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Section 3 – Medicines Governance

Practice Guidance 28: Instructions for supplying and/or administration

28.1 You should check that the direction to supply and/or administer medicines to your patient is appropriate according to your assessment of the patient’s needs. If you have any concerns with regard to the instructions given, you must consult the prescriber before administering the medicine to the patient.

28.2 If you instruct another person to supply and/or administer medicines on your behalf, you must ensure that the individual is educated, trained and competent to do so. Where you believe this not to be the case, you may refuse to instruct another person to supply and administer on your behalf.

28.3 When supporting patients to self-administer medicines, you must ensure that they are able to do so safely and ensure that you have followed any local policy in place relating to supporting patients to take their own medicine.

28.4 Instructions to supply and administer medicines must be given in writing and a record kept. An oral instruction is not acceptable on its own as there will be no independently verifiable record of what was said. In certain exceptional circumstances, it will be necessary to act on an oral instruction. A radiographer acting on an oral instruction must record what the circumstance was that prevented a written instruction being given and must record exactly what the instruction was and who gave it.

28.5 Remote instruction occurs if you receive an instruction based on a telephone call, e-mail, fax, text-message, video-link, web-based or other non face-to-face contact with the prescriber.

28.6 Written remote-instructions (e-mail, fax) must be printed off and collated with the patient’s clinical record. This should be followed up with an appropriate written prescription signed by the prescriber.

28.7 Non-written remote prescriptions such as text-messaging may become increasingly common. If you supply and administer on the basis of a text message from a prescriber you should obtain a second signatory to your clinical record to confirm that your record of the prescription agrees with the text message. The text message should be regarded as patient-confidential information and should be deleted from the receiving handset after transcription to, and countersigning of, the clinical record.

28.8 Local polices must be in place to ensure that the use of web-based and/or portable products for communication are secure and provide a robust audit trail. Clinical governance procedures should be in place to support such practice.

Practice Guidance 29: Dispensing

29.1 Dispensing is the preparation and supply of a medicine in accordance with the instructions contained within a prescription. Dispensing is generally performed by a Pharmacist or Pharmacy Technician. You must ensure the separation of prescribing and dispensing of medicines whenever possible. You should not normally dispense against a prescription that you have written.

29.2 You should not dispense medicines unless there is a local policy in place, agreed by the Clinical Governance Lead, to endorse your actions.

29.3 If you do dispense, you must understand the medicine you are dispensing, its therapeutic effect, correct dosage, side-effects and contra-indications. You should be able to inform the patient what to expect when taking the medicine and how to report any unexpected effects.

29.4 You should only dispense if you are educated, trained and competent to do so. A record must be kept of your dispensing actions and you should ensure that an audit trail is present and visible.

Practice Guidance 30: Storage

30.1 You should ensure all medicinal products are stored in accordance with the information within the Summary of Product Characteristics/Patient Information Leaflet or information found on the label. Some medicines may require refrigerated storage.

30.2 Medicines can only be stored in ‘lockable business premises’ prior to delivery to the patient. When not in use, medicines should be stored in lockable containers or cabinets or otherwise returned to a Pharmacy department for safe-keeping.

30.3 NHS staff: You must not store medicines at home unless you must have the written permission of your employer to do this which describes the exceptional circumstances that require you to store medicines in your home, and you must have suitable lockable storage facilities in place.

30.4 Home-based Private practice: You must only store medicines in lockable containers that constitute ‘lockable business premises’ which are within the business part of your premises.

30.5 All storage environments must meet the prevailing storage requirements and it is your responsibility to find out what these requirements are. You must ensure correct storage polices are in place and are being adhered to.

Practice Guidance 31: Transportation

31.1 You may transport medicines from the dispensing pharmacy to their place of use. You must display appropriate health and safety information on your vehicle if the medicine requires it e.g. medical gases.

31.2 You should not leave medicines unattended in your vehicle at any time

Practice Guidance 32: Disposal

32.1 You must dispose of used, partially used and unused medicines in accordance with current legislation and your local employer policy.

32.2 If there is no local employer policy in place, you should return all medicines to a Pharmacist for safe disposal.

Practice Guidance 33: Error Reporting

33.1 If you discover that you have made an error in prescribing you must take immediate action to prevent potential harm to the patient and you must report the error as soon as possible according to local protocols.

33.2 If you think there is an error in a prescription that has been written and/or dispensed by someone else, you must seek clarification of the prescriber’s wishes before administering the medicine. You should also report the error according to local protocols.

Practice Guidance 34: Reporting Unexpected Effects and Adverse Reactions

34.1 If a patient experiences a suspected adverse reaction to a medicine they have been prescribed, you should record this in the patient notes, notify the prescriber (if you did not prescribe the drug) and notify the Medicines and Healthcare products Regulatory Authority (MHRA) via the Yellow Card Scheme immediately. Yellow cards are found in the back of the British National Formulary and also online at https://yellowcard.mhra.gov.uk/.

34.2 You may also inform the patient that they can report any suspected adverse reactions independently to the Yellow Card Scheme.

34.3 You can also report adverse reactions via the MHRA website at : www.mhra.gov.uk and any untoward incidents can be reported to the National Patient Safety Agency (NPSA) at http://www.npsa.nhs.uk/

34.4 Drug Safety Update is the monthly electronic bulletin from the MHRA and the Commission on Human Medicines and is essential reading for the latest information and advice to support the safer use of medicines. You are encouraged to consult the bulletin as a matter of routine. http://www.mhra.gov.uk/Safetyinformation/DrugSafetyUpdate/index.htm

Practice Guidance 35: Access to Supplies of Medicines

35.1 A radiographer can obtain a stock of medicine ahead of its administration to a patient when the radiographer is using a Patient Group Direction (PGD) as the legal framework of medicines use and the named medicine is listed within the PGD.

35.2 A radiographer can obtain the medicines needed for administration to a named patient against a valid prescription for the named medicine that is dispensed by a Pharmacist.

Practice Guidance 36: Complementary, Herbal and Homeopathic Products

36.1 Complementary, herbal and homeopathic products may interact with other medicinal products and/or laboratory tests. You should ensure you obtain, and record, information from the patient as to whether they are using any such products. Where there is evidence complementary, herbal or homeopathic product prior to starting taking a conventional medicinal product or undergoing a medical and/or surgical procedure.

36.2 Some herbal and homeopathic preparations are classed as medicines and are classified as POM, P or GSL depending on their action and route of administration. You can only prescribe and/or supply and administer these products in accordance with an appropriate prescribing and/or supply and administration framework.

36.3 The MHRA regulates other herbal products under the Traditional Herbal Registration (THR) scheme and other homeopathic products under the National Rules Scheme (NRS). Other products may not be subject to regulation of their quality, safety or efficacy. You should only recommend these products if you have suitable education, training and experience to do so.

36.4 The MHRA holds a list of complementary, herbal and homeopathic products that are known to, or may have, interactions with medicinal products and you must be aware of these before recommending that a patient takes a complementary product in addition to, or as a substitute for, any currently prescribed medicine. Some herbal preparations are prohibited or restricted in their use in humans due to known toxic and/or harmful effects, and you should not recommend these products to your patients

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