When prescribing for new patients, do I need to do a physical examination in person, or can this be done via a virtual consultation?
15 October 2020
The MCNZ Guidance Good Medical Practice states the following at Paragraph 10:
‘Before prescribing any medicine for the first time to a patient, Council expects you to have an in-person consultation with the patient. If that is not possible because of exceptional circumstances, consider a video consultation with the patient or discuss the patient’s treatment with another New Zealand registered health practitioner who can verify the patient’s physical data and identity.’
The footnotes clarify what is meant by ‘exceptional circumstances’: Examples of exceptional circumstances include the urgency of the clinical situation or the unavailability of a doctor.’
It is understood that the Global Pandemic would also constitute ‘exceptional circumstances’.
Please note that the footnote continues:‘It is good practice to document in the patient’s clinical notes, the mode of the consultation and the reasons for not conducting an in-person consultation before prescribing any medication for the first time to a patient.’
What are the guidelines concerning monitoring patients on Clozapine if we move to higher Alert levels?
15 October 2020
The COVID pandemic changes the risk benefit balance of monitoring patients on clozapine.
Discontinuing clozapine, especially abruptly, creates significant risk of relapse or exacerbation of severity of illness and needs to be avoided.
The Ministry of Health’s Technical Advisory Group recommends the following:
1. The frequency of ANC may be reduced to every 3 months, with dispensation of up to a 90-day supply for people fulfilling all of the following criteria:
- continuous clozapine treatment for > 1 year
- have never had an ANC < 2000/µL (or < 1500/µL if history of benign ethnic neutropenia)
- no safe or practical access to ANC testing
Decisions about ANC monitoring for patients on continuous clozapine treatment for 6–12 months may be made on a case-by-case basis. Irrespective of ANC monitoring, patients on clozapine should continue to receive regular clinical assessments of mental state and review of potential adverse drug reactions, either face-to-face or through telehealth consultations. For patients being initiated on clozapine, adherence to current country-specific protocols for ANC monitoring is suggested for the first 6 months of treatment.
2. For patients on clozapine with any symptoms of infection (including those reported for severe acute respiratory syndrome coronavirus 2 [SARSCoV-2], such as cough, fever and chills, sore throat or other flu-like symptoms), an urgent physician assessment including a complete blood count (with ANC) should be obtained. The clinical assessment could take place either in person or by telehealth based on local protocols.
3. If patients on clozapine become symptomatic with fever and flu-like symptoms, the emergence of signs and symptoms of clozapine toxicity may require clinicians to reduce the dose of clozapine by as much as a half. Continue the lower dose until 3 days after the fever has subsided, then increase clozapine in a stepwise manner to the pre-fever dose. Where available, clozapine levels help facilitate clinical decision-making, particularly after substantial dosage change, inadequate response or unexpected adverse effects.
How long can I write a prescription for and what are the restrictions on medicine dispensing?
Last updated 15 October 2020
From 1 August 2020, pharmacists will be able to dispense three months’ supply of most medicines.
Some restrictions will continue - medicines that were on monthly dispensing before 27 March 2020 will continue to be dispensed monthly. This includes paracetamol.
View more information on the PHARMAC website.
Do I have to sign my prescriptions?
15 October 2020
A current Director-General of Health waiver under the Medicines Regulations 1984 allows unsigned prescriptions if the all the following conditions are met:
- the prescription does not include Controlled Drugs (Class A, B or C) but can include an exempted drug or partially exempted drug as defined by the Misuse of Drugs Act 1975
- the prescription is a NZePS barcoded prescription
- the prescription is scanned and downloaded at a community pharmacy.
- the system that generates the prescription has been authorised by the Ministry of Health for Signature Exempt Prescriptions. The following systems have currently been certified to pilot this capability:
- MedTech32, MedTech Evolution