prescribing and dispensing policy
prescription writing
We do not provide NHS services and do not issue NHS presciptions – all prescriptions are issued on a private basis.
Where a patient requires medicines as part of their treatment, a private prescription will be provided.
Private prescriptions are printed using the practice’s clinical computer software and always include the following information:
- The name, address and signature of the prescribing dentist;
- The name, address and age of the patient;
- The date of the prescription;
- The name of the medicine (generic, wherever possible);
- The dose, frequency and quantity to be supplied (without the use of potentially misleading decimals wherever possible);
- Additional directions to the patient, where appropriate (eg avoid alcohol)
We avoid the use of abbreviations when writing prescriptions.
We do not issue prescriptions for controlled drugs to patients and so do not keep copies of form FP10PCD (other than for obtaining midazolam for the emergency drug kit).
We do not arrange for prescription medicines to be dispensed remotely unless there is no other viable option and it is in the patient’s best interests.
prescribing protocols
We prescribe medicines in accordance with the guidelines set out in “Antimicrobial Prescribing for General Dental Practitioners” published by the Faculty of General Dental Practice (UK) and the additional guidance set out in the BNF (British National Formulary) published jointly by the British Medical Association and the Royal Pharmaceutical Society. Refer to these publications for full details of drug names, dosages and frequencies that are considered appropriate for use in general dentistry and the illnesses to which they apply.
Standard prescriptions for the most commonly used drugs are programmed into the practice computer system. These should ALWAYS be double-checked against the current BNF and FGDP guidelines before use.
review and follow-up
Where a patient is prescribed an antibiotic, they must be reviewed/followed up after 48 to 72 hours. If the infection has resolved, they should be advised to cease taking the medicine rather than to complete the course.
prophylaxis
Guidance issued by the National Institute for Health and Clinical Excellence (Clinical Guidelines CG64, issued March 2008) recommended that antibiotics no longer be prescribed as prophylaxis for the prevention of infective endocarditis on the basis that it is not cost effective. This is restated in the FGDP guidelines (see above).
However, this position has been modified by the issue of “Implementation Advice” relating to CG64 by the Scottish Dental Clinical Effectiveness Programme, which we now follow. As a result, we do discuss antibiotic prophylaxis with relevant patients and offer it to them in appropriate cases and in consultation with other relevant healthcare professionals (generally, the patient’s cardiologist). Full details of our approach are set out in our patient advice leaflet on Antibiotic Prophylaxis (refer to SOE Exact Dental software for full library of patient advice leaflets).
In order to help them arrive at an informed decision, patients who may be suitable for antibiotic prophylaxis prior to exposure prone procedures may also be supplied with a copy of the paper titled “Guidelines on prophylaxis to prevent infective endocarditis” by MH Thornhill et al, British Dental Journal Volume 220 No 2 (22 January 2016) which sets out a thoughtful and accessible rationale for the use of prophylaxis and a copy of the information leaflet on infective endocarditis produced by the British Heart Foundation. This is at the discretion of the prescriber and will depend principally on whether the prescriber feels the patient will be able to fully understand and, therefore, be aided by the paper in reaching an informed decision.
additional help and information
In case of doubt, information on any aspect of drug therapy in dentistry can be obtained from the regional North West Medicines Information Centre (NWMIC) on 0151 794 8206.
dispensing medicines to patients
The practice does not dispense prescription medicines.
purchase of medicines
Medicines (including controlled drugs) may only be purchased from a recognised dental wholesaler (eg Kent Express, Henry Schein).
Controlled drugs (currently only Midazolam for the emergency drug kit) may only be ordered / requisitioned / purchased by the Practice Director or the Clinical Director. A copy of the purchase invoice for controlled drugs is kept in the Waste Disposal “Transfer Notes and Consignment Notes” folder. This is matched to the form recording denaturing of the drug at the time of disposal, ensuring a complete audit trail for the controlled drug from purchase to destruction.
access to, storage of and transportation of medicines
The practice does not store prescription medicines for dispensing to patients.
The only controlled medicine held by the practice is Midazolam, which is listed as a Schedule 3 controlled drug under the Misuse of Drugs Regulations 2001. This is kept in the emergency drug kit for the management of status epilepticus and is not supplied to patients for use off the premises. As a schedule 3 controlled drug, it does not need to be stored in a controlled drug cabinet. It is kept in the emergency drug kit, which is, in turn, kept in a closed cupboard below the dentist’s computer work-station in surgery 1. This cupboard is located behind the dentist’s working position and is in the surgery, which is almost never unoccupied and cannot be accessed other than via reception, which is always staffed. It is, therefore, effectively impossible for an unauthorised person to access the drug. It cannot, in any event, be kept under lock and key since it is essential that it is accessible immediately in the event of a medical emergency. Refer to the practice General Risk Assessment for further information.
Access to Midazolam is restricted to those team members who are permitted to administer it (IE the Clinical Director) and those who check/verify the contents of the emergency drug kit.
The practice does not transport medicines since they are only used on our site at Malt Mill Lane, Totnes, Devon, TQ9 5NH. Medicines are shipped to the site by our dental suppliers / wholesalers and are removed from the site by licensed waste disposal contractors.
monitoring of stock and expiry dates
General stocks of pharmaceuticals and surgery supplies are checked every month to ensure that all items remain “in-date” at least until the end of the following calendar month. This check is carried out by the Clinical Director’s nurse. Any items that are about to go “out-of-date” are removed from storage and passed to the Practice Director (Neil Phillips), who re-orders the items as necessary and passes any short-dated stock to the surgery team with instructions to use or, if that is not possible/likely, discard the items.
Items kept in the emergency drug kit (which includes our only controlled drug, Midazolam) are checked daily by the Clinical Director’s nurse to ensure that all items listed on the inventory are present, in-date and undamaged / not tampered with. These items are re-checked weekly by the CLinical Director’s nurse, who also carries out double-checks of all records on a monthly basis. Any problems or irregularities are reported to the Practice Director.
These systems are also reviewed and checked regularly by the Practice Director.
disposal
Refer to the practice Waste Disposal Policy for details of disposal of pharmaceuticals.
record-keeping
Since the practice does not store or dispense prescription medicines, the requirements in relation to record-keeping largely do not apply.
The only controlled drug we use is a Schedule 3 drug (Midazolam), so we do not need to maintain a controlled drugs register. Records of controlled drug purchases are kept (in the form of invoices) as part of the normal practice accounting system and are retained for more than 2 years.
Copies of purchase invoices for Midazolam are also kept in the Waste Disposal “Transfer Notes and Consignment Notes” folder, where they are matched to the “Denturing and Disposal of Controlled Drugs” form at the time of disposal so as to keep a complete audit trail of Midazolam from purchase to disposal.
We maintain records of prescriptions issued as part of individual patient clinical records. Furthermore, the administration of any medicines as part of a patient’s treatment (including the use of drugs from the emergency drugs kit, such as adrenaline or Midazolam) is recorded in the patient notes.
Records of monitoring and expiry date checking are kept for at least 2 years.
Records of denaturing and disposal of controlled drugs (IE Midazolam) are also kept for at least 2 years (refer to Waste Disposal Policy).
adverse reactions and events
Adverse reactions to medicines are reported using the Yellow Card Scheme. It is the responsibility of the Clinical Director, Joanne Giddy, to deal with such reports and any team member who is aware of an adverse reaction to medicines must report it to her immediately.
Adverse events, errors and near-misses relating to medicines must be reported to the Clinical Director, Joanne Giddy, who is responsible for investigating any such events and implementing any changes to our procedures that are necessary in order to minimise the risk of them being repeated.
Web version 6: 28.8.2022
Previous web versions: 8.2.2011 (reviewed 26.1.2012; 13.3.2013); 13.4.2013 (reviewed 19.6.2014; 5.6.2015); 5.8.2016; 10.9.2016 (reviewed 1.9.2017; 11.11.2018); 23.5.2019 (reviewed 9.11.2019; 12.8.2020; 18.11.2021)