consultant if a new/strange drug is prescribed

• Learn about the new drug - it's the prescriber's responsibility once the FP10 is signed

• Is it appropriate for the clinical diagnosis?

• Is it a suitable GP prescription drug bearing in mind that the prescriber takes responsibility?

• In no circumstances take on specialist drugs such as cytotoxics

• Is the dosage appropriate? Check BNF, MIMS, Drug Tariff etc.

• Does it need to be supplied from the dispensary or only from OP Dept?

2. GP

New Drug prescription - familiar or otherwise

• current medication, recent past medication, diagnosis, pregnancy,

• breast feeding, medical history, allergies

NB All these should be possible with new computer systems but CHECK anyway

• Check dosage

• Enter into computer after checking correct patient is "on-screen" then:

• check labelling for:

• name of drug - not essential but good practice

• standard warnings - BNF

• dosage

• particular warnings - BNF

• quantity prescribed

Read the completed computer transaction screen carefully then

• Transmit transaction to dispensary

NB In the latest systems it is possible to bar-code each transaction

• Inform the patient of possible side-effects/precautions and when to return

• Include drug information leaflet

If now unsuitable or there is doubt then inform the doctor before issuing the drug or FP10

If still appropriate :

Follow standard dispensing procedures:

• Check labeling

• Check FP10 for: endorsements

• pack size

• quantity issued

• charge payable or exempt - if so, why?

Dispense the item - check label against drug

NB - the bar-code system is useful here as an ultimate safety check

• Check insert leaflet present or provided - if required

• Check whether patient requires child-proof container

• Have the transaction checked by the doctor or a colleague

• Record the check on the container with a small sticky label

• Record the transaction in the patients notes - dated.

Then

• Place item(s) for collection by patient

• Check identity of the "collector". This should be simple in a dispensing practice.

• Remind patient of drugs side-effects and when next to see doctor

• Collect payment if appropriate

• Check any exemption claim for the Fraud Squad

• Ensure that reverse of FP10 is properly completed and signed by patient  (For details, see this web site section)

• Sort FP10s into categories of charge etc.

Is the drug a familiar, stocked item?

FAMILIAR ITEM

• Check as in 1. above

UNFAMILIAR ITEM

• Double-check with prescribing doctor and BNF or other sources for appropriateness

NB. The computer may do this but it adds a vital extra safety aspect to do it manually in addition. If computer warnings are deficient, then amend.

• Check dosage in BNF

• Check quantity prescribed

• Carry out additional checks as in 1. above

• Learn about the drug being prescribed

pay particular attention to:

• labelling

• interactions

• BNF warnings

Record item on "New Drug List" for later intra-practice discussion

• Issue item to correct patient

• warning patient of the length of the course

• warning patient of possible side-effects and to report them to the doctor

• stressing that if they have any doubt they can contact either the doctor or the dispenser immediately

• Record details for Product Liability reasons

Be available for enquiries

• Ideally should hold a qualification or be prepared to obtain one such as the Nottingham BTEC one

• Should not dispense unsupervised until appropriately trained

• Should be aware that the doctors MUST be consulted whenever there is doubt even if that may delay the dispensing transaction

• Should not be anxious about consulting the doctors

• Should cross-check items dispensed and record that it has been done

• Should have a written job-description and contract

• Should not allow themselves to be rushed by either patients or doctors

• Should consider patient safety  and confidentiality at all times

• Should always be aware of and observe high standards of cleanliness themselves and in their working environment

• The dispensing protocol should be clearly displayed or available - and read

• All new and unfamiliar items should be listed for later discussion

• There should be a system of practice team meetings for this purpose

• A system may be devised to check the safety of the system without hazarding patients

• A critical incident/near miss recording procedure should be implemented

• The Health & Safety Policy should be clearly displayed

• An accident book should be to hand

• Any program deficiencies to be recorded and remedied as soon as possible

• Consultation with doctors for amendments to standard drug information

• Computer program supplier to be updated about program deficiencies