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A British Lourdes Medical Association Statement Issued Feb 2016


Introduction and Context

The British Lourdes Medical Association (BLMA) is an organisation comprising of clinicians involved in the running of pilgrimages to the Marian shrine of Lourdes in Southern France. The members come together to meet and to share good practice. The BLMA is in no way a regulatory or statutory body, nevertheless, the members come from a variety of healthcare backgrounds and together have a wealth of experience gained over many years with widely differing types of pilgrimages caring for the sick. This statement has been produced by the council of the BLMA and selected members, and, we believe, represents one workable approach to the transcription of medication for sick pilgrims away from home in the care of a pilgrimage clinical team.

Transcription of drugs can be defined as the accurate recording of a patients prescribed medication on a medication administration record (MAR) form, to ensure that the medicine is delivered in accordance with the prescription. Where a sick pilgrim cannot take responsibility for self-administration of their medication, due to physical or mental incapacity, the use of a MAR form ensures that there is evidence that their medication has been taken appropriately.

Principles of Transcription on Pilgrimages

1. Pilgrimage clinical teams do not have responsibility for the administration of medicines for members of the pilgrimage other than those registered as sick.
2. Where a sick pilgrim normally competently self administers their own medication, this should be continued where possible. The pilgrim then retains responsibility for the medicines administration.
3. Where a pilgrim is temporarily or permanently unable to assume this responsibility, a MAR form should be used to demonstrate that drug administration during the pilgrimage is compliant with the pilgrim's prescription. Administration of medicines in accordance with the form must be signed for by a designated responsible clinician (registered nurse or doctor).
4. A MAR form should be completed with the details of the prescribed drugs, (including dose, timing and special instructions) prior to the departure of the pilgrimage by the person who is normally responsible for it in the UK. In most circumstances, this will be the responsible clinician in the nursing or residential home.
5. All efforts should be made to ensure that pilgrims requiring MAR forms bring them ready completed on departure from their home location.
6. Under those circumstance where a pilgrim departs on the pilgrimage and neither has the capacity to take responsibility for the self administration of their medicines, nor has a completed MAR form, one should be completed as soon as possible to ensure that drugs are administered appropriately in accordance with the pilgrims needs. It must be recognised that undue delay in completing a MAR form may have unintended clinical consequences.

Transcription of Drugs onto a MAR form by pilgrimage clinicians

1. Transcription differs from prescription in the degree of responsibility assumed by the clinician transcribing the medication.
2. Transcribing is performed so that there is a medical record of administered drugs brought with a pilgrim that have already been both prescribed and dispensed.
3. The prescriber of a medication has legal liability for the content of the prescription, a transcriber is responsible for the accuracy of the transcription, and must therefore normally have seen an original prescription (FP10).
4. If this is not available, the decision to complete a MAR form should be based on an assessment of risk to the pilgrim of not receiving medication, and should normally be taken by the most senior appropriate clinician available. The accuracy of the MAR form transcribed must be confirmed at the earliest available opportunity, if necessary by requesting information from the UK.
5. Any clinician undertaking transcription should have a clear understanding of their responsibilities when transcribing medication instructions accurately. This means they should be registered medical or nursing practitioner, and would normally be those accustomed to transcribing or prescribing in their day to day clinical practice.
6. Good practice would suggest that two such clinical staff should undertake this activity where possible, and that both would sign the initial MAR administration order.
7. Pilgrimages should ensure that those undertaking transcribing of a prescription onto a MAR form are adequately supported to undertake these duties.

Use of this guidance

This guidance is intended mainly for those clinicians involved in the running of pilgrimages who wish to establish safe procedures that their clinical volunteers can follow. It is recognised that pilgrimages from the UK to Lourdes vary enormously in the size, type of sick and clinical support they have, and there will therefore be variation in the way that pilgrimages may wish to use it.

Resources

1. "Good practice in prescribing and managing medicines and devices" (2013), GMC.
2. "Transcribing - Guidance to support the safe and appropriate use of transcribing of medicines information for the purpose of recording administration of medicines in various health and social care environments." (2011) NHS England -East & South East England Specialist Pharmacy Services