Professional Practice

STUDENT HANDBOOK

Name:

January 2021

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CONTENTS PAGE

Professional Practice overview 3

Academic and Professional Support 3

Practical classes 4

Finding your way around the dispensary 5

Introduction to the computer programme: 7

- Classify 8

- Patient Medication Record 9

- Verify 11

- Register entries 12

- Dispensed medicine labels 19

- Endorsements 21

- File 22

Feedback about your work 24

Recommended textbooks 25

Appendices 26

Appendix 1: Common qualifications of health professionals 27

Appendix 2: Latin terms and abbreviations 29

Appendix 3: Arabic and Roman numerals 31

Appendix 4: Labelling codes 32

Appendix 5: Blacklist/SLS/ACBS 40

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Professional Practice overview

This guide is for use in the practical classes and is designed to complement the professional practice and legal teaching across the MPharm degree. These are professional classes and therefore we expect you to:

Dress and behave professionally at all times

Arrive ready to start the class at the timetabled time (i.e. arrive 5-10 minutes before the class is due to start).

Turn off mobile phones (or switch to silent) for the duration of the class and leave in your bag.

Follow the rules for the practice teaching area – i.e. no food or drink (including water) at the computers.

Have done any pre-work for the classes and to use the class time to maximise the learning opportunity

The purpose of the practical classes is to develop your ability to provide person centred pharmacy services. We focus on your communication skills, not just the safe and legal supply of medicines, and classes are designed to allow you to practise these skills. We help you develop in providing feedback and challenging the quality of your practice.

Academic and Professional Support

Mrs Priyanka Chandarana, Mr Zeeshan Ahmed, and Mr Tony Shaw oversee the professional practice classes at our UK campus (UNUK). If you have any queries about the classes, please direct them to Priyanka, Zeeshan or Tony: Priyanka.chandarana@nottingham.ac.uk Zeeshan.ahmed@nottingham.ac.uk or tony.shaw@nottingham.ac.uk.

Dr Jim Chai, Dr Yazdan Madani, Dr Georgina Marsh and Dr Valerie Shang oversee the professional practice classes at our Malaysia campus (UNM). If you have any queries about the classes whilst at UNM, please direct them to Jim: jim.chai@nottingham.edu.my . The University of Nottingham employs a number of qualified and experienced professional pharmacists to support and enhance your learning experience. Known as Professional Practice Consultants (PPCs) their role is to provide you with a vision of how your theorised learning translates into practice. They have undertaken a robust recruitment and training process, to meet the University of Nottingham high employment standards. They will coach and mentor you through all three years of Professional Practice and the year 4 Pharmacy Leadership and Management module.

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If you have any questions about the PPCs or the training they have undertaken please contact Priyanka (UNUK) or Jim (UNM).

Practical classes

This handbook guides you through the computer programme we use for professional practice. You will use this alongside the BNF, MEP and Dale & Appelbe. Preparation for the practical classes Prior to each practical class you are expected to complete the pre-work on Sway. The pre-work link will be sent to you a week before your timetabled class. Pre-work may include looking at exercises in Scripware, considering how you will apply any law you have learnt in lectures, background reading associated with exercises you will be exposed to in class, writing or revising your Standard Operating Procedure (SOP) and developing plans for how to improve your communications skills. What to expect to do in practical classes During each practical class you will complete a series of exercises related to pharmacy practice, some of which will require you to demonstrate and apply your learning from the pre-work. For some exercises, you will need to counsel or provide over-the-counter advice to simulated patients. These scenarios will be assessed by a PPC, who will provide feedback in relation to your clinical and communication skills. Video recording is available for these counselling exercises and should be used to review your performance. Remember to bring a USB memory stick with you to take your video recordings away! Writing SOPs As part of the practical classes you are expected to develop and use your own SOPs for exercises and counselling. These will help guide you through the processes and after each practical class you should reflect on your experiences, learning and feedback to update your SOPs. Near miss logs During the MPharm course you will be introduced to near miss logs. It is important that you keep track of the errors you have made, for you to review them regularly and to create a plan as to how you might avoid similar errors in the future. Note: Writing SOPs and reflecting on near misses are examples of CPD – you are encouraged to record these processes and your reflections.

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After the classes After the practical classes you are expected to look at the post-work Sway. The link to this Sway will be sent out after the last group as completed the class. Post-work may include making register entries or completing prescriptions in Scripware based upon exercises covered in class, reviewing your SOPs, or answering questions around themes explored during the practical. Health and Safety Whilst the classes involve the use of Display Screen Equipment over a period of up to hours, this will not be continuous. Natural breaks (enabling you to move away from the computer screen) will occur when you need to look in your books, locate medicines, counsel patients and hand in products to PPCs. It is recommended that you move your head, neck, arms and legs occasionally whilst sitting at the computer, as well as looking away from the computer screen from time to time. This advice also applies when you are practising with Scripware at home.

Finding your way around the dispensary

UNUK: Within the dispensary (C30) there are a number of computer bays. Each bay has a medication cupboard. You must only use the cupboard associated with your bay. See the video links in Moodle. UNM: Within the B1A30 teaching pharmacy there are a number of desks, each accommodating laptops for student use. Each desk has a medication trolley. You must only use the trolley associated with your desk. See the room layout schematic and video links on Moodle.

Prescription Only Medicines and Pharmacy Medicines for supply on prescriptions or requisitions can be found in the drug cupboards/trolleys.

Items are kept in alphabetical order.

Ensure you replace the products in the same order.

The drug cupboards/trolleys are your responsibility. If they get very untidy, the whole group will be penalised as no-one will be able to find anything.

Do not spend more than 5-10 minutes looking for an item. If you can’t find an item after 5 to 10 minutes please ask a demonstrator.

Do not borrow from other bays/trolleys.

Please do not cut the blister strips of medicines but tell the demonstrator how many you would dispense.

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OTC sales

UNUK: Medicines are available behind the counter in each room for you to select from.

UNM: Medicines are available behind the B1A30 pharmacy counter for you to select from.

Controlled drug (CD) cupboards: The cabinet should be kept locked at all times. The CD key in reality would be kept in the pharmacist’s pocket. For the purposes of the labs these will be unlocked for the duration of the practical.

Fridge: This cupboard is for medicines that require storage at 2 to 8°C. The Black List, SLS information, patient information leaflets, warning cards and spoons: UNUK: Are available at the end of each bay. UNM: Are available at the resources desk at the front of the class. Printing: Printers are located at the end of each bay (UNUK) or within the dispensary (UNM). Printing during the practical classes will not be deducted from your print balance. Academic staff and PPCs are always available for assistance.

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Introduction to the computer programme

Login to the program with your username and student number. The first time each year you login you will need to choose a password that is at least 7 characters and contains a minimum of 1 letter, 1 number and one item of punctuation (not quote marks or double quote marks) and then you need to choose your Scripware initials. My Scripware initials are: . To login:

Enter username and password

Select ‘Run Scripware Exercises’

In class you will be allocated a set (at home choose a set)

Print your responsible pharmacist notice and complete all fields

Then you are ready to start – select an exercise After selecting an exercise, the initial screen will be similar to the example below. The prescription, requisition or request will be on the left and a series of activities across the top of the right-hand side. The following pages guide you through these tabs.

Date on Rx

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Classify – applies to prescriptions, requisitions and emergency supplies

You need to decide: The type of form – prescription, requisition, emergency supply, etc. and who it comes from (doctor, dentist, vet, midwife, etc.). The legal category of each item - GSL, P, POM, Schedule 2 CD POM, etc. You will need to obtain this information using a combination of BNF/Veterinary formulary and the products. Note: Veterinary legal classes are listed separately

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Patient Medication Record (PMR) – applies to prescriptions and emergency supplies Some patients will have had prescriptions dispensed at your pharmacy previously. You need to check for each prescription and emergency supply whether the patient has a medication record. To do this: 1. Select PMR tab. 2. Enter patient surname and initial and select the correct patient from the list this generates. Not all patients will have a record, as they may not have previously visited your pharmacy. If your patient is an animal start the surname with c/o (care of).

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3. Then you will see a record of patients’ previous medicines, selected medical conditions, allergies and additional patient notes.

4. For each item on the current prescription you need to consider:

1. Have they had it before? If so, (a) Is it still appropriate for this patient?

(b) Is it the same dose, strength, etc. as before?

2. Is it a new item? If so, is it appropriate for this patient? Think about both previous medicines and past medical history.

5. If you identify any problems these should be queried using the verify tabs (see next page).

Date on Rx

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Verify – applies to prescriptions and requisitions

This means that you should check if the prescription or requisition is eligible for supply.

1. Is it legal?

2. Are there any details missing that you need before you can dispense the medicine? And for prescriptions

3. Are there any issues arising from the PMR?

4. Are there any interactions?

5. Check the dose

If an item changes as a result of your checks, remember to go back to the classify screen and re-classify that item as appropriate.

Date on Rx

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Register entries – applies to prescriptions, requisitions and emergency supplies

You need to decide if you have to make any register entries. There are two types of register entries: A. Prescription only register B. Controlled drugs register (either as a supply or receipt) Additionally for NHS prescriptions for the treatment of drug misusers - FP10 (MDA) only: C. The reverse of the MDA form must be completed. See later in this section for instructions on how to do this.

Date on Rx

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A. Prescription only register (POR) Pharmacists are legally required to keep a record of the sale or supply of all prescription only medicines, however you do not need to make an entry in the following circumstances:

• It is an NHS prescription

• It is a prescription for an oral contraceptive - although it is still Good Pharmaceutical Practice (GPP) to do so.

• A separate record is made in the CD register (but still GPP).

• The sale is by way of wholesale dealing and the order/invoice is kept for 2 years (but still GPP).

It is not always legally required but is GPP for all supplies other than NHS prescriptions, so you should make a record in the POR of:

• All private prescriptions (i.e. not NHS)

• All requisitions

• All emergency supplies You should not make a record in the POR for any NHS prescriptions (please note that private CD prescriptions look similar to NHS prescription but are classified as private). Each type of entry requires different information and the appropriate boxes will appear for the exercise type as described below.

Prescription Only Register Entries You should enter the data described in the appropriate boxes. There will be two rows for entering two items but if there is only one item on the script you will not be able to use the second. The display will show your last POR reference number and you should choose the next one. e.g. last reference is F.63.8, so you should enter F.63.9 last reference is F.63.9, so you should enter F.64.1

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1. Prescription record for private prescriptions Not needed for: (a) NHS prescriptions (b) Prescriptions for an oral contraceptive (c) If a separate record has been made in the CD register – but in the case of (b) and (c) it is still GPP to do so.

Ref number Name of patient

Name of practitioner

Drug name, strength, form, dose and quantity

Price (enter ‘price’)

Ref number (2)

Drug name, strength, form, dose and quantity (2)

Date of dispensing

Address of patient

Address of practitioner

Date on prescription

Note: For veterinary prescriptions you must also include the batch number of the product you are dispensing in the drug name box. 2. Prescription record for an emergency supply of a POM at the request of a prescriber

Ref number Name of patient

Name of prescriber

Emergency supply at prescribers request.

Drug name, strength, form, dose and quantity

Date on prescription

Price

Ref number (2)

Drug name, strength, form, dose and quantity (2)

Date of dispensing

Address of patient

Address of prescriber

Date prescription received

Date on prescription – in this box you should enter ‘date on Rx’ as you do not know for certain what the date is and would fill it in when the script arrived in your pharmacy. Date prescription received – in this box you should enter ‘date received’ as you do not know when you will receive the prescription and you would fill it in when the script arrived in your pharmacy.

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3. Prescription record for an emergency supply of a POM at the request of a patient

Ref number Name of patient

Drug name, strength, form, dose and quantity

Emergency supply at patients request

Nature of the emergency

Price

Ref number (2)

Drug name, strength, form, dose and quantity (2)

Date of dispensing

Address of patient

Nature of the emergency – in this box state that it is an emergency supply at the patients request and describe the nature of the emergency including why the patient could not visit GP. For example, ‘emergency supply at the request of a patient – patient is on holiday and has forgotten to bring her medicine with her, her blood pressure will not be controlled without the medicine and the surgery is closed therefore she cannot obtain prescription until Monday’. 4. Record of wholesale dealing (signed orders or requisitions from opticians/ chiropodists/ midwives/ doctors)

Ref number Drug name, strength, form and quantity

Name of person requesting the product

Requisition or signed order from which professional (purpose for which it is sold/supplied)

Price

Ref number (2)

Drug name, strength, form and quantity (2)

Date of dispensing

Address of the person requesting the product

Note: For veterinary requisitions you must also include the batch number of the product you are dispensing.

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B. Controlled Drugs Register Pharmacists must make an entry into the controlled drugs register for every schedule 2 drug supplied. This is a legal requirement. Before your start you register entry you should find out whether the person collecting the medicine has any ID with them. You do this by clicking on the ID icon on the righthand side of the screen as shown. You should make a note of who the collector is, whether any ID has been provided and, if they are a health care professional, their name and address.

You need to enter the supply (or receipt) on the page for an individual medicine, including specifying the brand you supply therefore you should find the product in the CD cupboard before you start your CD register entry. Then, select the controlled drugs register. You will then be asked to select the correct page of the register – using the selections available for drug class, brand, strength and form, as in the example below:

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The page you selected will then appear with a stock balance, you must then complete the details of the CD you have received or supplied and calculate the stock balance.

When you are happy that you have entered all the necessary information correctly write the details to the page. This will then record your entry and any amendments must be done using the process described below. Amending CD register entries Amendments to CD register entries must follow a footnote procedure as it is a criminal offence to change or obliterate a CD register entry. To amend the CD register if you have made an error. Go back into the register – an extra line will appear and you must start the amended entry with * (asterisk) and then re-write the whole entry for that box, your student ID, date and initial that entry. e.g. * should read John Smith 25 Acacia Avenue Nottingham NG7 5TR STUDENT ID DATE INITIALS. You must do this process for each box in which you have made an error. If you have made an entry on the wrong page of the register you must write ‘ * entered in error STUDENT ID DATE INITIALS’ in each box to ‘cancel’ that entry and then go to the correct page to make the correct entry.

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C. FP10 (MDA) forms

To meet the NHS requirements for instalment dispensing you need to endorse the back of the prescription. For FP10 (MDA) both GP and hospital forms will have an extra choice for registers of ‘Turn form over’, bottom left of the yellow box on the registers tab.

With FP10 (MDA) forms a record needs to be made on the prescription for each individual dispensing. See your NPA CD guide for information about endorsing these prescriptions.

To do this select the ‘Turn form over’ option and enter the date, drug supplied, quantity and your initials in the 4 boxes provided as below.

Technical errors on CD prescriptions

Pharmacists may amend minor typographical errors or add the quantity in words or figures where one is missing on controlled drug prescriptions provided due diligence has been exercised. The prescription must be marked to show which pharmacist the amendments are attributable to. In practise you would mark the amendment with your name, GPhC number, signature and date. See section 3.6.7 of the MEP for full details.

In Scripware this means you should select the relevant item you wish to amend and then ‘I shall do it myself’. You should then write what the amendment is and write your name, student ID and the date.

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Dispensed Medicine Labels – applies to prescriptions and emergency supplies You are expected to produce labels for the medicines you dispense. Below is a summary of the labelling required on a dispensed medicine issued in response to a prescription. Full details can be found in the MEP.

Examples of ancillary labels

KEEP OUT OF SIGHT AND REACH OF CHILDREN SHAKE THE BOTTLE

DISCARD AFTER 28 DAYS

+ Cautionary and Advisory Warning Labels See BNF drug monographs

Quantity Name Strength Form (select from list)

Directions for use (use labelling codes ONLY)

Reference number from POR (if applicable)

Quantity

Name of patient

Ancillary labels

Date

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Label for veterinary prescriptions (for further details see MEP)

Medicines supplied in response to a requisition should not be labelled (see wholesale supply lecture). Labelling codes for directions for use and ancillary labels are listed in Appendix 4 of this handbook. Labelling codes should be entered with a space between each different code. Once you are happy with your label click ‘save label details’. This will bring up a copy of the label that will print. Read it carefully and check that it says what you intended, then continue. If you notice any problems select the label again and amend. Check:

Is it what you intended (quantity, name, strength, form, dose instructions)? Is it grammatically correct? Would it make sense to a patient? Have you selected the correct ancillary labels? Does it need a reference number? Have you spelt the patient’s name correctly?

The labels will print out on the mark sheets. You cannot change labels once you have printed the mark sheet so please ensure you carry out the above checks.

Quantity Name Strength Form (select from list)

Directions for use (use labelling codes ONLY), plus batch number & expiry date

Reference number from POR (if applicable)

Name of patient & owner

Ancillary labels

Prescriber details

Owners address Date

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Endorsements – applies only to prescriptions and requisitions

You are required to endorse prescriptions and requisitions as follows:

Pharmacy stamp required on all prescriptions and requisitions. Tick the pharmacy stamp box. For TTOs, the pharmacy stamp will endorse the form with your initials and the date.

Date legally required on all schedule 2 and 3 controlled drugs but GPP to stamp everything. The date is incorporated into the pharmacy stamp.

Prescription Only Register (POR) reference number is required on all prescription/requisitions that you have entered into the prescription only register. Tick the POR box for each item as necessary.

Pack size required for all drugs dispensed against a NHS prescription in order to receive the correct payment from the prescription pricing division (PPD-NHSBSA). Also needed on TTOs for the hospital finance department. Tick the pack size box for each item as necessary.

Suppliers name & address on requisitions for S2 and S3 CDs - this will be filled in when you use the pharmacy stamp on relevant requisitions.

Date on Rx

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File

You need to decide where to file the document when you have completed it.

All NHS prescriptions are sent to the PPD-NHSBSA when completed in order to receive payment for dispensing. MDA forms: Remember that addict precriptions (FP10 MDA) are retained in the pharmacy until the final installment has been dispensed, then they are sent to the PPD-NHSBSA.

All private prescriptions (other than veterinary) are retained in storage for two years after completion. The only exception to this is where a GSL or P medicine has been ordered or where the prescription is allowed to be repeated. In these cases the prescription can be returned to the patient – provided you have stamped and endorsed the prescription first. S2 and S3 CDs: For private controlled drug prescriptions the orignal script is sent to the PPD-NHSBSA and a copy of the prescription must be kept for two years.

All TTOs should be sent to the hospital finance department. Emergency supplies will have no document to file.

Date on Rx

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Requisitions (other than veterinary) are kept for two years – legally required unless you have done a POR entry or you have retained a copy. However, it is GPP to both complete a register entry and retain the form. S2 and S3 CDs: Requisitions for controlled drugs should be sent to the PPD-NHSBSA and it is good practice to retain a copy of the requisition for two years. Note: this does not apply to Midwife requisitions for S2 and S3 CDs, where the original should be retained in the pharmacy and no copy sent to the PPD-NHSBSA. Veterinary prescriptions should be retained for 5 years. Veterinary requisitions should be retained for 3 years, other than for S2 & S3 CDs where the requistion should be retained for 5 years. 3 Important Things After you have filed your form if it is a prescription you will additionally be asked to fill in the three most important things you would explain to the patient about that prescription. Put yourself in the patient’s shoes, what are the three most important pieces of information you need to know to take the medicine correctly and safely? You only have 50 characters for each item. Handing out your product (i.e. handing to demonstrator for marking) You must check you have the correct patient or person to hand out the product to – this is done by checking the name and address. e.g. ‘Prescription for Ann Smith’, and when they say it’s them, ask them to confirm their address. Ensure you tell the PPC BEFORE handing over your product (you can write these on the marksheet) if either of the following apply:

(a) The product is out of date. (b) That you would dispense a different quantity to that in the packet (e.g. as

there is not enough in the cupboard). If it is a prescription tell the PPC your 3 important things.

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Feedback about your work

To view this feedback about each exercise you do in the classes or at home, log-on to the Scripware program and select ‘non-exam mode’. You should then select ‘look at results of individual exercises’ followed by the exercise you wish to view and you will see your mark and feedback in 4 sections: 1. Main – this is a summary of your results for that exercise, including any feedback. 2. CD register – will show any entries you made in the CD register and any feedback about your CD register entry or lack of entry. 3. POR – will show any entries you made in the POR register and any feedback about your POR register entry or lack of entry. 4. Demonstrator input – we no longer use this function. You will also be able to see the prescription as you left if (with any amendments) and your label within the results pages – by clicking on the appropriate icon. You will be able to practise the scripts you experienced during the session again after the practical classes and there will be additional exercises to be completed outside of the practical classes in the pre- and post-work. After you ‘file’ an exercise ensure you check the feedback before you select that particular exercise again – when you click on the icon to re-do an exercise the previous feedback is cleared and you will only be able to see feedback about your latest attempt. ‘Look at generic comments’ will help you monitor common errors made in assessments. It is important that you ask the PPCs or academic staff in the practical classes if you do not understand any aspect of the feedback you receive. We expect to spend time answering your individual queries about feedback during each practical class.

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Recommended Textbooks

1. Dale and Appelbe’s Pharmacy and Medicines Law

Appelbe GE, Wingfield J. 11th edition. London: Pharmaceutical Press, 2017. Comprehensive book about the law.

2. Medicines, Ethics and Practice: the professional guide for pharmacists Latest edition (published in July each year). London: Pharmaceutical Press. The practising pharmacist’s guide to legal and ethical issues.

3. BNF, latest edition (published biannually)* London: BMA and RPSGB. A guide to prescribing and much more. Use the edition the school has provided.

* These references are provided free of charge

Textbooks available in the dispenary include: Stockley’s Drug Interactions – 7th, 8th, 9th and 10th editions. Veterinary Formulary – 5th and 6th editions (UNUK only). Appendices

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Appendix 1: Common qualifications of health professionals Appendix 2: Latin terms and abbreviations Appendix 3: Arabic and Roman numerals Appendix 4: Labelling codes Appendix 5: Blacklist/SLS/ACBS

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Appendix 1: Common qualifications of health professionals

a) MEDICAL DOCTORS (Note: Use of the title Dr does not necessarily mean that the person is medically qualified. They may have a doctorate in another subject, eg PhD, DTheol).

MB, BM Bachelor of Medicine MD, DM Doctor of Medicine ChB, BChir, BS Bachelor of Surgery MBBS, MBChB, BMBS Bachelor of Medicine and Surgery MRCP, FRCP Member / Fellow of the Royal College of Physicians MRCGP, FRCGP Member / Fellow of the Royal College of GPs MRCS, FRCS Member / Fellow of the Royal College of Surgeons DRCOG Diploma Royal College of Obstetrics and Gynaecology And many others

Governing body is General Medical Council (GMC) – that is doctors must be registered with GMC to practise in UK. b) DENTISTS

BDS, BChD Bachelor of Dental Surgery

Governing body is General Dental Council. c) VETS

MRCVS Member of the Royal College of Veterinary Surgeons FRCVS Fellow of the Royal College of Veterinary Surgeons

Governing body is Royal College of Veterinary Surgeons d) OPTOMETRISTS (used to be called OPHTHALMIC OPTICIANS)

MCOptom Member of the College of Optometrists FCOptom Fellow of the College of Optometrists

Governing body is General Optical Council e) DISPENSING OPTICIANS (not as highly qualified as optometrists and are not allowed the drugs on the optometrist’s list)

FBDO Fellow British Dispensing Opticians

Governing body is General Optical Council

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f) MIDWIVES

RM Registered Midwife

Governing body is Nursing and Midwifery Council g) NURSES

RN Registered Nurse RNA Registered Nurse Adult RNMH Registered Nurse Mental Health RNLD Registered Nurse Learning Difficulties RNC Registered Nurse Children

Governing body is Nursing and Midwifery Council h) CHIROPODISTS

MChS Member of The Society of Chiropodists and Podiatrists FChS Fellow of The Society of Chiropodists and Podiatrists FCPods Fellow of The College of Podiatrists of The Society of Chiropodists

& Podiatrists

Governing body is the Health and Care Professions Council i) PHYSIOTHERAPISTS

MCSP Membership of the Chartered Society of Physiotherapy

Governing body is the Health and Care Professions Council j) PHARMACISTS

MPharm Master of Pharmacy (degrees awarded since 2000) BSc Bachelor of Science BPharm Bachelor of Pharmacy MRPharmS Member of the Royal Pharmaceutical Society FRPharmS Fellow of the Royal Pharmaceutical Society

Governing body is General Pharmaceutical Council k) PARAMEDICS

SRPARA State Registered Paramedic

Governing body is the Health and Care Professions Council

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Appendix 2: Some common Latin terms and abbreviations Latin has been used in writing prescriptions for many years, the main reason being that Latin abbreviations provide a convenient form of shorthand for prescribers. Due to the possibility of errors of interpretation, prescribers are being discouraged from using Latin names and terms on prescriptions. However, their continued use is likely for some years, especially when writing directions for the use of a preparation. The following list is a list of Latin terms and abbreviations that may appear on prescriptions but in practice only a few of these are commonly used.

Abbreviation Latin term Meaning

a.c. ante cibum before food

alt.die alterna die every other day

a.m. ante meridiem before noon

aq. aqua water

aurist. auristillae ear drops

b.d. bis die twice daily

b.i.d. bis in die twice daily

c. cum with

c.c. cum cibum with food

co. compositus compound

conc. concentratus concentrated

crem. cremor a cream

emul. emulsio an emulsion

enem. enema an enema

et. et and

ex. ex out of, from

ex aq. ex aqua in water

fort. fortis, forte strong

gtt. gutta a drop

gtt. guttae drops

h.s. hora somni at bedtime

h.s.s. hora somni sumendus to be taken at bedtime

L left (ear, eye, nostril, etc)

linct. linctus a linctus

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Abbreviation Latin term Meaning

m. mane in the morning

m. mistura a mixture

m. mitte send

m.d. more dicto as directed

m.d.u. more dicto utendus to be used as directed

mist. mistura a mixture

mitt. mitte send

n. nocte at night

n. et m. nocte et mane night and morning

n. m. nocte maneque night and morning

narist. naristillae nose drops

n.p. nomen proprium proper name (ie: label with the name of the article)

o.d. omni die every day

o.m. omni mane every morning

o.n. omni nocte every night

OP original pack

p.c. post cibos after food

p.i. pro infantibus for children (paediatric)

p.m. post meridiem afternoon

p.r.n. pro re nata when required

q.d.s. quarter die sumendus to be taken four times daily

q.h.s. quartis horis sumendus to be taken every four hours

q.q.h. quarta quaque hora every four hours

q.i.d. quarter in die four times daily

R right (ear, eye, nostril, etc)

s.o.s. si opus sit when necessary

sig. signa label

stat. statim immediately

t.i.d. ter in die three times daily

t.d.s. ter die sumendus to be taken three times a day

ung. unguentum an ointment

u.d. ut dictum as directed

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Appendix 3: Arabic and roman numerals Prescribers are being advised to use Arabic numbers when stating quantities on prescriptions and in some cases they are legally required to state the number in words as well. However, some prescribers have used Roman numerals for a long time and such persons will, without doubt, continue to use them. For this reason, a few examples are given as a guide.

Arabic Numbers

Roman Symbols

Arabic Numbers

Roman Symbols

Arabic Numbers

Roman Symbols

1 2 3 4 5 6 7 8 9 10 11 12

I II III IV V VI VII VIII IX X XI XII

13 14 15 16 17 18 19 20 21 22 24 28

XIII XIV XV XVI XVII XVIII XIX XX XXI XII XXIV XXVIII

29 30 40 50 60 70 80 90 100 500 1000

XXIX XXX XL L LX LXX LXXX XC C D M

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Appendix 4: Labelling codes for professional practice classes

Remember to enter a space between each code

DOSE CODES

T Take

HT Take HALF a tablet 1T Take ONE tablet HT1T Take ONE AND a HALF tablets 2T Take TWO tablets 3T Take THREE tablets 4T Take FOUR tablets 5T Take FIVE tablets 6T Take SIX tablets

8T Take EIGHT tablets 1T2 Take ONE or TWO tablets 2T3 Take TWO or THREE tablets 3T4 Take THREE or FOUR tablets T100 Take with 100mcg strength

1C Take ONE capsule 2C Take TWO capsules 3C Take THREE capsules 4C Take FOUR capsules

1C2 Take ONE or TWO capsules 2C3 Take TWO or THREE capsules 3C4 Take THREE or FOUR capsules

0.5 0.5ml 1 ONE ml 6 SIX ml 5 Take ONE 5ml spoonful 10 Take TWO 5ml spoonfuls

15 Take THREE 5ml spoonfuls 20 Take FOUR 5ml spoonfuls 5-10 Take ONE or TWO 5ml spoonfuls 5-15 Take ONE to THREE 5ml spoonfuls 10-15 Take TWO or THREE 5ml spoonfuls 15-20 Take THREE or FOUR 5ml spoonfuls 10-20 Take TWO to FOUR 5ml spoonfuls

23 Take TWENTY THREE millilitres

25 Take TWENTY FIVE millilitres 30 Take THIRTY millilitres 40 Take FORTY millilitres 50 Take FIFTY millilitres 60 Take SIXTY millilitres

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90 Take NINETY millilitres 100 Take ONE HUNDRED millilitres 120 Take ONE HUNDRED AND TWENTY millilitres

G Give

HTG Give HALF a tablet 1TG Give ONE tablet 2TG Give TWO tablets 3TG Give THREE tablets 1CG Give ONE capsule 2CG Give TWO capsules 3CG Give THREE capsules

0.6G Give a 0.6ml dose 1G Give a 1ml dose 1.5G Give a 1.5ml dose 2G Give a 2ml dose 3G Give a 3ml dose 4G Give a 4ml dose 25G Give a 2.5ml dose 7.5G Give ONE and a HALF 5ml spoonfuls (7.5ml)

5G Give ONE 5ml spoonful 6G Give SIX ml 10G Give TWO 5ml spoonfuls 15G Give THREE 5ml spoonfuls 20G Give FOUR 5ml spoonfuls 5-10G Give ONE or TWO 5ml spoonfuls 5-15G Give ONE to THREE 5ml spoonfuls 10-15G Give TWO or THREE 5ml spoonfuls

15-20G Give THREE or FOUR 5ml spoonfuls 10-20G Give TWO to FOUR 5ml spoonfuls

SYRINGE using the oral syringe provided INJECT (the injection)

U Use

1U Use ONE 2U Use TWO 3U Use THREE 4U Use FOUR 1U2 Use ONE or TWO 2U3 Use TWO or THREE 3U4 Use THREE or FOUR

1TU Use ONE tablet 1TU2 Use ONE or TWO tablets D1 Instil ONE drop

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D2 Instil TWO drops D3 Instil THREE drops D4 Instil FOUR drops 1D2 Instil ONE or TWO drops 2D3 Instil TWO or THREE drops 3D4 Instil THREE or FOUR drops 2D4 Instil TWO to FOUR drops

NOSTRIL in each NOSTRIL R into the affected EAR(S) E into the affected EYE(S) BR into BOTH ears BE into BOTH eyes LR into the LEFT ear LE into the LEFT eye RR into the RIGHT ear

RE into the RIGHT eye

P1 Inhale ONE puff P2 Inhale TWO puffs P3 Inhale THREE puffs P4 Inhale FOUR puffs 1P2 Inhale ONE or TWO puffs 1P8 Inhale ONE to EIGHT puffs 2P3 Inhale TWO or THREE puffs

3P4 Inhale THREE or FOUR puffs 2P4 Inhale TWO to FOUR puffs

1S Use ONE spray 2S Use TWO sprays 1S2 Use ONE or TWO sprays SL under the tongue

INSERTP Insert ONE pessary INSERTE Insert ONE enema INSERTS Insert ONE suppository INSULIN Inject subcutaneously just before or shortly after meals RECTUM into the RECTUM SUBCUT by subcutaneous injection VAGINA into the VAGINA

1SACH Take the contents of ONE sachet G1SACH Give the contents of ONE sachet 100 dissolved in 100ml of water 200 dissolved in 200ml of water WATER dissolved in plenty of water STOOL Use after every loose motion A Apply

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AS Apply sparingly 1P ONE patch

AF to the affected areas ANUS to skin around anus area ATHLETE to the athletes foot ECZ to the eczema COLD to cold sores IMPET to the impetigo INSECT to the insect bite(s) PSOR to the psoriasis RASH to the rash SPOT to the spot(s) WOUND to the wound FACE to the face ARM to the affected arm(s)

HAND to the affected hand(s) LEG to the affected leg(s) KNEE to the affected knee(s) SHOU to the affected shoulder(s) FOOT to the affected foot FEET to both feet WART to the wart BODY over the whole body

SUCK Suck ONE 1SL Dissolve ONE tablet under the tongue 2SL Dissolve TWO tablets under the tongue 1-2SL Dissolve ONE or TWO tablets under the tongue MOUTH to be held in the mouth

OD each DAY BD TWICE DAILY

TDS THREE TIMES a day QID FOUR TIMES a day B-T TWO to THREE TIMES a day T-Q THREE to FOUR TIMES a day FIVE FIVE TIMES a day

OM each MORNING ON at NIGHT HS at BEDTIME PM In the EVENING MN MORNING and NIGHT AD on ALTERNATE days 1PM at 1pm

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MIDDAY at MIDDAY STOP24 on day of stopping tablets and remove every 24 hours

SD as a SINGLE dose QDD FOUR doses per day MAX8 No more than 8 in 24 hours MAXBD maximum twice daily SEX Half an hour before sexual activity MTX ONCE a WEEK on the same day each week MTXFOL ONCE a WEEK - not on the same day as methotrexate MTXMON ONCE a WEEK on the same day each week (MONDAY) MTXTUE ONCE a WEEK on the same day each week (TUESDAY) MTXWED ONCE a WEEK on the same day each week (WEDNESDAY) MTXTHU ONCE a WEEK on the same day each week (THURSDAY) MTXFRI ONCE a WEEK on the same day each week (FRIDAY) MTXSAT ONCE a WEEK on the same day each week (SATURDAY)

MTXSUN ONCE a WEEK on the same day each week (SUNDAY) WARF Take as directed by the anticoagulation clinic

EW EACH WEEK 2W TWICE WEEKLY 3W THREE TIMES a week EM EACH MONTH

EV4D every 4 days EV5D every 5 days EV6D every 6 days EV7D every 7 days EV14D every 14 days

EV Every

HR Every hour 2H TWO hours 3H THREE hours 4H FOUR hours 6H SIX hours 8H EIGHT hours 12H TWELVE hours 24H every 24 hours 48H every 48 hours 72H every 72 hours

2H3 TWO to THREE hours 2H4 TWO to FOUR hours 3H4 THREE to FOUR hours 4H6 FOUR to SIX hours 6H8 SIX to EIGHT hours 1DAY for ONE day

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2DAY for TWO days 3DAY for THREE days 4DAY for FOUR days 5DAY for FIVE days 7DAY for SEVEN days 14DAY For FOURTEEN days 15DAY for FIFTEEN days

1MONTH for ONE month 7-10D for up to 7 to 10 days

UPTO up to WEEK for _ week(s) WEEKS for _ to _ weeks SUPPLY This is a ONE days supply. AND and THEN then

STOP STOP

PILL Take ONE tablet each day for 21 days followed by a 7 day break ST at the same time each day DD21 from DAY 16 to DAY 21 (inclusive) of the cycle DD24 from DAY 5 to DAY 24 (inclusive) of the cycle DD25 from DAY 5 to DAY 25 (inclusive) of the cycle

CC2 for TWO menstrual cycles CC3 for THREE menstrual cycles CC4 for FOUR menstrual cycles CC6 for SIX menstrual cycles

AC BEFORE food PC AFTER food

CC WITH food IC BETWEEN meals EMPTY on an empty stomach

PRN when required SOS when necessary STAT immediately BEFORE before treatment PRIOR prior to treatment

AFTER after THEREAFTER thereafter WASH8H12 wash off after EIGHT to TWELVE hours SOAP May use as a soap substitute or dissolve in bath 1EXTRA Can take an extra one per day

CONSTIPATION for constipation

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CONTRACEPTION for contraception FCI for chest infection FD for diabetes FHBP for high blood pressure FHG for lowering blood sugar levels FHC for lowering cholesterol levels MALARIA for one week prior to travel, during and for four weeks after return

MALARIA12 for 1-2 days prior to travel, during and for four weeks after return FNP for nerve pain NERVES for nerves PAIN for PAIN UTIP for prevention on urinary tract infection FBP for protection of bones FTB for thinning the blood UTI for urinary tract infection

MDUGP as directed by your doctor MDUD as directed by your dentist MDUP as directed by your prescriber ASB as before

FRIDGE Store in a fridge (2-8˚C) ES EMERGENCY SUPPLY DISCARD Discard any remaining unused medicine NURSE To be administered by a NURSE

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ANCILLARY LABEL CODES Remember to enter a space between each code

KOOSAROC KEEP OUT OF SIGHT AND REACH OF CHILDREN NTBT NOT TO BE TAKEN FNUO FOR NASAL USE ONLY FRUO FOR RECTAL USE ONLY FVUO FOR VAGINAL USE ONLY UOS USE THIS MEDICINE ONLY ON YOUR SKIN FATO FOR ANIMAL TREATMENT ONLY STB SHAKE THE BOTTLE D28 Discard any unused medicine after 28 days. BNF Codes Enter appropriate number 1 to 32 Text as per appendix 3 of BNF

As a guide the table below should help you decide which statement is required for products used on different areas of the body.

Product Label

Ear & eye preparations NOT TO BE TAKEN

Mouth preparations (washes, gargles & lozenges)

NOT TO BE TAKEN

Nasal preparations FOR NASAL USE ONLY

Pessaries, vaginal preparations FOR VAGINAL USE ONLY

Suppositories, rectal preparations FOR RECTAL USE ONLY

Creams, ointments, etc. for use on skin including scalp preparations and patches

USE THIS MEDICINE ONLY ON YOUR SKIN

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Appendix 5: Blacklist/SLS/ACBS – Limits to prescribing on the NHS

Copies of the Black List and SLS list are available near the drug cupboards in each bay (UNUK), or on the resource desk at the front of the class (UNM). a) Black List

Background Prior to 1985 there were no restrictions on prescribing on an NHS prescription. As a means of reducing costs and limited prescibing of products of doubtful efficacy, the limited list (or black list), was introduced. This is a list of products which cannot be prescribed on NHS prescriptions. The black list is in part XVIIIA of the Drug Tariff – a copy is provided at the end of this appendix. Products on the black list should not be prescribed on NHS prescriptions and cannot be dispensed.

Types of Products Affected Products affected include those in the following areas:

Analgesics for mild to moderate pain Antacids Cough and cold remedies Drugs acting on the ear and nose Drugs acting on the skin Drugs used in anaemia Hypnotics and anxiolytics Laxatives Tonics and bitters Vitamins

Prescribing/Dispensing Blacklisted Items It is against a pharmacist’s terms of service to dispense blacklisted products, and the supply will not be paid for. A pharmacist can choose to dispense any branded product (proprietary) against a non-blacklisted generic but only the Drug Tariff price will be paid for such supplies. Blacklisted items can be prescribed on private prescriptions (as the patient pays for these). If a medicine is not on the black list it is prescribable and dispensable.

b) Selected List Scheme (SLS)

The limited list regulations provide for some drugs to be prescribed only for a specific therapeutic indication (see part XVIIIB of Drug Tariff, a copy if porvided at the end of this appendix). Pharmacists should only dispense an NHS prescription for a drug in the Selected List if it is endorsed ‘SLS’ by the prescriber.

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c) Advisory Committee on Borderline Substances (ACBS)

Borderline substances are products which, though not always classed as medicines in the strictest sense, have medicinal uses, eg special dietary foods, sunblocks, covering creams. The Advisory Committee on Borderline Substances advises which of these products should be supplied on NHS prescriptions (see part XV of Drug Tariff). The products are allowable only for specfic conditions and prescriptions should be endorsed ACBS by the prescriber. d) Checking the Lists

These lists need to be checked very closely, sometimes the brand is not allowed but the generic is – so you could supply a black listed brand against a generic prescription.

BNF - The British National Formulary now uses a section in the drug monograph titled ‘National funding/Access decisions’.

Synonyms are not permissible, e.g. Morphine and ipecacuanha mixture BP cannot be written as ‘mist tussi nig’.

Extemporaneous Preparations - A black listed mixture e.g. ammonium chloride and morphine mixture cannot be prescribed by listing ingredients.

Proprietary Formulae - Black listed drugs may not be dispensed against prescriptions written as lists of ingredients even if the individual ingredients have appropriate non-proprietary names unless there is a non-black listed appropriate non-proprietary name for the combination. For example, Benylin may not be dispensed against prescriptions setting out its ingredients.

NB: NHS prescriptions cannot be used as private prescriptions because they are the property of the NHS.