Medicines-related questions

Q: Can practices that share buildings share pharmaceuticals, for example, an out-of-hours service sharing with a daytime practice, or would this act against auditing purposes?

Where there are two separate legal entities – for example, a daytime practice and a different company using the daytime practice’s facilities to provide an out-of-hours service – they should each have records of the drugs they purchase and the drugs they dispense/supply,  and be able to carry out an annual audit. This could make it difficult if two separate practices were using the same medicines.

Q: Are receptionists or nurses unable to dispense wormers and flea products unless a vet authorises it/is present? Thinking about lunchtimes etc when a vet may not be present when a client comes in?

In order to prescribe a prescription-only veterinary medicine (POM-V) a veterinary surgeon must have the animal under his care and carry out a clinical assessment. If the supply takes place when the veterinary surgeon is not present, it must still be authorised by the veterinary surgeon. The guidance notes in the Practice Standards Manual (8.4) set out various means for authorisation.

Q: At what level of waste/out-of-date drug do you need a witness?

All out-of-date controlled drug disposal should be witnessed by a Practice Standards or Veterinary Medicines Directorate inspector, an independent vet. Waste – ie residue in vials – can be disposed of by rendering irretrievable without being witnessed by an independent person.  However, it is good practice for two members of staff to sign a disposal record.

Q: Does recording temperatures weekly also apply to in-car fridges, if all medicines are brought in overnight?
Temperatures in car fridges (or anywhere temperature-sensitive medicines are stored) must be monitored daily, but only need to be recorded weekly.

Q: Just to confirm that Somulose doesn’t need to be locked up, either in storage or in cars?
No, it does not need to be locked up. Quinalbarbitone is a Schedule 2 controlled drug and has to be recorded, but does not need to be locked up. However, it is good practice to keep it locked up.

Q: Are smaller branch practices expected to dispose of bottles of antibiotics just 28 days after broaching?
Yes, unfortunately so. There is no reason why you can’t take them to your main surgery within the 28 days and use them up there.
Q: I am concerned about misuse (by clients) of meds such as tramadol and diazepam, so how can one keep tabs on this?
You should only dispense the minimum quantity needed for treatment.
Q: Is the ‘28 days’ rule in tablets of stone?
If the Summary of Product Characteristics (SPC) of a product states that once broached the contents of a vial must be discarded after 28 days (or any other period) – then that is what must happen. The period may vary by product and should always be checked.

Q: Are there any specific regulations which state that storing medications within the door of a fridge can be detrimental, due to the temperature fluctuations from opening and closing the door?
If storing drugs in the fridge door means that the temperatures are going out of the range 2-8°C, then this is not suitable storage for a temperature-sensitive medicine.

Q: If you dispense more than one drug under the cascade, which we often do in cats, can we use a form allowing more than one drug, or do we need a separate one for each drug, which is very time consuming in consultation?
It is OK to put more than one drug name on the consent form, but remember that you need to explain each drug to the owner, as it needs to be informed consent.

Q: How rigid are the regulations about the length of screws, type of wall fittings, thickness of metal for CD cabinets? Is a safe attached to a wall from inside the safe adequate?
These very detailed requirements do not apply to veterinary surgeons; the obligation is to keep CDs securely stored in a locked receptacle which is constructed and maintained to prevent unauthorised access and can only be opened by a veterinary surgeon or person authorised by him/her. Assuming that the safe meets these requirements (and fixing to the wall from the inside is preferable to external fixing) then it would be acceptable.

Q: Re the Cascade and informed consent, you said ‘ideally’ in writing… this is causing us a huge headache. Correct me if I’m wrong but I thought the legal (VMD) requirement was just for a lifelong consent for all animals, not just small furries. The RCVS has deemed we need a consent form every time we dispense metronidazole etc, with no clear guidance as to how often this needs to be signed, for example, if an animal has two episodes of colitis two months apart. Any practical suggestions?

You are right, it is not a legal requirement to have permission in writing, but it is a requirement under the Practice Standards Scheme (and now the Code of Professional Conduct).

In the case of exotics (where most medicines used will not be authorised for use in the UK), owners can consent to this from the outset. This is not, however, the situation for other species. Lifelong consent may be given for use of a specific product. What cannot be obtained is a ‘blanket’ lifelong consent to the use of any and all Cascade product use in the future. If written consent has been obtained for one drug for one condition, and a further episode occurs shortly thereafter, additional signed consent would not be required. However, if a different drug is used under the Cascade, then written consent is needed for the new drug.

General questions

Q:  Are there not issues with veterinary surgeries being located within pet stores where there is the potential for those animals who may be carrying infectious diseases, for example, should an animal enter the pet store with suspected parvovirus and vomit or defecate on the pet store floor, is there not a serious risk to the other animals entering the pet store or veterinary surgery?  This is something that often concerns me and I would be most keen to find out the answer to this.
Practices in pet stores must have abiosecurity policy which takes this into account. The Practice Standards Scheme doesn’t cover the pet stores themselves.

Q: Where can I find info about preventing radiation exposure?
The Health and Safety Executive and/or your practice Radiation Protection Advisor.

Q: Are registered veterinary nurses (RVNs) legally able to move the dial on an anaesthetic machine either to a higher or a lower level without informing the vet of our decision every time? Obviously, we would inform immediately if there are any concerns.
Inducing anaesthesia by administration of a specific quantity of medicine directed by a veterinary surgeon may be carried out by an RVN. However, administering medicine incrementally or to effect to induce and maintain anaesthesia may only be carried out by a veterinary surgeon.

Maintaining anaesthesia is the responsibility of a veterinary surgeon. While a suitably-trained person may assist by acting as the veterinary surgeon’s hands (to provide assistance which does not involve practising veterinary surgery), for example, by moving dials, this does not mean that they can make judgments independently about increasing or reducing anaesthetic levels.

Q: I wonder where to find cleaning/disinfecting SOPs standards that could be adjusted to our practice, or should it be worked out for each surgery?
SOPs really should be ‘surgery specific’. The British Veterinary Association website provides assistance with SOPs and information on a number of topics that can be adapted for use by individual practices.