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Medicines that optometrists can order

Pharmacists will have come across requests for medicines that have originated in a local opticians. Although they may be written on headed paper and look bona fide, how can you tell it is all right to supply the medicine? This article discusses the legal and professional issues that need to be considered when responding to requests for a prescription-only medicine.

By Miriam Gichuhi

Is this a valid prescription? 

An authority to supply a POM can only be issued by an appropriate practitioner. A registered optometrist who is not qualified as a supplementary or independent prescriber would not be regarded as an appropriate practitioner so cannot provide a prescription. Panel 1 explains optical healthcare professionals.

Panel 1: Optical healthcare professionals

Ophthalmologists Ophthalmologists — doctors who specialise in eye conditions — are regulated by the General Medical Council. They are often members of the Royal College of Ophthalmologists and may use FRCOphth, MRCOphth or DRCOphth as post-nominals.

Optometrists Optometrists (also known as ophthalmic opticians) will have a degree in optometry or equivalent. Some use the post-nominal MCOptom or FCOptom (member or fellow of the College of Optometrists). There is no post-nominal to indicate whether a person is registered with the General Optical Council. An optometrist examines eyes, tests sight and prescribes spectacles or lenses.
Additional supply and supplementary or independent prescriber optometrists might use the post-nominals DipTpAS (specialist diploma in therapeutics [additional supply]), DipTpSP and DipTPIP, respectively. These optometrists might specialise in treating conditions such as dry eyes, hay fever, glaucoma and iritis.

Dispensing opticians Dispensing opticians fit spectacles and, where qualified, contact lenses. Opticians must also be registered with the GOC and their registration number will start with “D-”.
Dispensing opticians may obtain certain medicines by signed order for use by optometrists or doctors in the optician’s practice (wholesale dealing). They may also obtain lignocaine hydrochloride, oxybuprocaine hydrochloride and proxymetacaine hydrochloride from pharmacies when they practise as contact lens specialists.

An optometrist can, however, issue a signed order — a list or order for medicines signed by the person requesting those medicines.

Only optometrists registered with the General Optical Council (GOC) can issue a signed order . These optometrists are issued with a registration number containing the prefix “01-”. Pharmacists can check registration by using the GOC website (www.optical.org).

Optometrists with supplementary or independent prescribing qualifications will have this information included in their registration records as a specialty.

Supply direct to the patient

Registered optometrists, through a series of exemptions in legislation, have a list of POM medicines that they can sell or supply direct to patients in the course of their professional practice and in an emergency. These exemptions also allow optometrists to provide the patient with a signed order for these medicines, which can be taken to a registered pharmacy for direct supply.

Optometrists who have undertaken additional training and are accredited by the GOC as “ additional supply optometrists” can issue signed orders for an extended range of medicines. Panel 2 lists the current POMs that can be provided on a signed order. Up-to-date lists are available on the Medicines and Healthcare products Regulatory Agency website (www.mhra.gov. uk). Optometrists accredited by the GOC as an “additional supply optometrist” can be confirmed on the GOC register (under “specialities”).

Panel 2: Medicines that optometrists can order

Registered optometrists Pharmacists can supply the following, not for parenteral administration, on a signed order from a registered optometrist:*

  • Eye drops that contain not more than 0.5 per cent chloramphenicol
  • Eye ointments that contain not more than 1 per cent chloramphenicol
  • Medicines containing cyclopentolate hydrochloride, fusidic acid or tropicamide

Additional supply optometrists Pharmacists can supply the following products which are not for parenteral administration on a signed order from an additional supply optometrist:*

  • Acetylcysteine
  • Atropine sulphate
  • Azelastine hydrochloride
  • Dicofenac sodium
  • Emedastine
  • Homotropine hydrobromide
  • Ketotifen
  • Levocabastine
  • Lodoxamide
  • Nedocromil sodium
  • Olopatadine
  • Pilocarpine hydrochloride
  • Pilocarpine nitrate
  • Polymyxin B/bacitracin
  • Polymyxin B/trimethoprim
  • Sodium cromoglycate

Optometrist prescribers Optometrist independent prescribers can prescribe any licensed medicine for ocular conditions affecting the eye and surrounding tissue. Controlled Drugs cannot be prescribed independently. Supplementary prescribers can prescribe medicines under an agreed patient-specific clinical management plan.

* Up to date lists can be found at www.mhra.org

Signed order requirements

A signed order is not a prescription so it does not have to meet prescription requirements. The pharmacist should, however, be satisfied that sufficient information has been given to enable an appropriate supply to be made, and that advice has been provided by the optometrist to enable the patient to use the product correctly.

Typically, the information provided on the signed order would include:

  • A date (because signed orders are not defined in legislation, there is no legal time limit but pharmacists would need to use professional judgement on clinical appropriateness)
  • The optometrist’s name, address and GOC number
  • The name and address of the patient (if applicable)
  • The name of the drug, quantity, pharmaceutical form and strength
  • Labelling directions
  • An original signature of the optometrist

As a matter of good practice pharmacists should label the dispensed product and provide a patient information leaflet.

A record of the transaction should also be made in the POM register.

Citation: The Pharmaceutical Journal URI: 11096711

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