Medicines Management

Background:

The handling of medicines in the UK for example, is stipulated by the Department of Health’s “National Minimum Standards Regulations for Independent Health Care” and is under the governance of the Care Quality Commission. Standard 22 stipulates that medicines are to be handled according to the requirements of the Medicines Act 1968, the Misuse of Drugs Act 1971 and the Misuse of Drugs Regulations. It is therefore essential that we aim to achieve at least the minimum standards. Below are a set of policies that practitioners need to adopt to meet these standards and comply with the UK Medicines Act, but more importantly to practice the delivery of healthcare to their players in a safe and efficient manner. Similar processes should be followed using national guidelines in all countries.

Medicines Ordering Policy:

• Medicines orders should be in writing and signed by an appropriate healthcare practitioner who is also a prescriber.
• Written Orders should be sent to the supplying pharmacist
• Special regulations are in place in relation to the supply and storage of controlled drugs (CDs) which require them to be signed for by an approved prescriber , and they will only be valid in the UK, if written on form FP10CDF which is only available from local authority for controlled drugs. Pharmacists need to be in possession of the original signed order before they can supply the CDs.
• A copy of all medicines orders must be kept for the club’s records
• Medication orders should be sent to a registered pharmacy, or a supplier that holds a current Wholesale Dealer Licence, whose “responsible person” is preferably a pharmacist

Receiving Policy

• Check all medicines items received against the supplier’s delivery note, matched to the original order and entered on a Medication Tracking Form (See appendix 2)
• Receipt of controlled drugs must be recorded in the club’s CD register
• Ensure a “first in, first out” use for medications to ensure newer stock is stored and older stock used first

Storage Policy

• Medicines must be stored in lockable cabinets that comply with British Standards BS 2881:1989 in the UK. (See standards in your country).
• Controlled Drugs must be stored in Controlled Drug Cabinets
• Controlled Drugs can only be held in premises holding the appropriate Home Office/Government Licence in the UK
• Keys to CD cabinets need to be subject to a security system which restricts access to named personnel.
• Medicines requiring refrigerated storage must be stored in a dedicated pharmacy refrigerator and not in a refrigerator used for foodstuffs or other non-medicines items. The pharmacy refrigerator must have a fridge max/min thermometer and a written record must be kept daily of temperature readings
• Emergency medicines must be clearly marked and stored to be easily accessible

Administration Policy:

• Dispensing medications to any player or other team member, must be according to an instruction from the club doctor/prescriber, and the issue of the medicines must be recorded on the Medicines Tracking Form (or on a weekly medications issue form or an event/match day medicines issue form (see appendix 3) and then transferred weekly to the Medicines Tracking Form). The lead prescribing doctor/clinician is required to sign the appropriate forms to maintain a written record of the instruction for each issue from the stock medicines.
• Medicines should be given out as a “stat dose” as required and if more than one dose is given out the medicine must be in a sealable packet or bag, labelled with the player’s name, the drug being given and the dosage instructions
• Written advice should be given to the player relating to the use, benefits and potential side-effects of taking the medicine
• Players must be advised that any medicine issue is only for their use and must not be given to anyone else. Any unused medicines must be disposed of (see below) and not put back into the stock for re-issue.

Disposal Policy:

• A contract must be in place with a pharmaceutical waste disposal company or pharmacy for disposal of out of date, returned or damaged medicines
• In the UK Controlled drugs awaiting disposal must continue to be stored in the CD cabinet and must be clearly marked that they are not to be issued to patients

Adverse Reaction Reporting Policy:

• Adverse drug reaction forms should be completed in the case of an untoward reaction being experienced after taking a medicine
• The medical lead or nominated deputy must be notified immediately and medical aid delivered as appropriate
• The medial lead or appointed deputy must investigate any incident and involve the pharmacy supplier

Error Reporting:

• Error reporting should be encouraged through a no blame culture
• Errors in prescribing and issuing medicines must be recorded on a reporting form. A clinician must be notified immediately and emergency care delivered as appropriate
• The medical lead or appointed deputy must investigate the incident and complete a report identifying necessary steps to prevent further errors

Periodic Stock /Expiry Date Checks:

• A monthly check of stock medicines must be undertaken to ensure the Medicines Tracking Forms balance with the stock of medicines held at the sporting venue.
• A monthly check of medicines stock must be undertaken to ensure out of date stock is identified and clearly marked that they are not to be issued to patients
• See disposal policy for removal of out of date or damaged stock

Availability of reference resources:

• There should be access to up to date relevant reference sources the summary of product characteristics for every product and access to information about all medicines stocked

Prohibited Substances:

• Practitioners must be aware of substances which are not permitted by the sport’s governing body
• Practitioners must ensure they do not administer prohibited substances to players unless they are required in an emergency
• Prohibited substances may be in the form of prescription only medications (POM), over the counter (OTC) medicines or products, or nutritional supplements.
• Players should be made aware they are ultimately responsible for prohibited substance intake and they should always check the contents of any medicines or products they are taking and seek guidance if uncertain.