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The Medicines Control Authority of Zimbabwe (MCAZ) licenses industrial clinics to provide dispensing services for employees of a company or companies involved in the retailing, manufacturing, wholesaling, mining, agriculture, commercial (including banking) and tourism industry. The clinics mostly provide services to the employees and/or their dependants. In most instances a qualified nurse or nurses are employed on a daily basis to run the clinics. The nurses therefore diagnose, prescribe and dispense medicines from these clinics. As nurses are currently not prescribers in terms of the Medicines and Allied Substances Control (General) Regulations, 1991, (SI 150 of 1991) (hereafter referred to as “the regulations”) for certain categories of medicines the clinics have employed qualified Medical Practitioners to provide medical services. The Medical Practitioner may therefore be employed on a part-time or full- time basis depending on the clinic’s circumstances and requirements for services. The purpose of these guidelines is therefore to define the responsibilities expected of the medical practitioner and nurse employed at an industrial clinic licensed by the MCAZ. The guidelines will also provide conditions under which the clinics may be licensed.
These guidelines apply to industrial clinics licensed by the MCAZ.
Industrial Clinic: A clinic providing health services to employees and/or dependants of employees of a particular company or a group of affiliated companies. Affiliated companies: more than one company that belong to the same corporate holding or have written contractual arrangements with a common provider of health services.
4. REQUIREMENTS FOR THE CLINIC 4.1 To comply with the requirements of the Regulations or any other requirements set by the MCAZ
from time to time.
4.2 To have opening times which are clearly displayed at all times and indicating the doctor’s attendance
times. 4.3 For a clinic to be licensed it should be intended to provide services to at least 50 persons (i.e. a catchment of not less than 50 persons) excluding contract employees. 4.4 Services to be provided only to employees and/or the dependants of one company or group of affiliated companies. Companies pooling resources to provide clinic services for their employees only are included. Specific clinics with unique settings may be granted authority to provide services
amongst other matters. No PIM. The particular clinic classification will be stated on the premises licence: 4.6 below apply.1 Other clinics except those of affiliate companies.6.2.2 Class B Clinic – where there is a supervising doctor as specified in (5) below – All categories of medicines when the medical practitioner is present.4. The clinics opening times when medicines may be dispensed will be as stated on the premises licence.5. The licensee must therefore indicate the proposed opening times when applying for issue or renewal of a licence. Any nurse to provide locum services must hold a valid person's licence for not more than two industrial clinics or have prior written approval of the MCAZ to provide such locum services for the clinic.2 Holder of a valid unrestricted practising certificate from the Medical and Dental Council Approved by MCAZ as supervising medical practitioner. The Supervising Medical practitioner’s surgery even if they hold valid licences or permits. PP10 or N category medicines to be prescribed or dispensed in the absence of the supervising medical practitioner. indicate the expected beneficiaries (employees only). REQUIREMENTS FOR THE SUPERVISING MEDICAL PRACTITIONERS 5. 4. their numbers and that the clinic will be expected to comply fully with these guidelines. the nurse’s name must appear on the premise’s licence. 5. access to the medicines by those persons not appearing on the clinic’s licence is prohibited particularly when the approved supervisors are not on the premises.5. 5.2 An independently operated clinic that is contracted by more than one company to provide services may be licensed provided evidence of the written contractual arrangements is provided and motivation for approval of the service provision is provided from each company to be provided with the services. Local Authority or Defence forces on a full time basis. The contract must. 4.8 In the case where a clinic is operated on behalf of a company or affiliated companies. Countersigning of prescriptions after the fact is also not permitted except in cases of emergency when the conditions in 5.to dependants. 4. prior written permission from the Secretary for 2 . PP.7 Should the clinic have more than one nurse dispensing medicines from the clinic.1 In the case of a medical practitioner who is employed in the Public Service.4.5. 4.5 The medicines that may be prescribed at an Industrial Clinic will be determined by the MCAZ on the following classification.1 Class A – where there is a supervising medical practitioner all the times that the clinic is open – all categories of medicines 4. be it for a few hours a day. 4. Such approval will not be for a period of more than 3 calendar months after which only permanent supervisors will be acceptable.6 A licenced clinic should not supply medicines for use at any other premises including: 4.3 Class C Clinic – where there is no supervising medical practitioner – only those medicines in the Household Remedy (HR) and Pharmacy Only (P) categories.1 5.
6 184.108.40.206 When the nurse effects the order they should indicate on the dispensing records that it was an emergency and the nature of the emergency.2 The medicines which may be contained in the emergency tray are listed under Appendix I. To ensure proper records are kept for all prescription preparation (including PIM) medicines. Regular stock checks to include checks on validity of expiry dates of the stock in the tray should be done.3 To visit the clinic not less than once a week for a period of not less than 2 hours per visit.1. 5. In cases where he deems the case not of an emergency nature appropriate action must be taken.6. 5.3. In the case of an emergency the Medical Practitioner may order the medicine over the phone on condition he provides a prescription or records his instruction in writing within seven days thereof.1 The tray will be sealed at all times with a temper evident seal. 5. on the basis of the Medical Practitioner’s written instructions (prescription).1 Should the Medical Practitioner fail to comply with the above he will be held liable for all the activities supposedly under his control at the Industrial clinic until or unless the notification is received in writing by the MCAZ. 5.3 In the event of use of medicines in the tray the nurse should advise the Medical Practitioner as soon as possible of such use.2.1 the supervising medical practitioner will evaluate the incident to determine whether it was an emergency. 5. 5.5 5.9.4 5.9.2 If the supervising medical practitioner is satisfied that the event was an emergency he may confirm this on the records. 3 .8 Any Medical Practitioner who knowingly makes a false declaration in any way to the MCAZ that they are the supervising medical practitioner of any clinic will be liable for prosecution. 5.9. 5. The Medical Practitioner may make the availability of an “emergency medicines tray” which may only be used in his absence in an emergency under the following conditions: 5.9 5. To ensure that medicines that require a prescription (including PIM) are dispensed by licensed persons endorsed on the clinics licence only.7 Should the Medical Practitioner cease to be the supervising medical practitioner for that clinic he should notify the MCAZ in writing within seven days of cessation of provision of those services. 5. 220.127.116.11.Health and Child Welfare or respective Director of Medical Services to engage in such practice should be obtained respectively.
2 In case a nurse is granted authority by the MCAZ to supervise more than one clinic the times of attendance will be stipulated on their persons licence.2.1 Access to the medicines is restricted to those people whose names are endorsed on the clinic licence 5. 5.3 The supervising medical practitioner will supervise the replenishment and re-sealing of the emergency tray.1 6. 5.3 The supervising medical practitioner and those other persons with names endorsed on the licence are responsible for reporting to the MCAZ any changes to the conditions under which the licence was issued.2 Licensed with MCAZ to dispense medicines at that particular clinic (valid persons licence) 6.10 There should be a written contract which stipulates the responsibilities of the supervising medical practitioner at the clinic. 5.3.10 and 5.13. The nurse must also have passed the forensic examination for nurses or attended such forensic refresher course every three years as set by the MCAZ from time to time 4 . 5.4.14 A Medical Practitioner may supervise more than one clinic provided the clinics are within reasonable distance to allow for the minimum visiting times indicated in section 5. he may arrangements for another medical practitioner to cover for him provided that: make 5.2 and 18.104.22.168 he complies with requirements of Sections 5.12 Should the supervising medical practitioner be unavailable to provide services..2.6. 5.12.4 above. 5. 5. any deviations (intended or otherwise). 5.11 of these guidelines 5.5.11 The supervising medical practitioner should not attend to other patients who are not employees or dependants of the company from the clinic except in an emergency.22.214.171.124.13 The supervising medical practitioner should ensure that medicines are only handled by approved and qualified persons and compliance with these guidelines and relevant statutes are adhered to. 5.1 Holder of a valid unrestricted practising certificate from the Nurses Council 6. 5. 5.3 6. REQUIREMENTS FOR THE NURSE 6.5.1 The contract should be available for inspection by inspectors of the MCAZ.126.96.36.199 The contract should stipulate that the supervising medical practitioner is available to provide medical services in emergencies at times other than those indicated in sections 4.10.2 the period of absence is not more than three calendar months in which instance prior written approval should be sought from the MCAZ. Loss of medicines due to theft must be reported to the MCAZ and the Police within twenty-four hours.9.
5 Should the nurse cease to be employed at that clinic the nurse should notify the MCAZ in writing within seven days of cessation of provision of those services and ensure that the employer does so too.5. in appropriate containers and under appropriate conditions of Good Dispensing Practice. APPENDIX I EMERGENCY TRAY MEDICINES FOR INDUSTRIAL CLINICS 5 .6.1 To dispense only those categories of medicines stipulated on the clinics licence.2.3 Transition to full compliance – those nurses that already hold valid person’s licences should attend a course and an examination as specified in 6. 6.1 Should the nurse fail to comply with the above they will be held liable for all activities supposedly under their control until or unless the notification is received in writing.3 To ensure that medicines are dispensed by those persons appearing on the clinics licence only 6. 6. 6.7 To conduct regular stock control of all medicines the nurse dispenses. 6.3. administers.6 To ensure that only registered medicines that are procured only from sources approved by the MCAZ are used at the premises and adequate records of use are kept. 6.2 above within three years of the effective date of these guidelines (1st June 2002) 6.2. disposes of.4 In the event of an emergency and the Medical Practitioner makes a verbal order to the nurse for medicine to be made available to a patient.8 To ensure that medicines are dispensed with the appropriate labelling. the nurse should indicate on the dispensing records that it was an emergency and the nature of the emergency. 6.