Services Database Supervised Consumption (Derbyshire County Area)

Service description

• The pharmacy shall offer the supervised self-administration of both methadone and buprenorphine (including buprenorphine/naloxone combination products). Where new medications (i.e.  Buvidal) are prescribed, the pharmacy are expected to deliver this in line with the applicable guidance from NICE.
• Supervision of self-administration of medication shall be carried out by a qualified pharmacist.
• The pharmacist shall dispense the medication and observe the patient while they swallow the medication (methadone) or allow the medication to dissolve sublingually (buprenorphine) as directed.

Notes:

Due to the risk of overdose, medication should not be dispensed to patients who present as intoxicated.

In the case of buprenorphine, the patient should remain in the pharmacy until the medication is fully dissolved.

• The patient will be registered onto the web-based monitoring system stipulated by the Council (currently PharmOutcomes) and all subsequent dispensing activity (supervised, take-home or missed) recorded.
• In regard to new patients, the pharmacist should:

1. Explain the expectations of the pharmacy and patients in regard to confidentiality, privacy, behaviour, etc.;
2. Give medication information at first dispensing event;
3. Advise patients on safety and storage for any take-home doses of medication.

• The pharmacist must contact the prescriber or keyworker if:

1. A patient presents a prescription marked for the attention of a different pharmacy;
2. The pharmacist has concern regarding the validity of the prescription;
3. The patient misses one pick-up during dose titration;
4. The patient misses three consecutive pick-ups once on stable dose;
5. The patient continues to show intermittent contact, with regularly missed doses;
6. The patient regularly presents to the pharmacy in an intoxicated state;
7. The patient fails to comply with directed self-administration of medication;
8. The pharmacist has concerns regarding a patient’s physical or mental health;
9. The pharmacist has concerns regarding risk to the service or others, including safeguarding concerns.

A record of any contact with the prescriber or keyworker should be entered on the patient medication record (PMR).

• In the case of a patient transferring between pharmacies, the new pharmacy should contact the previous pharmacy to confirm recent dispensing.
• The pharmacy shall provide water to the patient, to rinse mouth after taking medication or to wet mouth prior to consumption of buprenorphine.
• Medication usage reviews shall be carried out as appropriate.
• Patients shall be referred or signposted to other substance misuse, health or social care agencies as appropriate.

Not known.