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The following notes augment Chapters 9 - 14 to take account of special needs in the Out-Patient Clinics. The guidelines in this section are intended to apply to all out-patient clinics within NHS Tayside. However, the system for maintaining the security of medicines will need to be tailored to meet particular needs and to reflect specific risks. Areas which have a high degree of public access may need special precautions. Medicines will not normally be supplied for out-patients by the hospital, since clinical responsibility will normally rest with the GP. There may be some circumstances which demand exception to this general principle:
(a)	Where it is agreed between consultant and GP that the consultant shall retain clinical responsibility. Such circumstances may arise from the special needs of the patient or from characteristics of the medicine (e.g. hospital only items, Clinical Trial).
(b)	Where the patient needs to commence therapy before they are able to see their GP. In such circumstances medicines may be obtained from the hospital pharmacy or prescribed using an HBP form, which the patient takes to a community pharmacy. In those circumstances no more than one months treatment must be supplied.
17.1	Out-patient Clinics: The System for Security of Medicines
	Each out-patient clinic shall have a system of procedures to ensure the safety and security of medicines stored in it. Where premises are shared with other clinics, stocks of medicines for each clinic shall be stored separately from the rest - ideally in a separate cupboard, but at least in an identifiable area of the communal lockable storage.
17.1.1	Out-patient Clinics: Liquid Nitrogen
	Liquid nitrogen is a cryogenic liquid which is hazardous and volatile. It is required to be kept in a controlled manner during a clinic and not stored in the department. The Policies for the Sae Use of Liquid Nitrogen must be adhered to.
17.2	Out-patient Clinics: Authorisation for Administration of Medicines
	The written authorisation of a suitably qualified prescriber shall be obtained before medicines can be administered to patients (see also Section 18).
17.3	Out-patient Clinics: Administration of Medicines to Patients
	Administration of medicines to the patient shall be in accordance with procedures contained in this document and will be accomplished in one of two ways: Administration by a Registered Nurse or Practitioner in accordance with a written prescription. Administration by a suitably qualified practitioner in accordance with a Patient Group Direction. Medicines administration by nursing staff shall be in accordance with NMC Guidance - medicines may only be administered by Registered Nurses who have demonstrated their competence for the purpose. For nurses working outwith their speciality (e.g. temporary agency or other locum staff) it is desirable to involve two persons in the administration of the medicine. A record of administration shall be made, and the administering practitioner(s) identified. Medication refused or wasted shall also be recorded. Where a second nurse checks the administration of a medicine, the identity of the checking practitioner shall also be recorded.
17.4	Out-patient Clinics: Medicines for issue to Out-patients
	These are variously known as Out-patient Packs (OP) or To Take Out packs (TTO). In order for a pre-dispensed pack to be issued to a patient a doctor or other practitioner with authority to prescribe these items must write a prescription as usual or the relevant PGD be implemented by an approved practitioner. A signed and dated note in the patient’s medical records is acceptable. In order to make packs available where dosage may be decided by the doctor for the patient, the packs may not carry full dosage instructions. Before issue, any required dosage instructions, the patient’s name and the date must be written on the label and checked against a written prescription with another practitioner. OP packs must carry a label stating which department they have been issued from.