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).
Shared responsibilities
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 surges in acute respiratory infections 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.
Managing stocks of 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).
Staff training
Appropriate staff training and/or refresher training on the management of medical gas cylinders will need to be provided.
Security and storage of medical gas cylinders
The following guidance has been provided by NHS Protect on security advice for staff responsible for the management and use of medical gas cylinders, pipeline systems and vacuum insulated evaporators.
Pharmacy teams and Medical Gas pipeline systems
Pharmacy responsibilities
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.
Quality control
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 other involved in over sight and management of medical gases at times of exceptionally high use 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
Using FutureNHS
A national (English) COVID-19 oxygen information resource has been established on the FutureNHS platform that can be accessed by request. To register, email nhsi.efmportalsubmissions@nhs.net and request access. Pharmacy and QA/QC colleagues can access these resources and others by requesting acces to the Pharmacy and Medicines Optimisation Workspace
The Chief Pharmacist should be aware of current problems and should ensure that information and updates are accessed and actioned as required.
Unresolved concerns should be escalated via the Regional Pharmacy Procurement Specialist or equivalent, in the first instance
Update history
- NHS Protect guidance on security and storage of medical gas cylinders added
- Details of escalation process modified
- Text updated to reflect the context of surges in acute respiratory infections including but no limited to COVID. Title and URL updated.
- Medical gasses are under constant review and article series remains valid. Full content review due 2022, or sooner if National guidance dictates.
- Published