Dispensing and Labelling
As well as manufacturing of medicines, dispensing and labelling of products are necessary elements of the supply of medicines.
- For the dispensing of medicines pharmacy staff approving or dispensing prescriptions, must have access to the protocol and treatment plan from the hospital that initiated treatment and access to advice of a specialist pharmacist in that hospital – such that they can confirm that the prescribed dose is appropriate for the patient and that the patient is aware of the required monitoring arrangements
- Dispensary staff must work to detailed standard operating procedures
- Label details must comply with regulatory requirements and NPSA recommendations as defined in local policy
- All dispensed containers for cytotoxic medicines must be labelled with a ‘Cytotoxic’ warning Label
- Tablets or capsules must not be handled directly. All staff should use a ‘no touch’ technique or wear gloves to minimise risks of exposure to all medicines especially cytotoxic drugs
- Counting triangles designated only for use for cytotoxic drugs must be used. These must be cleaned after use with IMS (Industrial Methylated Spirit 70%), or an alternative locally approved agent, and a wipe. Wipes must be disposed of as cytotoxic waste.
- Automated counting machines should NEVER be used for oral anti-cancer medicines.
- During normal working hours, all quantities of oral anti-cancer medicines must have a physical double check (count) by the pharmacist prior to release to patient.
- Tablets should never be crushed or halved and capsules should never be opened. Where a commercial liquid preparation is not available, and Pharmacy is able to extemporaneously prepare a formulation this must be done in an appropriate controlled environment.
- Oral anti-cancer medicines must not be dispensed in compliance aids or monitored dose systems.
- When dispensing tablets or capsules, sufficient quantity for the complete cycle of treatment must be supplied.
- When dispensing short courses of oral anti-cancer drugs in liquid formulations, the exact quantity required (plus an overage of approximately 10ml) must be supplied. Work over a leak-proof tray to contain any spillage.
- For patients on maintenance treatment (for example, mercaptopurine for paediatric leukemic patients) dispense a complete original container.
- All patients must receive appropriate written information in accordance with NPSA guidance. This must either be in the form of manufacturer’s Patient Information Leaflet (PIL) or a locally approved information leaflet
- Medicines must not be supplied to a patient unless he/she has received education relating specifically to the medicines, the intended treatment plan and likely side-effects. It is important that the patient accepts their roles and responsibilities relating to their treatment.
Falsified Medicines Directive (FMD)
When supplying any medicines, the HaH Pharmacy will complete the FMD regulatory check to ensure product contains a tamper proof seal that it is verified before decommissioning as close to supply as possible. Any error messages will be overseen by the Responsible Pharmacist.
Ordering of Items to be Compounded
Ordering of dose specific compounded items can only take place once a valid prescription is received and is fit for purpose. A suitably trained pharmacy technician must check to make sure the product is suitable i.e., confirm suspending fluid, concentration and final volume whilst inputting the order. A trained pharmacist must then check the order is correct and valid alongside a prescription and treatment date before placing the signed order.