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Medicines matters

Medicines Matters
A guide to mechanisms for the prescribing, July 2006
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Medicines Matters: a guide to mechanisms for the prescribing, supply and administration of medicines National Practitioner Programme, DH Core Prescribing Group Publication Date
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Description
This document describes the mechanisms available for the prescribing, supply and administration of medicines to support the development of new roles or service redesign. It also outlines the aims of the continuing work of the non-medical prescribing programme.
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Contents

1. Background
2. What is a Patient Specific Direction?
3. What is a Patient Group Direction?
4. What are the ‘specific exemptions’ in medicines legislation for the supply or
administration

medicines?
5. What is the Nurse Prescribers’ Formulary for Community Practitioners?
6. What is the Nurse and Pharmacist Independent Prescribing?
4
7. What is supplementary prescribing?
8. What is the situation with the supply and administration of Controlled Drugs?
9. What is the situation with the prescribing of Controlled Drugs independently?
10. How do I choose the most appropriate option?
administer
medicines?
12. What are the continued professional development requirements?
13. What is the next stage in the Department of Health non-medical prescribing
programme?
14. Who is involved in changing prescribing legislation?
15. Where can I find further information?
Glossary
17. Appendix: Prescribing, supply and administration of medicines
Medicines Matters
A guide to mechanisms for the prescribing,
supply and administration of medicines

1. Background
This publication is a brief guide for staff working in NHS trusts, NHS foundation trusts,
primary care trusts (PCTs) and other health and social care organisations, describing the
mechanisms available for the prescribing, supply and administration of medicines which
help to support the development of new/enhanced roles or service redesign. It also
outlines the aims of the continuing work of the Department of Health’s (DH) non-medical
prescribing programme.
As this booklet is not intended to be a detailed guide, it refers the reader to additional
sources of information and reference, as required. It is a brief guide to good practice,
highlighting appropriate mechanisms that can be used when developing new/enhanced
roles or redesigning services.
The mechanisms available for the prescribing, supply and administration of medicines
are:
• Patient Specific Directions
• Patient Group Directions (PGDs)
• Specific exemptions covering supply or administration - as contained in medicines
legislation
• Nurse Independent Prescribing
• Pharmacist Independent Prescribing
• Supplementary prescribing by nurses, pharmacists optometrists, physiotherapists,
radiographers and chiropodists/podiatrists
More detailed information on these mechanisms is summarised in a matrix form in the
Appendix.

2. What is a Patient Specific Direction?
A Patient Specific Direction is the traditional written instruction, from a doctor, dentist,
nurse or pharmacist independent prescriber, for medicines to be supplied or
administered to a named patient. The majority of medicines are still supplied or
administered using this process.
In primary care, this might be a simple instruction in the patient’s notes. Examples in
secondary care include instructions on a patient’s ward drug chart.
As a Patient Specific Direction is individually tailored to the needs of a single patient, it
should be used in preference to a Patient Group Direction (PGD) wherever appropriate.
3. What is a Patient Group Direction?
A Patient Group Direction (PGD) is a written instruction for the supply or administration
of a licensed medicine (or medicines) in an identified clinical situation, where the patient
may not be individually identified before presenting for treatment. This should not be
interpreted as indicating that the patient must not be identified; patients may or may not
be identified, depending on the circumstances.
A PGD is drawn up locally by doctors, pharmacists and other health professionals and
must meet certain legal criteria. Each PGD must be signed by a doctor or dentist, as
appropriate, and a pharmacist, and approved by the organisation in which it is to be
used, typically a PCT or NHS trust.
PGDs can only be used by the following registered healthcare professionals, acting as
named individuals:-
nurses, midwives, health visitors, paramedics, optometrists, chiropodists and podiatrists, radiographers, orthoptists, physiotherapists, pharmacists, dieticians, occupational therapists, prosthetists and orthotists, and speech and language therapists. Each PGD has a list of individuals named as competent to supply/administer under the direction. A senior person in each profession locally should be designated with the responsibility to ensure that only fully competent, registered and trained professionals operate within directions. The National Prescribing Centre (NPC) has developed an outline competency framework for local use. It should be noted that not every practitioner is expected to use PGDs. Patient and service need should be considered when deciding who needs to use them. A PGD can include a flexible dose range so the healthcare professional can select the most appropriate dose for the patient. Medicines can be used outside the terms of their Summary of Product Characteristics (SPC) (so called ‘off-license’ use), provided such use is supported by best clinical practice. The PGD should state when the product is being used outside the terms of the SPC and why this is necessary. The majority of clinical care should be provided on an individual, patient specific basis. The supply and administration of medicines under PGDs should be reserved for the limited number of situations where this offers an advantage for patient care (without compromising patient safety). The use of PGDs must also be consistent with appropriate professional relationships and accountability, i.e. the nurse or other health professional must act within their own expertise and competence. Since 2003, many non-NHS organisations have been able to use PGDs. They are: • Independent hospital agencies and clinics registered under the Care Standards Act
2000
• Prison healthcare services
• Police services
• Defence medical services
PGDs can also be used for services funded by the NHS but provided by the private,
voluntary or charitable sector. Further guidance on the use of PGDs in the private sector
is available from the Medicines and Healthcare Products Regulatory Agency (see
section 15 below).
There are no specific national training programmes for PGDs, but individual
organisations must ensure that people supplying/administering medicines under a PGD
are competent to do so.
More detailed advice on PGDs is available from the National Prescribing Centre website
, and in Health Service Circular (HSC) 2000/026 Patient Group
Directions [England only]
, available from www.dh.gov.uk/publications.
National template PGDs are accessible via the National Electronic Library for Health
website at
4. What are the ‘specific exemptions’ in
medicines legislation for the supply or
administration of medicines?
A number of health professions – for example, midwives, chiropodists/ podiatrists,
optometrists, paramedics – have specific exemptions in medicines legislation to supply
or administer medicines. Provided the requirements of any conditions attaching to those
exemptions are met, a PGD as outlined above is not required. For specific exemptions
for each professional group, please refer to the Appendix.
For example, registered chiropodists/ podiatrists have exemptions under medicines
legislation for parenteral administration of a number of prescription only medicines
(POMs), including bupivacaine and lignocaine. Further details are available within the
Appendix.
5. What is the Nurse Prescribers’ Formulary
for Community Practitioners?
(formerly District Nurses and Health Visitors)

The Nurse Prescribers’ Formulary (NPF) for Community Practitioners (formerly District
Nurses and Health Visitors), is the formulary used by community practitioner prescribers-
see part XVIIB(i) of the Drug Tariff. In addition, school nurses can now train and qualify
to prescribe from the Community Practitioners’ Formulary. The Formulary contains 13
POMs, some pharmacy (P) and general sales list (GSL) medicines, and a list of
dressings and appliances relevant to community nursing and health visiting practice.
There are more than 29,000 community practitioner nurse prescribers in England
registered with the Nursing and Midwifery Council (NMC). Training to prescribe from the
NPF is integrated into the specialist practitioner programme for community practitioners,
so all newly qualifying community practitioners are also entitled to undertake training to
qualify them to prescribe from the NPF, dependent on clinical need. Further information
is available in the Drug Tariff, the British National Formulary, the National Prescribing
and Midwifery Council (NMC) Standards
of Proficiency for nurse and midwife prescribers at .

6. What is Nurse and Pharmacist
Independent Prescribing
?
From 1 May 2006 Nurse Independent Prescribing (formerly Extended Formulary Nurse
Prescribing) was expanded. This allows nurses to prescribe any licensed medicine for
any medical condition that a nurse prescriber is competent to treat, including some
Controlled Drugs. It allows virtually any licensed medicine in the British National
Formulary (see part XVIIB(ii) of the Drug Tariff) to be prescribed. Section 8 and 9 below
contains further information on the prescribing of Controlled Drugs by nurse independent
and supplementary prescribers.
Pharmacist Independent Prescribing was also introduced on 1 May and allows
pharmacists to prescribe any licensed medicine for any medical condition that a
pharmacist prescriber is competent to treat. This allows access to virtually the whole of
the British National Formulary with the exception of Controlled Drugs and unlicensed
medicines.
All first level registered nurses, registered midwives, registered specialist community
public health nurses and registered pharmacists may train to be Independent
Prescribers. However, the DH Guide to Implementation and the
NMC Standards of Proficiency for nurse and midwife prescribers state that nurses put
forward for prescribing training must have at least three years’ post-registration
experience. Pharmacists should have at least two years’ experience following their post-
registration year.
The development of Independent Prescribing is part of a drive to make better use of
nurses’ and pharmacists’ skills and to make it easier for patients to get access to the
medicines that they need. Nurse and Pharmacist Independent Prescribing is an
important part of developing their role in delivering frontline care and a patient-centred
service.
Higher education institutions (HEIs) provide a specific programme of preparation and
training for independent prescribing. These programmes are approved by the Nursing
and Midwifery Council and the Royal Pharmaceutical Society of Great Britain (RPSGB)
Nurses who successfully complete the programme must register their prescribing
qualification with the NMC before they can start prescribing. For further information visit
ualification with the RPSGB
.
Prescribing training courses are centrally funded through the Strategic Health Authority
(SHA) Workforce Directorates. The training for nurses and pharmacists is spread over a
period of six months, and consists of at least 26 days training and 12 days learning in
practice. A designated medical practitioner must supervise the student and provide
support, and there are elements of self-directed learning. A buddying system using
another qualified independent prescriber may also be very beneficial. Previous learning
can be taken into account through the Accreditation of Prior Learning (APL), at the
discretion of the HEI, and some elements of the course can be delivered through
distance learning. All participants must pass the end of course assessments.
The RPSGB is currently considering the content of the training programme for
pharmacists, including the length of the programme. It is intended that the first courses
from HEIs will be available from late 2006
7. What is supplementary prescribing?

Supplementary prescribing was introduced in April 2003 for nurses and pharmacists. It
was extended to physiotherapists, chiropodists/podiatrists, radiographers and
optometrists in May 2005.
Supplementary prescribing is a voluntary prescribing partnership between the
independent prescriber (doctor or dentist) and supplementary prescriber, to implement
an agreed patient-specific clinical management plan (CMP), with the patient’s
agreement.
Following agreement of the CMP, the supplementary prescriber may prescribe any
medicine for the patient that is referred to in the plan, until the next review by the
independent prescriber. There is no formulary for supplementary prescribing, and no
restrictions on the medical conditions that can be managed under these arrangements.
This mechanism of prescribing will be helpful for nurse and pharmacist prescribers when
they are newly qualified. It will also be appropriate in specific situations, for instance
when working within a team where a doctor is accessible for situations involving Controlled Drugs.
Supplementary Prescribers can prescribe Controlled Drugs and unlicensed
medicines in partnership with a doctor, where the doctor agrees within a patient’s CMP.
From July 2006 chiropodists/podiatrists physiotherapists, radiographers and optometrists
are also able to prescribe Controlled Drugs as supplementary prescribers, but only
where there is a patient need and the doctor has agreed in a patient’s CMP.
The training for supplementary prescribing is incorporated into Nurse and Pharmacist
Independent Prescribing. Many HEIs are offering the supplementary prescribing
elements of the course as multi-disciplinary training for nurses, pharmacists, and AHPs,
which the professions have found valuable. The exception is optometrists, who follow a
programme more specific to the eye. All professional groups must register their
supplementary prescribing qualification with their regulatory body before beginning to
prescribe.
8. What is the situation with the supply and
administration of Controlled Drugs?

Nurses can supply and administer some Controlled Drugs (CDs) under the terms of a
PGD. PGDs can be used for the supply and administration of Schedule 4 and Schedule
5 Controlled Drugs – with the exception of anabolic steroids. In addition, but limited to
nurses in accident and emergency departments and in coronary care units in hospitals,
diamorphine can be supplied/administered for the treatment of cardiac pain.
Paramedics, chiropodists/podiatrists, orthoptists, physiotherapists and radiographers can
supply and administer Schedule 4 and Schedule 5 CDs under the terms of a Patient
Group Direction, with the exception of anabolic steroids,. Occupational therapists and
prosthetists and orthotists were added to the list of those who can supply and administer
Schedule 4 and 5 Controlled Drugs under a Patient Group Direction from July 2006.
9. What is the situation with the prescribing
of Controlled Drugs independently?

Following agreement by the Home Office’s Advisory Council on the Misuse of Drugs
(ACMD), changes to regulations on 1 May 2006 enable nurse independent prescribing of
some Controlled Drugs. Nurse Independent Prescribers can prescribe 13 Controlled
Drugs independently, but only for specific medical conditions. These include
diamorphine and morphine for palliative care and post-operative pain relief. A list of
these Controlled Drugs and medical conditions is contained in the Drug Tariff (see part
XVIIbii) and from September 2006, also in the BNF. For further information visit

Nurse Independent Prescribers are also able to prescribe lower strength P and GSL
medicines containing codeine phosphate and dihydrocodeine tartrate.
Pharmacists Independent Prescribers cannot at present prescribe any Controlled Drugs
independently.
10. How do I choose the most appropriate
option?
Separate legal requirements govern the prescribing, supply and administration of
medicines. Decisions to adopt one process or a mix of the arrangements outlined above
will be influenced by different clinical situations, and different staff groups. Before
deciding to undertake, or encourage staff to attend, lengthy training courses, it is worth
checking which would be the most appropriate option in your particular circumstances. The summaries below can help with these decisions. Nurse Independent Prescribing and Pharmacist Independent Prescribing is appropriate in the following circumstances: • The nurse or pharmacist is competent to assess, diagnose and make treatment decisions for the patient • For conditions that the nurse or pharmacist independent prescriber is competent to treat independently • The nurse or pharmacist works remotely from a doctor, seeing patients independently Nurse and Pharmacist Independent Prescribing is not suitable for prescribing for complex medical conditions or for patients with several co-morbidities. Supplementary prescribing is most useful in the following circumstances: • Patients with long-term conditions, who can be managed by a supplementary prescriber between reviews by the doctor • The supplementary prescriber is competent to manage the patient’s condition • There is a close working partnership between the independent prescriber (doctor) and the supplementary prescriber, and the supplementary prescriber has access to the same common patient record. Supplementary prescribing is not suited to emergency, urgent or acute prescribing situations because an agreed clinical management plan is needed before prescribing can begin. Use of PGDs is appropriate in the following circumstances: • The medicines to be given, and the circumstances under which they should be given, can be clearly defined in the written direction • There are ‘high volume’ groups of patients who present for treatment, such as people needing vaccines, or ‘routine’ treatments such as eyedrops before clinical examination • Medicines are to be supplied and administered by one of the registered health professionals allowed to use PGDs. PGDs are not suitable where a range of different medicines needs to be given to the patient at the same time. They may only be used by a registered healthcare professional in one of the professions listed in section 3. Professionals work under PGDs as named individuals, and no delegation of the supply or administration of medicines is permissible. Use of exemptions for supply and administration is most appropriate in the following circumstances: • The health professional is delivering specific care within their area of expertise and the range of medicines specified in legislation meets patients’ needs. 11. Who can administer medicines?
Any suitably trained member of staff in health or social care can administer medicines that
have been prescribed, by an authorised prescriber, for an individual patient. The medicines
can then only be given to that named patient.
This principle applies to registered and non-
registered staff at all levels. However, non-registered staff cannot administer medicines
using a PGD, and cannot train to prescribe medicines.
12. What are the continued professional
development requirements?
Nurse and Pharmacist Independent Prescribers and Supplementary Prescribers will be
expected to keep up-to-date with evidence and best practice in the management of the
conditions for which they prescribe, and in the use of relevant medicines. For nurses,
Continued Professional Development (CPD) should be incorporated into their personal
practice profile, as evidence to renew their registration with the NMC. For pharmacists
they will be required to demonstrate CPD in their area of prescribing practice. AHP
registrants will have to meet the requirements of the Standards for CPD of the Health
Professions Council (HPC). The National Prescribing Centre has developed outline
frameworks for ‘Maintaining Competency in Prescribing’.
CPD support is available from the National Prescribing Centre
Independent and Supplementary prescribing must be included in employing
organisations, overall clinical governance framework, in order to ensure that nurses,
pharmacists and AHPs practice safely and competently and within organisational
requirements. Further guidelines can be found within the Implementation Guides for
Independent and Supplementary prescribing at
13. What is the next stage in the Department
of Health non-medical prescribing
programme?

The next stage of the project aims to:
• Implement and promote Nurse and Pharmacist Independent Prescribing
• Take forward a consultation on optometrist independent prescribing
• Refine the training framework for Pharmacist Independent Prescribing
• Consider the prescribing needs of new and emerging roles, in light of the impact of the
Patient safety remains the paramount consideration in any further expansion of non-medical prescribing. A high-level programme board, chaired by the Chief Nursing Officer, oversees the programme and a DH project team is responsible for delivery.
The NHS National Practitioner Programme projects and experience feed into this project

14. Who is involved in changing prescribing
legislation?

The Commission on Human Medicines (CHM) (formerly Committee on Safety of
Medicines) is an independent advisory committee, established under section 4 of the
Medicines Act 1968. CHM advises the UK Licensing Authority on the quality, efficacy
and safety of medicines in order to ensure that appropriate standards to safeguard
public health and safety are met and maintained.
The Medicines and Healthcare products Regulatory Agency (MHRA) the Licensing
Authority. It is an executive agency of the DH, responsible for ensuring that medicines
and healthcare products meet appropriate standards of safety, quality, performance and
effectiveness, and are used safely. Proposals to change medicines legislation are
subject to statutory consultation and those consultations are arranged and undertaken
by the MHRA, on occasions jointly with the DH. The MHRA provides information from
the consultations to aid CHM in formulating its advice to Ministers. Once Ministers have
reached their decision, any necessary amendments to medicines regulations are
arranged by the MHRA.
The DH is responsible for any necessary amendments to NHS regulations arising from
the extension of prescribing responsibilities.
The Home Office has responsibility for the prescribing of Controlled Drugs, under the
terms of the Misuse of Drugs Act and Misuse of Drugs Regulations. The Home Office is
advised by the Advisory Committee on the Misuse of Drugs (ACMD).
15. Where can I find further information?

Department of Health website
The DH website is regularly updated and has comprehensive information on all aspects
of prescribing. A section on ‘Non-Medical Prescribing’ can be found in the ‘Policy and
guidance A-Z’. This includes “Improving Access to Medicines – the DH guide to
implementation of nurse and pharmacists independent prescribing” April 2006.

PRODIGY
PRODIGY guidance on common conditions and symptoms managed in primary care is
available in a variety of formats. Full guidance provides concise information to support
decision-making in the consultation and more detailed background information for use as
a learning resource.
Quick reference guides summarise the key management options and link these to concise supporting information and prescription details. PRODIGY Patient Information Leaflets (PILs) provide guidance for people who are not healthcare professionals and give an overview of the condition, side effects, advice on self-management, information on treatment options and sources of further help. PRODIGY Drugs – lists the drugs recommended by PRODIGY, and links them to the condition and situation in which they are recommended. Medicines and Healthcare products Regulatory Agency (MHRA) The MHRA website contains information about the legal framework governing the prescribing, supply and administration of medicines. Other useful websites British National Formulary (BNF) Examples of Patient Group Directions (PGDs) Medicines Partnership Programme National Electronic Library for Health NHS Drug Tariff for England and Wales NHS National Practitioner Programme National Prescribing Centre Nursing and Midwifery Council Prescribing news Royal Pharmaceutical Society of Great Britain
16. Glossary of terms
Administration
. Medicines legislation does not specifically address the issue of
administration of medicines except where the product is for injection. Then it may only
be:
• Administered by a doctor or, subject to certain limitations, an independent nurse prescriber or supplementary prescriber • Administered by anyone acting in accordance with the Patient Specific Directions of a doctor or, subject to certain limitations, an independent nurse prescriber or supplementary prescriber.
Non-registered staff in health and social care
can administer medicines that are
appropriately prescribed on a patient specific basis. However, the following principles
apply:
• Registered health professionals, such as doctors and nurses, have a duty of care and are professionally and legally accountable for the care they provide, including those tasks they delegate to non-registered staff. If expecting non-registered staff to administer medicines, those delegating the duty must ensure that they are competent to do so safely. Non-registered staff are accountable for their own practice. • The employing organisations have a legal duty of care and are responsible for ensuring that the staff they employ are properly trained and undertake only those responsibilities specified in agreed job descriptions. • Non-registered staff cannot work under a Patient Group Direction

Legal Classification of Licensed Medicines

Prescription only medicine (POM)
POMs require a prescription to be written, usually by a doctor, dentist, nurse or other
approved prescriber.
Pharmacy medicine (P)
P medicines can only be sold through a registered pharmacy under the personal
supervision of a pharmacist i.e. the pharmacist needs to be present before a P medicine
can be sold.
General Sales List medicine (GSL)
GSL medicines are deemed even safer than P medicines and can be sold in general
shops as well as through pharmacies, albeit often in small quantities. All of the products
are sold in manufacturers’ original packs.
Over the counter medicine (OTC)
Not a legal classification but a generic term that covers both GSL and P medicines.
Patient Specific Directions or Patient Group Directions are the written instruction to supply
and/or administer medicines or treatment (explained in detail in sections 2 and 3).

POM
and P medicines can only be sold or supplied at registered pharmacy premises by
or under the supervision of a pharmacist. POMs are subject to the additional requirement
that they are sold or supplied in accordance with an appropriate practitioner’s
prescription. An ‘appropriate practitioner’ is a doctor, dentist, nurse independent
prescriber, pharmacist independent prescriber or supplementary prescriber. GSL
medicines can be sold from a wider range of premises, such as supermarkets, provided
those premises can be closed to exclude the public (i.e. they are lockable) and the
medicines are prepacked. There are, however, a number of exemptions from these
restrictions. For further information visit
Prescribing means ordering the use of a medicine or other treatment.
Repeat Prescribing. The National Prescribing Centre has produced guidance and a
resource of repeat prescribing, Saving time, helping patients: A good practice guide to
quality repeat prescribing
, available on the NPC Publications section of the NPC website
.
Sale, Supply and Administration of Medicines. One of the responsibilities of the MHRA is
to enforce the provisions of the Medicines Act 1968 and associated secondary
legislation. The law regulates the sale, supply and administration of all medicines
available in the UK. Each medicine is assigned to one of three legal categories –
prescription only medicine (POM), pharmacy (P) or general sales list (GSL). These
classifications determine how medicines can be supplied to the public.
Appendix: Prescribing, supply and administration of medicines
Health

Independent
Supplementary
Able to supply or
Current exemptions
Professional
Prescribing
Prescribing
administer under
exemptions
exemptions
[from req’t from written
[from req’t for
[from req’t for
directions of practitioner] for
Group Directions?
prescription] for
prescription] for
parenteral administration of
sale or supply of
supply of POMs
POMs [Sch 5 Part III of POM
POMs [details from
[details from Sch 5
Sch 5 Part I of
Part II of POM
POM Order]
Pharmacist
opticians (see below) (2) sale or supply of amyl nitrate to those to whom cyanide salts may be sold for purpose of antidote to cyanide poisoning Independent
Supplementary
Able to supply or
Current exemptions
Professional
Prescribing
Prescribing
administer under
exemptions
exemptions
[from req’t from written
[from req’t for
[from req’t for
directions of practitioner] for
Group Directions?
prescription] for
prescription] for
parenteral administration of
sale or supply of
supply of POMs
POMs [Sch 5 Part III of POM
POMs [details from
[details from Sch 5
Sch 5 Part I of
Part II of POM
POM Order]
YES - if Nurse
YES YES Sale or supply of
be only while attending on a woman in childbirth. Medicines Matters


Independent
Supplementary
Able to supply or
Current exemptions
Professional
Prescribing
Prescribing
administer under
exemptions
exemptions
[from req’t from written
[from req’t for
[from req’t for
directions of practitioner] for
Group Directions?
prescription] for
prescription] for
parenteral administration of
sale or supply of
supply of POMs
POMs [Sch 5 Part III of POM
POMs [details from
[details from Sch 5
Sch 5 Part I of
Part II of POM
POM Order]
Optometrist NO
for parenteral administration and which- (a) are eyes drops and are POMs by reason only that they contain not more than 0.5% Chloramphenicol, or (b) are eye ointments and are POMs by reason only that they contain not more than 1% Chloramphenicol, or (c) are POMs by reason only that they contain any of the following substances: *Atropine sulphate *Bethanecol chloride *Carbachol *Cyclopentolate hydrochloride *Homatropine hydrobromide *Naphazoline hydrochloride *Naphazoline nitrate *Physostigmine salicylate *Physostigmine sulphate *Pilocarpine hydrochloride *Pilocarpine nitrate *Tropicamide Sale or supply shall be only- (a) in the course of their professional practice and (b) in an emergency. Independent
Supplementary
Able to supply or
Current exemptions
Professional
Prescribing
Prescribing
administer under
exemptions
exemptions
[from req’t from written
[from req’t for
[from req’t for
directions of practitioner] for
Group Directions?
prescription] for
prescription] for
parenteral administration of
sale or supply of
supply of POMs
POMs [Sch 5 Part III of POM
POMs [details from
[details from
Sch 5 Part I of
Sch 5 Part II of
POM Order]
POM Order]
Therapists
Dieticians
Orthoptists
Prosthetists and
Orthotists
Physiotherapists

Radiographers
Speech and
Language
Therapists
Occupational

Therapists
Independent
Supplementary
Able to supply or
Current exemptions
Professional
Prescribing
Prescribing
administer under
exemptions
exemptions
[from req’t from written
[from req’t for
[from req’t for
directions of practitioner] for
Group Directions?
prescription] for
prescription] for
parenteral administration of
sale or supply of
supply of POMs
POMs [Sch 5 Part III of POM
POMs [details from
[details from Sch 5
Sch 5 Part I of
Part II of POM
POM Order]
Chiropodists and
Podiatrists
weight; * Amorolfine hydrochloride lacquer where the maximum strength of the Amorolfine in the lacquer does not exceed 5% by weight in volume; and * Topical hydrocortisone where the maximum strength of the hydrocortisone in the medicinal product does not exceed 1% by weight in weight. The sale or supply shall be only in the course of their professional practice and (a) in the case of Codydramol 10/500 tablets the quantity sold or supplied to a person at any one time shall not exceed the amount sufficient for 3 days' treatment to a maximum of 24 tablets. Independent
Supplementary
Able to supply or
Current exemptions
Professional
Prescribing
Prescribing
administer under
exemptions
exemptions
[from req’t from written
[from req’t for
[from req’t for
directions of practitioner] for
Group Directions?
prescription] for
prescription] for
parenteral administration of
sale or supply of
supply of POMs
POMs [Sch 5 Part III of POM
POMs [details from
[details from Sch 5
Sch 5 Part I of
Part II of POM
POM Order]
Paramedics
The following POMs for parenteral administration- (a) Diazepam 5 mg per ml emulsion for injection; (b) Succinylated Modified Fluid Gelatin 4 per cent intravenous infusion; (c) prescription only medicines containing one or more of the following substances, but no active ingredient- *Adrenaline Acid Tartrate, *Amiodarone *Anhydrous Glucose *Benzylpenicillin *Bretylium Tosylate *Compound Sodium Lactate Intravenous Infusion (Hartmann's Solution) *Ergometrine Maleate *Frusemide *Glucose *Heparin Sodium *Lignocaine *Hydrochloride *Metoclopramide *Morphine Sulphate, *Nalbuphine *Hydrochloride *Naloxone Hydrochloride *Polygeline * Reteplase ** *Sodium Bicarbonate *Sodium Chloride *Streptokinase *Tenecteplase ** The administration shall be only for the immediate, necessary treatment of sick or injured persons and in the case of a POM containing Heparin Sodium shall be only for the purpose of cannula flushing. ** from 18 May 2004. Also current proposal to add amiodarone



Crown copyright 2006
Produced by the NHS National Practitioner Programme and the Department of Health
www.wise.nhs.uk
www.dh.gov.uk

Source: http://www.rosalieboyce.com.au/Alison-Hogg-papers/Medicines_matters.pdf

Prefácio meguilat ester

A história relatada no Livro de Ester ocorreu há cerca de 450 a.e.c. O preceito mais destacado na observância da festa de Purim é a leitura do Livro de Ester — popularmente chamado de “Meguilá” — na sinagoga, na noite de Purim, e também no serviço de Shacharit, na manhã seguinte. O nome Purim deriva da palavra “pur” — sorteio em persa —, pelo qual Haman estabeleceu a data p

Microsoft word - 3ebfccff-428c-1833ce.doc

DOPINGLIJST K.N.K.B. Lijst van verboden farmacologische groepen van stoffen en verboden methoden (behorende bij het Dopingreglement van de K.N.K.B.) Datum inwerkingtreding: 1september 2002 I. Verboden groepen van stoffen A. Stimulantia B. 1. androgene anabole steroïden 2. ß -agonisten II. Verboden methoden A. Bloeddoping B. Toediening van kunstmatige zu

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