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Supervised consumption during the COVID-19 crisis

How should you maintain social distancing practices for patients requiring supervised consumption?

Unplanned learning

This article was correct at time of publishing (March 31). To keep up with the latest information please visit our coronavirus hub

In the current COVID-19 focused climate, social distancing is of utmost importance. But there are many situations in which pharmacists and pharmacy staff will find themselves where this feels difficult to implement.

Keep your distance

Public Health England (PHE) recommends individuals in pharmacies – both staff and customers – maintain a distance of at least two metres from each other in order to prevent droplet spread, and states that hand hygiene measures must be followed.

Patients who require supervised consumption in the pharmacy are not excluded from this, and practical solutions will vary according to each individual pharmacy set-up. For example, if the pharmacy has a designated room or counter for supervised consumption, consider how best to maintain distance, perhaps by placing the item on the table, the patient picking it up and then disposing of the container into a waste bag so it is not touched again by the pharmacist.

It is worth contacting the local substance misuse team to see if contingency arrangements have been put in place to manage supervised consumption and daily collections during this unusual time.

Using personal protective equipment

Personal protective equipment (PPE) is only required for close patient contact within two metres, but there may be occasions when it is deemed appropriate to put on the equipment for a supervised consumption patient. PHE advises donning a disposable plastic apron, disposable gloves and a fluid-resistant surgical mask, a stock of which has been supplied to pharmacies. All pharmacy staff should be trained in the correct use of PPE. Waste generated from the use of PPE should be stored securely within a disposable rubbish bag, placed into a second bag, tied securely and kept separately to other waste for at least 72 hours before being put in the usual bin for disposal.

What if a patient who requires supervision is unwell?

Supervised consumption patients who have COVID-19 symptoms should not come to the pharmacy for their usual dose, but instead send a representative to collect on their behalf (this representative should be someone who does not live at the same residence, as anyone living in the same household will also have to self-isolate for 14 days). Supervision is not possible in this instance, so before anything else happens the prescriber should be contacted in order to verify that this change is acceptable. Verbal confirmation from the prescriber is acceptable, but a record of the conversation should be made in some form.

The representative must bear a letter from the patient authorising them to collect on their behalf, and also show identification in order to prove that they are the person named. The pharmacist must be satisfied that the letter is genuine and include information about the individual who has collected on the patient’s behalf in the controlled drugs register and annotate the record, so it is clear that the dose in question has not been supervised in the pharmacy.

Given the isolation period recommended for patients with COVID-19 symptoms or those who are isolating due to suspected exposure, the prescriber should be contacted to work out a suitable arrangement for the duration.

Changes to supervised consumption prescriptions

For those patients under the Change Grow Live service, changes have been made to Medication Assisted Treatment to reduce the risk of their exposure to COVID-19 and to help prevent the spread of infection. If suitable, those who are on supervised consumption will move to unsupervised consumption and will get a two-week take-home supply. Pharmacists will be made aware of this change and will need to inform patients when they collect their prescription. 

Other available resources

The charity Release has created cards that can be printed or downloaded to a mobile phone by those who may need to leave their house to pick up medication or harm reduction equipment. These cards allow patients to demonstrate that the journey is essential as outlined in the government's rules around movement during the COVID-19 outbreak.

References
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