Richard Hough and Thorrun Govind examine the medicines regulations that helped pharmacists support their patients during and after the CrowdStrike outage…

Some of the biggest airlines, TV broadcasters, banks and other essential service providers ground to a standstill recently as a massive IT outage caused chaos across the globe.

The CrowdStrike outage occurred on July 19 with millions of Windows systems failing and subjecting its multitude of users to the infamous blue screen of death.

The ability for GPs to send prescriptions electronically was also severely impacted, and patients’ continuity of care was jeopardised.

As is frequently the case in healthcare crises, pharmacy and pharmacists went above and beyond to ensure that, despite GPs’ temporary inability to send out electronic prescriptions, patients continued to receive their vitally needed medicines.

Pharmacists are sometimes called upon by members of the public to make an emergency supply of medicines. The Human Medicines Regulations 2012 (HMR) allows certain exemptions in respect of the lawful supply of prescription-only medicine requirements in order to enable pharmacists to make an emergency supply.

In the case of the CrowdStrike outage, numerous patients attended their pharmacy with no valid prescription for their required POMs and sought support from their pharmacist in order to ensure continuity of supply.

In order to make a supply in such circumstances, pharmacists need to be aware of the applicable law and the restrictions surrounding it. Emergency supply at the request of a patient pursuant to Regulation 225 of the HMR.

Firstly, despite what many patients may assert to the contrary, you are not making “a loan” of the POM.

Secondly, any such supply is at the discretion of a pharmacist and the pharmacist must interview the person requesting the POM. In order to make the emergency supply, the pharmacist must be satisfied:

-     - that there is immediate need for the POM to be sold or supplied and that it is impracticable in the circumstances to obtain a prescription without undue delay;

-     - that treatment with the POM has on a previous occasion been prescribed for the person requesting it; and

-     - as to the dose that it would be appropriate for the patient to take.

Thirdly, just because the patient’s GP surgery is open does not necessarily mean that a pharmacist must refuse an emergency supply at the request of a patient.

It is also important to note that if the referral has come via NHS 111 as part of the Pharmacy First scheme, this does not automatically indicate that an emergency supply is appropriate: that is for the pharmacist providing the service to determine.

With any request for an emergency supply, you must consider the best interests of the patient. However, only a few controlled medicines can be provided in an emergency, such as those for epilepsy and only up to five days’ supply can be given.

Many controlled medicines, such as morphine or diamorphine, cannot be supplied at the request of a patient without a prescription by a pharmacist in an emergency.

It would therefore be appropriate to signpost the patient to a prescriber but also to consider their current presenting state and to highlight what they should do if they worsen.

Up to 30 days’ supply of a POM may be made, except for phenobarbitone or a Schedule 4 or 5 controlled drug. Pharmacists should use their clinical judgement to supply a reasonable quantity that will last until the patient can see a prescriber to obtain a further supply.

In many cases, this may be less than the maximum quantity allowed under Regulation 225.

An entry must made in the pharmacy record kept under Regulation 253 within the time specified in that regulation stating the particulars required under paragraph 4 of Schedule 23.

Usual labelling requirements apply together with an additional requirement to add the words “Emergency Supply” to the dispensing label.

Emergency supply at the request of a prescriber pursuant to Regulation 224 of the HMR.

If a prescriber cannot provide a prescription quickly enough, a community pharmacist may be able to issue an emergency prescription at the request of the prescriber.

However the prescription cannot be issued if it is for a controlled drug specified in Schedules 1, 2, or 3 of the Misuse of Drugs Regulations 2001, except for phenobarbital or phenobarbital sodium for the treatment of epilepsy.

Community pharmacists should make a record of the supply in the pharmacy record and the prescriber must supply a prescription to the pharmacy within 72 hours.

Law and ethics

There is no doubt that managing requests for emergency supplies can be tricky. Whether at the request of a patient or a prescriber, a record of the supply is required. It is also prudent to keep a record of why a supply was considered inappropriate as well as any other advice regarding escalation.

Pharmacists should also consider the medical consequences of not supplying a medicine in an emergency.

Richard Hough is a partner and head of healthcare at Brabners LLP and a former pharmacist. His co-author Thorrun Govind is a solicitor at Brabners, a pharmacist and TV health expert.