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End of Life COVID-19 Medicines Service to supply Just in Time Emergency Medicine Packs

The End of Life COVID-19 Medicines Service to supply  “Just In Time” emergency medication pack (JEMP) scheme is to be stood down across Wales as of 1 July 2021. The service  was implemented in response to the first Covid-19 surge to improve access to the supply of palliative medicines. The overall approach was intended to reduce uncertainty and delays in securing medicines and increasing the agility of potentially limited supplies (making stock go further).

As the  supply chain for palliative medicines remains robust  a decision has been made to pause the use of the JEMP scheme. Health Boards will continue to support anticipatory prescribing and rapid access to medicines commonly prescribed in palliative care via existing schemes.

Background to the scheme

A new NHS Wales Interim End of Life (EoL) COVID-19 Medicines Service has been developed to provide access to a “medication box” of an agreed list of medication – a Just-In-Time Emergency Medication Pack (JEMP) – through a single point of access to supplement the normal service, with a focus on coverage of out-of-normal working hours during the COVID-19 pandemic.

The Health Courier Service Wales (HCSW) will manage a Single Point of Contact (SPOC), and direct the JEMP request to the most appropriate EoL Pharmacy Hub (EPH) situated at one of five sites around Wales.

The Hub will supply a patient with a JEMP in the following circumstances:
  1. Out of hours where there is a 'need' to supply irrespective of where the patient resides at that time e.g. community or field hospital.
  2. During normal working hours if local service provision cannot access the required medicines in a timely manner.

The service will deliver medication directly to the patient within a 2 hour timeframe from receipt of a request.

Prescription requirements

One of the most common causes of delays for patients and carers in obtaining controlled drugs is prescribers writing prescriptions that do not fulfil legal requirements.

A prescription should be generated to reflect the contents of the JEMP box and must meet controlled drug prescription requirements:

  • Prescriptions for controlled drugs in Schedules 2 and 3 must be prescribed in words and figures
  • The Home Office has expressed the view that a dose of 'as directed' or 'as required' is not acceptable for a controlled drug prescription but '2.5mg to be injected subcutaneously as directed' is acceptable.

Example prescription

The contents of the JEMP

It is not possible to tailor the contents of the JEMP as they are prepared in advance. There can be no substitution and the quantities must be exact. Medication not included within the JEMP cannot be supplied via the End of Life COVID-19 Medicines Service.

There is the possibility of medicine shortages in the future, thus it is important that the prescription is accurate as the content of the pre-packed JEMP may change. The JEMP currently contain the following medicines and quantities:

Medicine Strength Quantity
Morphine sulphate injection 10 mg/ml 10
Midazolam injection 10 mg/2 ml 10
Hyoscine hydrobromide injection 400 mcg/ml 5
Levomepromazine injection 25 mg/ml 5
Haloperidol injection 5 mg/ml 5
Water for injection 10 ml 5

How to access the End of Life COVID-19 Medicines Service

SPOC telephone number: 0300 123 4092 (this phone line is available 24/7; if you are calling between 22:00 and 08:00 you will need to choose Option 3).

Hospify

In order to send a digital image of the prescription to the SPOC, prescribers will need a Hospify account.  Hospify is an app for sending messages and images (like an NHS Whatsapp). It has been designed for use by clinicians to allow encrypted messaging, and NWIS have advised it meets all NHS Wales IG and GDPR requirements. It has to be downloaded from an app store. You have to have an NHS email to be able to register to use it.  Prescribers will need to ‘Add’ Health Courier Service Wales to their connections before they start sending messages.  OOH clinicians can also ask the 111 admin/ shift leads to send the prescription image in their behalf. Further details are available on the above website. 

What is the difference between the Just in case scheme (JIC) and the Just in time (JEMP) schemes?

The JIC scheme places end of life medications in a patient’s home in advance of them requiring these medications, sometimes weeks ahead.  This takes the medication out of the supply chain.
 
The JEMP scheme guarantees that end of life medications can be delivered to a patient within 2 hours of a decision being made that they need them, 24/7. This maintains medications in the supply chain for as long as possible.
 
During the coronavirus pandemic we want to maintain medication within the supply chain for as long as possible which is why the JEMP scheme has been developed.
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