The pharmacy remit and medical gases
Medical gases are medicinal products
As organisational leads for medicines, the Chief Pharmacist within each Trust or Health Board is responsible for the safe supply, storage, prescribing and administration of medicines across their organisation.
For pharmacy teams, a key resource for information on responsibilities, is the NHS Pharmaceutical Quality Assurance committee, operating under the auspices of Specialist Pharmacy Services (SPS).
Due to the engineering elements associated with the safe supply of these medicines, medical gases also come under the remit of Estates departments. It is essential that the Chief Pharmacist develops strong and sustained working relationships with their Estates Directors & teams. Increased oxygen demand, resulting from the COVID-19 pandemic, presents significant challenges in terms of safety and continuity of supply to meet patient needs. EFA alert NHSE/I-2020/003 issued November 2020 describes actions to be taken to mitigate and manage risk to patient care.
Pharmacy teams supporting the management of cylinder stock
Pharmacy procurement teams are responsible for, or should have a close involvement with, the ordering, stock management and safe use of medical gas cylinders.
Ordering, supply and return
Ensure that there are instructions for ordering, supply and return of cylinders from wards and departments in place. It may be necessary, if not already undertaken, to carry out a process mapping exercise for cylinder ordering, delivery, intra-site movement and return to the supplier. This should ensure that cylinder processes are efficient and do not create systems whereby cylinder stocks are excessive or not held in suitable locations.
Checking expired and empty cylinders
A check for expired and empty cylinders is essential so that these cylinders are returned immediately to the supplier for re-filling. Efficient cylinder turnaround is good practice under normal working situations but is essential during the pandemic. As with other medicines, clinical areas should only hold the number and size of cylinders as absolutely necessary (in accordance with agreed stock list).
Appropriate staff training and/or refresher training on the management of medical gas cylinders will need to be provided.
Pharmacy teams and Medical Gas pipeline systems
These systems are not solely an estates and engineering issue.
Whilst the maintenance of physical pipelines is an estates/engineering responsibility, the contents of the pipework remain a medicinal product and come under the responsibility of the Chief Pharmacist.
Whenever work is carried out on a medical gas pipeline system, there is a risk that the medical gas quality is compromised. This could be through contamination of the pipeline or cross-over of pipeline systems leading to contaminated or the wrong gas being delivered to patients. Therefore robust systems of quality control need to be in place to ensure medical gas quality is maintained.
A multidisciplinary approach
It is essential that there is a multidisciplinary approach taken to all aspects of medical gas provision. Chief Pharmacists (or a senior deputy) must ensure that the organisation’s Medical Gas Committee and any additional pandemic response groups fully understand that medical gases are medicines and their safe procurement, storage, prescribing and administration comes under the responsibilities and accountability of the Chief Pharmacist.
Escalating oxygen and other issues nationally during the pandemic
With the activation of the national Emergency preparedness, resilience and response (EPRR) structures an Oxygen and medical gases ‘cell’ has been established. This is accessed through your local EPRR process into the regional and then national systems.
A national (English) COVID-19 oxygen information resource has been established on the FutureNHS platform that can be accessed by request. To register, email firstname.lastname@example.org and request access. Pharmacy and QA/QC colleagues can access these resources.
The Chief Pharmacist should be aware of current problems and should ensure that information and updates are accessed and actioned as required.
Escalation Process and Contact Details
The current issue escalation process and contact details are represented diagrammatically below.