Why is this guidance important to you?
As a pharmacist, you can supply prescription only medicines (POMs) to a patient without a prescription in an emergency at the request of a prescriber or a patient. You should consider each request on a case by case basis, using your professional judgement to decide which course of action you believe will be in the best interest of the patient and support patient care.
What this guidance does not cover
- This guidance does not cover the use of patient specific directions or the faxing of patient specific directions in secondary care.
- It does not cover the request of an emergency supply in the event of a pandemic or through patient group directions (PGD).
- Myths about GPhC and your employer not approving an emergency supply ( see here for RPS Mythbuser Emergency Supply).
- National emergency services:
- Faxed prescriptions - see Medicines, Ethics and Practice (MEP).
Emergency supply at the request of a prescriber
The following prescribers are able to request emergency supplies:
- An EEA or Swiss doctor, dentist, prescribing pharmacist or prescribing nurse
- The following prescribers registered in the UK:
- a doctor, dentist, supplementary prescriber, community practitioner nurse prescriber, nurse independent prescriber, optometrist independent prescriber, pharmacist independent prescriber, physiotherapist independent prescriber, podiatrist independent prescriber, therapeutic radiographer
Conditions that apply
Nature of emergency: Be satisfied that the request is from one of the prescribers stated above and the prescriber is unable to provide a prescription immediately due to an emergency (e.g. patient cannot collect the prescription from the prescriber, the prescriber is unable to drop off prescription at the pharmacy and patient urgently needs the medicine(s), etc).
Prescription: Prescriber agrees to provide you with a prescription within 72 hours.
Directions: The POM is supplied in accordance with the direction given by the requesting prescriber.
Controlled drugs: Cannot supply controlled drug Schedule 1, 2 and 3 (except phenobarbitone or phenobarbitone sodium for epilepsy). Note: an EEA or Swiss doctor, dentist, prescribing pharmacist or prescribing nurse cannot request a Schedule 1, 2 and 3 controlled drug including phenobarbital for any purpose or medicines that do not have a UK marketing authorisation.
An entry needs to be made in the POM register with the following information on the day of supply (or if impractical the next day following):
- The date the POM was supplied
- The name (including strength and form where appropriate) and quantity of medicine
- The name and address of the prescriber requesting the emergency supply
- The name and address of the patient for whom the POM was prescribed
- The date on the prescription (can be added to the entry when the prescription is received in the pharmacy)
- The date on which the prescription is received (this should be added to the entry when the prescription is received in the pharmacy).
Usual labelling requirements apply (see Medicines,Ethics and Practice (MEP) for further details.
Emergency supply at the request of a patient
It is possible to make an emergency supply at the request of a patient who has previously been prescribed the requested POM(s) by:
– an EEA or Swiss doctor, dentist, prescribing pharmacist or prescribing nurse
– the following prescribers registered in the UK:
- a doctor, dentist, supplementary prescriber, community practitioner nurse prescriber, nurse independent prescriber, optometrist independent prescriber, pharmacist independent prescriber, physiotherapist independent prescriber, podiatrist independent prescriber, therapeutic radiographer.
Conditions that apply
Interview: Regulation 225 Human Medicines Regulations 2012 requires a pharmacist to interview the patient. The RPS recognises that in some circumstances this might not be possible, for example if the patient is a child, or being cared for, etc. In these circumstances the RPS advises pharmacists to use their professional judgement and consider the best interest of the patient.
Immediate need: Be satisfied there is an immediate need for the POM and it is not practical for the patient to obtain a prescription (e.g. they are out of town, etc).
Previous treatment: The POM requested has previously been used as a treatment prescribed by at least one of the prescribers listed above. Note: the time interval from when the medicine was last prescribed to when it is requested as an emergency supply would need to be considered and you should use your professional judgement as to whether a supply or referral to a prescriber is appropriate.
Dose: Be satisfied of the dose the patient needs to take (e.g. refer to PMR, prescription repeat slip, labelled medicine box,electronic health records ,etc).
Controlled drugs: Cannot supply controlled drug Schedule 1, 2 and 3 (except phenobarbitone or phenobarbitone sodium for epilepsy) and medicines which consist of or contain the following substances:
- Ammonium bromide, calcium bromide, calcium bromidolactobionate, embutramide, fencamfamin hydrochloride, fluanisone, hexobarbitone, hexobarbitone sodium, hydrobromic acid, meclofenoxate hydrochloride, methohexitone sodium, pemoline, piracetam, potassium bromide, prolintane hydrochloride, sodium bromide, strychnine hydrochloride, tacrine hydrochloride, thiopentone sodium.
Note: requests made by a patient of an EEA or Swiss doctor, dentist, prescribing pharmacist and prescribing nurse cannot be supplied a controlled drug Schedule 1, 2 and 3 or medicines that do not have a UK marketing authorisation.
Length of treatment of controlled drugs: Cannot supply more than five days treatment of controlled drugs
(i.e. phenobarbitone, phenobarbitone sodium, Schedule 4 and 5).
Length of treatment of POMs: Cannot supply more than 30 days for other POMs, except where:
- The POM is insulin, an ointment, a cream, or an inhaler for asthma, (i.e. the packs cannot be broken) the smallest pack available in the pharmacy should be supplied.
- An oral contraceptive, a full treatment cycle supplied.
- An antibiotic in liquid for oral administration, supply the smallest quantity that will provide a full course of treatment
Please note: you do not have to provide the full 30 days supply, you can supply the required amount until the patient can obtain a prescription for their treatment.
Entry is made in the POM register with the following information on the day of supply (or if impractical the next day following):
- the date the POM was supplied
- the name (including strength and form) and quantity of medicine
- the name and address of the patient requesting the POM
- information on the nature of the emergency, such as why the patient needs the POM, why a prescription cannot be obtained, etc
Usual labelling requirements apply (see Medicines, Ethics and Practice (MEP) for details), additionally have the words "Emergency Supply" on the label.
Other points to consider when faced with requests for emergency supply
You should be mindful of patients abusing emergency supplies, for example where the patient medication record shows the patient has on a number of occasions requested a medicine as an emergency supply or the patient is known to the pharmacy for regularly requesting emergency supplies.
You are able to make an emergency supply even when the surgery is open and out of hours services are available. Trying to obtain a prescription may sometimes cause undue delay in treatment and potentially cause harm to the patient.
If patients are away from home and have run out of their medicines, referring them to the nearest surgery to register as a temporary patient may not always be appropriate and making an emergency supply can be considered to support patient care.
Your company SOP or policy may have further information on charges (if any) for an emergency supply. You may want to consider discussing this further with your superintendent. Please bear in mind a payment for the supply shouldn't be a barrier to you making an emergency supply or delaying a supply to the patient.
You should consider risks associated with loaning of medicines when legal mechanisms such as emergency supply exists to support patient care.
What you should do when the POM requested by the patient is not supplied
You may want to refer to the RPS guide "Mythbuster on Emergency Supply" before making a decision to not do an emergency supply. The guide has been developed to help remove myths/fears you may have about the General Pharmaceutical Council (GPhC) and your employer not approving you making an emergency supply of medicines.
If you decide not to make an emergency supply after gathering and considering the information discussed in this guidance, you should advise the patient on how to obtain a prescription for the medicine or appropriate medical care such as referral to a doctor, walk in centre, accident and emergency, etc.
As good practice you could also make a record of your decision (e.g.in the POM register, PMR, etc).