SAFE HANDLING OF PRESCRIPTION FORMS FOR DOCTORS AND DENTISTS

STANDARD OPERATING PROCEDURE SAFE HANDLING OF PRESCRIPTION FORMS FOR DOCTORS AND DENTISTS Issue History Issue Version Purpose of Issue/Description of Change Planned Review Date One To ensure robust systems are in place to maximise the security of prescription forms against theft and abuse within Wirral Community NHS Trust 2014 Named Responsible Officer:- Approved by Date Medicines Governance Pharmacist Section:- Medicines Management Quality, Patient Experience and Risk Group Target Audience April 2012 MMSOP26 Medical Doctors, Dentists and Staff involved in the handling of UNLESS THIS VERSIONHAS BEEN TAKEN DIRECTLY FROM TRUST WEBSITE THERE IS NO ASSURANCE THIS IS THE CORRECT VERSION

This main section will be completed by the QGS CONTROL RECORD Title Safe Handling of Prescriptions Purpose To ensure robust systems are in place to maximise the security of prescription forms against theft and abuse within the Trust Author Quality and Governance Service (QGS) and L Knight Impact Assessment Incorporated into procedure Yes No Subject Experts Medicines Governance Pharmacist Document Librarian QGS Groups consulted with :- Medicines Management Group Infection Control Approved Not relevant for this SOP Date formally approved by 2 nd April 2012 Quality, Patient Experience and Risk Group Method of distribution Email Intranet Archived Date Location:- S Drive QGS Access Via QGS VERSION CONTROL RECORD Version Number Author Status Changes / Comments Version 1 N DH standards for safe handling of Status New / Revised / Trust Change 2/16

NAME OF DISCIPLINE: TRUST WIDE OBJECTIVES To ensure robust systems are in place to maximise the security of prescription forms against theft and abuse within the NHS. SCOPE TARGET GROUP (Staff authorised to follow this SOP) CROSS REFERENCE RELATED POLICIES EVIDENCE TO SUPPORT PROCEDURE To cover all aspects of stock control, the stages of ordering, delivery, receipt, storage and distribution of prescription forms and the actions to be taken in the event of loss or theft of prescription forms. Medical Doctors and Dentists employed by Wirral Community NHS Trust who prescribe medicines as outlined by their job description All Members who are involved in the handling of prescription forms This document should only be circulated to members of staff in the target group. Wider circulation may be of use to those who would misuse prescription forms. WCT Safe Handling and Administration of Medicines WCT Health Records Policy Security of Prescription Forms Guidance. March 2011 This document can be viewed at the following web site link: www.nhsbsa.nhs.uk/securitymanagement IT IS THE RESPONSIBITITY OF ALL STAFF TO COMPLY WITH RELEVANT TRUST POLICIES, PROCEDURES AND PROTOCOLS IN CONJUNCTION WITH THIS PROCEDURE PROCEDURE ACTIVITY RATIONALE RESPONSIBILITY 1. Responsibility of WCT It is the responsibility of the Director of Quality and Governance to oversee the handling of prescription forms throughout WCT. The Local Security Management Specialist (LSMS) will be responsible for investigation and advice regarding further action in the event of loss or theft of prescription forms and will liaise with the All health bodies should designate a member of staff with overall responsibility for overseeing the whole process Secretary of state for Health Directions 2003/04 3/16 Director of Quality and Governance LSMS

Trust Counter Fraud Officer All medical and dental practitioners should have regular checks to ensure they are registered with the relevant Professional Council The Head of Service is responsible for monitoring these standards are adhered to within their service 2. Pro-security Culture The theft and abuse of prescription forms is a major problem in the NHS resulting in unsupervised treatment of illness, feeding of addiction, financial loss to the NHS and may contribute to violence and aggression. Prescription forms must be regarded as blank cheques which in the wrong hands would lead to a misuse of NHS resources. They can be stolen from a prescribers bag, car, home or whilst being delivered. Professional advice on general security management matters (such as access control, alarms and CCTV) maybe sought from the LSMS contact telephone numbers: 0151 514 2888 ext 1492 or 07717766162 Email: philip.davies@wirralct.nhs.uk 3. Ordering Prescriptions Prescription forms are requested from Central Operation Mersey (COM) Tel No 296 7000 FAX No 296 7189 by a Member authorised by the service requiring. Orders should be FAXED on headed paper with the spurious code for the service stated, the number of required ( come in packs of 50) and the name of the person to whom the order should be delivered Legal requirement Clinical governance and prevention of fraud To ensure all staff work to reduce the possibility of theft, prescription fraud and follow safe practice The LSMS is trained and accredited in the management of security in the NHS To maintain a clear audit trail that will enable immediate recognition of theft or fraud. Head of Service Head of Service All Medical Doctors and Dentist who prescribe and all Members who are involved in the handling of All WCT staff Member authorised by service 4/16

For any queries regarding prescription orders, contact the Supervisor for Stationery and Stores COM, Peter.mcmullen@centralopsmersey.nhs.uk Tel: 0151 296 7185 All order details must be recorded in the Central Prescription Form Register. Details to be entered in the register are outlined in appendix 1 4. Delivery of Prescriptions The service should be notified in advance of the date of delivery. Prescription forms will only be delivered to the address stated on the prescription by COM by Medical Courier Services (MCS). Prescriptions that are required for doctors or dentists working within the service at a different location must be hand delivered by a Member and signed for Prescription forms must never be put in the post For records kept of internal transfer refer to section 6 5. Receipt of Prescriptions A permanent member of staff must sign acknowledgement of receipt of the prescription order after checking all packaging is sealed and unbroken. The Member will at the earliest opportunity, check the received are as requested and recorded in the Central Prescription Form Register. The serial numbers of the received must then be recorded in the Central Prescription Form Register. For prescription pads, there are 50 to a pad, the first and last number of each pad needs to be recorded. To ensure safe and secure delivery. To ensure safe and secure delivery. To ensure safe and secure delivery. Discrepancies are reported immediately to deter and prevent breaches of security. COM MCS Member authorised by service Member authorised by service 5/16

The serial number on the prescription forms is positioned at the bottom of the form. The first 10 numbers are the serial number (these numbers run in sequence); the last (the 11 th ) character is a check digit and does not run in sequence). All of the above should, as far as possible, always be done away from public/patient view. Ideally, a drop off point for delivery vehicles should be as close as possible to the clinic. If there are any irregularities at delivery stage the driver should be asked to remain on site whilst the supplier is contacted If the forms do not arrive on the due date, the clinic should notify the suppliers of the missing prescription forms. 6.Records Kept at Trust Services The Authorised Member must maintain a record of prescription pads ordered, by recording details in the Central Prescription Ordering Log see appendix 1. All order details should be entered at the time of order and include the date of order. All delivery details should be entered upon receipt of order and include: The date of receipt The name of the person accepting the delivery What was received (quantity and serial numbers) All original orders, delivery notes and any supplied list of serial numbers should also be kept Records of serial numbers must be retained for at least three years. A check of the details of the delivery at the time of delivery will enable enquires to be made at the earliest opportunity. To ensure any discrepancies are seen as soon as possible and can be acted upon. In the event of loss or theft, the record is immediately available so that the police, NHS Security Management Services, The Quality and Governance Service and local pharmacies can be alerted of the relevant details 6/16 Member authorised by service Member authorised by service Member authorised by service

Records of any prescription pads circulated to different bases within the service must be recorded by completing the Log Sheet for Internal Transfer of Prescriptions. All order details should be entered at the time of order and include the date of order. All delivery details should be entered upon receipt of order and include: The date of receipt The name of the person accepting the delivery What was received (quantity and serial numbers) Records of serial numbers must be retained for at least three years. There are also situations where are issued directly to doctors or dentists within a service. For example to doctors or dentists on home visits or for emergency doctors or dentists attending at the weekend. The following should be entered into the register including: To whom they were issued The number of issued The serial numbers of the issued Prescriptions that have been destroyed or returned. To maintain an audit trail To maintain an audit trail 7. Storage of Prescriptions/ Stamps and Security of Computer Prescribing Systems Stocks of prescription forms should be kept in a secure cupboard within a locked room, with access limited to those who are responsible for prescription forms. Keys or access rights for any secure area should be strictly controlled Patients, temporary staff and visitors should never be left alone with prescription forms or allowed into secure areas where forms are stored It is advisable to hold minimum stocks of prescription stationery To aid security This deters criminals from targeting Trust services and reduces the number of forms vulnerable to theft Member authorised by service Member authorised by service All prescribers and all clinic staff who are involved in the handling of 7/16

Prescription pads should not be stamped in advance of them being issued to the doctor or dentist. Clinic stamps should be kept in a secure location separate from prescription forms and to the same standard of security as prescription forms. Single sheet prescription forms, used in printers, should be afforded the same security controls as prescription pads. It is not advisable to leave single sheet prescription forms in printer trays when not in use or overnight When the printers are being replaced or if there is concern over existing arrangements, consideration should be given to fitting a secure device to the printer to prevent theft of prescription forms from printer trays Alternatively the printer should be in a secure part of the clinic, away from areas where the patient has access Clinics should clearly define which staff have access to the system and which staff have access to the functions that generate All staff with access to the computer system must have an individual password, known only to the individual concerned Each member of staff is liable for all medicines ordered in their name Computer systems must have a screen saver facility so that access can be denied and details prevented from being read when the user is away from the desk for a specified period WCT should not store prescription forms for other healthcare providers. 8. Distribution within WCT Services It is more difficult to detect a stolen prescription form that has been stamped with a genuine stamp Single sheet prescription forms are acceptable in handwritten form and this makes them a target for theft and fraud To maintain security and deter offenders WCT are not responsible for the security of other organisation s prescription forms All prescribers and all clinic staff who are involved in the handling of All prescibers and all clinic staff who are involved in the handling of Head of Service in conjunction with All Prescribers All clinic staff who are involved in the handling of 8/16

Doctors and dentists are responsible for the security of prescription forms once issued to them, and should ensure they are locked away when not in use. When making home visits doctors or dentists should take suitable precautions to prevent the loss or theft of forms, such as carrying them in unidentifiable lockable carrying cases and not leaving them on view in a vehicle Doctors or dentists should keep the prescription forms on their person at all times, if in exceptional circumstances prescription forms have to be left in a vehicle, they should be stored in a lockable compartment Doctors or dentists on home visits must record the serial number of any prescription forms they are carrying and only carry a small number. The Head of Service must ensure a system is in place for recording this information 9. Using Prescription Forms Doctors or dentists must keep a record of the serial number of prescription forms issued to them. The first and last serial number should be recorded. A record must be made of the number of the remaining prescription forms in an inuse pad at the end of the working day. Blank should never be presigned. Where possible, all unused forms should be returned to stock at the end of the session or day. If this is not possible prescribers must store prescription forms securely in their own homes. Prescription pads must not be kept in vehicles overnight. To maintain security and deter offenders. This will help to immediately identify any lost or stolen. Prescriptions are less likely to be stolen from locked cupboards. Doctors or dentists All prescribers and all clinic staff who are involved in the handling of 9/16

If an error is made in a prescription, best practice is for the doctors or dentist to do one of the following: (1) put a line through the script and write spoiled on the form (2) cross out the error, initial and date the error, then write the correct information (3) Destroy the form (i.e. shred) and start writing a new prescription. Where are written correctly but later found to be surplus to requirements a record should be made and then securely destroyed ie via shredding and disposal via confidential waste. This should be witnessed by another member of staff. The destruction record should include serial numbers and be retained for a minimum period of eighteen months. There must be an audit trail for prescription forms, so that services know the serial numbers of forms they have received and which have been issued to each doctor or dentist If a doctor or dentist leaves the service, systems must be in place to recover all unused prescription forms In the case of a significant numbers of requiring destruction these should be returned to the Quality and Governance Service to be destroyed in a secure manner. These must be hand delivered and signed for The service must ensure they have in place a robust audit trail, to ensure a prescription can be traced from receipt of the blank form to when it is prescribed or destroyed. 11. Actions to be Taken in the Event of Incidents Incidents involving the loss, theft or misuse of prescription forms must be reported immediately to the Service Manager or the On Call Duty Manager and an incident form must be completed Ensure security systems are effective So that no further can be issued bearing the details of the prescriber in question To initiate investigation 10/16 All prescribers and all clinic staff who are involved in the handling of All prescribers and all clinic staff who are involved in the handling of Medical Doctor or Dentist

in the same span of duty. The incident must be reported to The Head of Nursing, Quality and Governance Service The Accountable Officer for Controlled Drugs, Clinical Director of Quality and Governance The Local Security Management Specialist (LSMS) should be contacted using the Missing/Lost/Stolen Prescription Form see Appendix 3 The LSMS initiates investigation and sends the notification form by e-mail to SecurityManagement@nhsprotect.gsi.go v.uk for input on the national database The LSMS will retain copies of these forms as part of the Trust s audit trail The findings of the LSMS will be shared with the Accountable Officer for Controlled Drugs and the Local Counter Fraud Specialist if required Outside office hours, the On Call Duty Manager must be informed who should contact the police directly Tel: 0151 777 5856 or the main police switchboard 0151 709 6010 Staff must report any concerns about fraud to the Trust s Counter Fraud Officer on 0151 6513879 ext 1592 Alternatively staff may prefer to use the confidential NHS Fraud and Corruption Reporting Line on 08000284060 COM will fax an alert to all pharmacies alerting them of the incident, and informing them that the prescriber will write all prescription forms in a particular colour for a period of two months. The investigation will review any weaknesses or failures that have allowed the incident to occur. To initiate investigation To initiate investigation To investigate and escalate for inclusion on National data base To share information with other NHS bodies and Health Providers via local intelligence networks To report any concerns regarding security of To reduce the possibility of stolen being dispensed To highlight actions that need to be taken to prevent further loss or diversion Service Manager or On Call Duty Manager Service Manager or On Call Duty Manager LSMS Accountable Officer for Controlled Drugs On Call Duty Manager All Trust Staff COM Quality and Governance Service 11/16

12. CLINICAL INCIDENTS Any related incidents arising from carrying out this procedure which may involve a clinical error or near miss must be reported following the Trust s Incident Reporting Policy. To maintain patient safety and comply with Trust Incident Reporting system for effective clinical governance Health professional or delegated staff member EQUALITY ASSESSMENT TRAINING SPECIALIST COMPETENCIES OR QUALIFICATIONS CONTINUING EDUCATION & TRAINING RISK ASSESSMENTS ORGANISATION DEPARTMENT (IF APPLICABLE) During the development of this procedure the Trust has considered the clinical needs of each protected characteristic (age, disability, gender, gender reassignment, pregnancy and maternity, race, religion or belief, sexual orientation). There is no clinical evidence of exclusion of these named groups. If staff become aware of any clinical exclusions that impact on the delivery of care a Trust Incident form would need to be completed and an appropriate action plan put in place All Doctors and Dentists will have a current registration with a Professional Council and appropriately informed of this SOP on induction and when updated As required by Professional Body and appraisal system in the Trust Loss or Theft of Prescription Forms Wirral Community NHS Trust Trust Wide STANDARD OPERATING PROCEDURE APPROVED BY: Peer Review Forum Medicines Management Group Trust Formal Approval Quality, Patient Experience and Risk Group Central Prescription Ordering Log Sheet Appendix 1 Date Amount Ordered Method Amount Date Received Quantity Doctor Date given to 12/16

Ordered Ordered by of Order Received Received by and Serial Numbers or Dentist Doctor/Dentist/ Clinic LOG SHEET FOR INTERNAL TRANSFER OF PRESCRIPTION PADS Appendix 2 13/16

TO ORDER PRESCRIPTION PADS PLEASE SPEAK TO A LEAD DESIGNATED STAFF MEMBER Date Ordered Ordered by - (Initials) Amount Ordered Doctor or Dentist & Location Order Received by (Initials) Quantity and Serials Numbers Stored by Prescriptions Received by (Initials) Appendix 3 Missing/lost/stolen NHS prescription form(s) notification form 14/16

Health body: Wirral Community NHS Trust Contact name: Date reported: Contact telephone number: Contact address: The following numbered NHS forms have been identified to us as lost or stolen: Date of theft/loss Name of person reporting (GP, practice manager, nurse, trust pharmacist) Telephone number Full details of theft/loss (please fill in details below) Include the following information: date and time of loss/theft date and time of reporting loss/theft place where loss/theft occurred type of prescription stationery serial numbers quantity details of the LSMS to whom the incident has been reported. Details of doctor/department/dentist/nurse etc from whom prescription form(s) have been stolen or lost Name Personal dispensing or identification code/number Address Serial number(s) lost or stolen From Details of NHS prescription form type lost or stolen (tick appropriate box) Issue FP10NC FP10HNC FP10SS FP10MDAS FP10HMDAS FP10MDASP FP10MDASS Colour Green Green Green Blue Blue Blue Blue To Please indicate type lost/stolen 15/16

FP10PN FP10CN FP10SP FP10P FP10D FP10PCDSS Lilac Lilac Lilac Lilac Yellow Pink FP10PCDNC Pink * updated current forms in use October 2006 Has this incident been reported to the police? Name and police station of investigating police officer (please fill in details below) Yes No Has an alert and warning been issued to all local pharmacies and GP surgeries within the area? (please tick box) Yes No Please give details of any ink change or security measures and the effective dates of these measures (please fill in details below) Name: Position: Signed: Dated: Return this completed form by email to SecurityManagement@nhsprotect.gsi.gov.uk Use most current version of this form available on the Trust Web Site 16/16