Halliwell Midnight Pharmacy (1099351) - Improvement action plan

The pharmacy’s risk assessments do not identify all of the risks associated with the prescribing service. In particular, the pharmacy does not effectively manage the risks in relation to the supply of asthma, weight loss and anxiety medication.

After a further medical review, treatments for Propranolol, Diabetes Mellitus, Hyperlipidaemia, Hypertension, hypothyroidism and Asthma( all corticosteroid inhalers) have been indefinitely suspended from the online service as of 30/06/2022

The medicine risk assessment tool which has been developed shall be further assessed and developed. This assessment will comprise of product and prescribing risks and how it is mitigated and managed.
Some of the pre-listing assessments will include – Risk assessment findings and recommendations from assessors.
Recommendation for Online Prescribing.
Further Audits or Reviews will be required.

The pharmacy is not able to demonstrate that sufficient safeguards are in place to make sure the medicines it supplies through the prescribing service are clinically appropriate. It does not effectively verify the information provided by the person completing the online questionnaire, or share all relevant information with the patient's regular doctor or ensure that effective monitoring is in place. This is of particular concern when supplying medicines for chronic conditions such as asthma, weight loss and anxiety, when monitoring is crucial.

After a further medical review, treatments for Propranolol, Diabetes Mellitus, Hyperlipidaemia, Hypertension, hypothyroidism and Asthma ( all corticosteroid inhalers) have been indefinitely suspended from the online service as of 30/06/2022

The question pertaining to eating disorders has been amended to “Are you suffering from or have previously suffered from any eating disorders such as Anorexia Nervosa? Please provide more information, including as much detail as possible. “ This additional safeguard is in place to make sure the medicines supplied through the prescribing service are clinically appropriate.

We shall request evidence of the patients weight. Before a supply is considered evidence of patients weight will be required.

We shall share results of the Saxenda consultation with the patients registered GP.

We shall implement a video consultation options. A meeting with the developers concluded that this feature may take 6 months to put into place. This is due to the technical changes required to make the video feature possible.

We manage additional risks via 3 ways
(Waist hip ratio, waist-height ratio and BMI, all of which are deemed appropriate measurements for assessing cardiovascular health risk.

Saxenda 12-week Assessment tool will be further developed, After 12 weeks the system will automatically flag that the new order request requires a weight review, the BMI will be clearly stated and require an assessment to see if 5% weight loss has been achieved as per criteria.

The prescriber will request waist to hip ratio as an additional assessment where required.

Some of the bugs highlighted on the BMI tool are in progress to be fixed. Only a small number of patients were affected by this bug. It was due to patients using an out of date version of the web browser. For now, we have mitigated this risk by prompting the customer to update the version of the browser before they can commence further.

Asthma reliever only!
The minimum reorder limit is 28 days per inhaler for all reliever inhalers. The maximum allowed per prescription is 2 inhalers. The system has an inbuilt reorder limit system which identifies early orders.

SCR checks will be mandatory for any patients who request reliever inhalers. If there is no SCR record, evidence will be required such as a repeat medication slip or GP/Specialist letter.
This is a safeguard to confirm asthma/COPD status and any inhaler therapy.
For reliever inhalers, it will be mandatory to provide GP details. If a supply is made, an email will be sent to the GP.

Annual monitoring of reliever inhalers is required. The system will flag a 6-month and 12-month assessment to be conducted.

Online health care is rapidly growing, Prescription Doctor shall continue to look at new ways to make their online health care A safe environment for professionals and patients.