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 Mixing of medicines
It is common practice for healthcare professionals to mix one or more medicines together before administration to a patient. This is permissible under medicines legislation where one product is a vehicle for the administration of another. However, mixing two licensed medicines where one is not a vehicle for the administration of the other, results in a new, unlicensed product being produced.
Prior to recent legislative changes, the law restricted mixing practice to:
- Doctors and dentists mixing medicines and then administering to a patient
- Pharmacists mixing medicines to the specification of a doctor or dentist
- Holders of a manufacturing licence.
Following consultation by the Medicines and Healthcare products Regulatory Agency (MHRA), and recommendations by the Commission on Human Medicines (CHM), medicines legislation was amended to now enable doctors and dentists to direct others to mix. In addition, nurse, midwife and pharmacist Independent Prescribers can now mix medicines themselves and direct others to mix for the purpose of administration to an individual patient. These changes also relate to Supplementary Prescribers provided the mixing of medicines is included in the Clinical Management Plan relating to the treatment of an individual patient.
The legislative changes do not yet extend to controlled drugs, although work is in hand with the Home Office to ensure that this is incorporated. In the meantime, existing good practice should continue in relation to mixing of controlled drugs based on the MHRA's existing statement, of which the Home Office are aware.
To accompany the changes in legislation, the Department of Health (DH) has published a series of guidance points which promote safe practice for the benefit of patients within the context of the legislative changes, please click here to view.
 At the request of DH, the NPC has produced an accompanying resource, which is available to download here, to help organisations and practitioners understand and implement these changes. It is not intended that this document should replace any generic guidance or professional codes of conduct from the professional regulatory bodies, but rather be read in conjunction with them.
The NPC has produced the following e-learning materials to support individuals involved in the mixing of medicines:
Workshop 1 – for prescribers
This presentation provides guidance to prescribers on the recent legislative changes supporting the mixing of medicines and accompanies the written guidance.
Workshop 2 – for those mixing medicines
This presentation provides guidance to those professionals who are likely to be mixing medicines in clinical practice. It focuses on the recent legislative changes supporting the mixing of medicines and accompanies the written guidance.
Quiz
Test your knowledge on the legislative changes by answering the questions in this quiz
Podcast
Duncan Jenkins, who has been working with the NPC on the guidance to support the legislative changes relating to the mixing of medicines, talks to Jonathan Mason, who is the National Clinical Director for Primary Care and Community Pharmacy at the Department of Health and also the Head of Prescribing and Pharmacy at NHS City and Hackney, about the mixing of medicines.
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