Medicines management in sport - keeping athletes safe
For many years medicines have been part of the armoury of medical departments in sports teams and sports organisations. In some circumstances these are handled appropriately, but in some others they are not, and although this has (as far as we know) not resulted in serious harm to an athlete, there are those who feel that it is just a matter of time before a serious incident occurs.
Medicines Management is defined as, “The entire process by which medicines are selected, procured, delivered, prescribed, administered and reviewed to optimise the contribution they make to produce informed and desired outcomes of patient care”.
Historically, because there are very few professional clubs with full-time doctors employed, it generally falls to the physiotherapist to be the one who issues medicines to athletes, and often to management staff as well. This is acting outside their scope of practice, and is in direct contravention of advice from the Chartered Society of Physiotherapy. Additionally, the following are issues that need to be addressed in a sport setting:
- If a prescriber has authorised supply of a medicine to an athlete, there needs to be written evidence of the doctor’s authorisation to the physiotherapist to issue medicines, and this is rarely the case;
- Poor recording: Records are often not kept of who gets what medicines – this prevents reviews of prescribing practice;
- Poor storage & security;
- Unable to monitor and keep track of stock levels of medicines;
- Cannot audit or review practice effectively;
- Policy on Controlled Drugs;
- Policy on unlicensed medicines, and “Off-Label” use of licensed medicines.
Admittedly, the very nature and urgency of life in elite sport environments can make the achieving of the above quite challenging, but there are many improvements that can be made without too much inconvenience, effort or major changes in work practices.
Most sports teams and governing bodies are not registered with the Care Quality Commission, the UK Regulatory Body for all healthcare provision in the UK (whether NHS or Private). The requirement for registration depends upon whether registerable activities are carried out at the healthcare provider, and “treatment of disease or injury” is one of the criteria for registration. The CQC regulate via the provisions of the Health & Social Care Acts, 2008 & 2012, and CQC Outcome 9 refers to Regulation 13 of The Act which is concerned with management of medicines. It states “Management of medicines ………by means of “clear procedures, followed in practice, monitored and reviewed for medicines handling that include obtaining, safe storage, prescribing, dispensing, preparation, administration and disposal”
There is a specific exemption from registration for Occupational Health Schemes (OHS), and in a team scenario, (and only where staff receiving healthcare are employed by the club or organisation), it could be claimed that the healthcare provision is via an OHS. However, this is not an excuse for not developing policy and procedure documents – there is a Royal College of Physicians voluntary code of practice for Occupational Healthcare Schemes which affirms the need for the same documentation.
In addition to the CQC, Accountable Officers for Controlled Drugs at local Primary Care Trusts are targeting sports clubs and organisations as possible repositories for Controlled Drugs, and have been conducting inspections.
It is clear that there are risks attached to medicines handling, and by consideration being given to production of, adherence to, and review of such policies and procedures, particularly for record keeping, storage and doctor authorisation, these risks can be reduced, particularly for many physiotherapists whose current situation leaves them medico-legally vulnerable.
The risks that exist are manifold. First and foremost has to be the health and well-being of the athlete, and with the volumes of analgesics and non-steroidal anti-inflammatory drugs used in sport, both long and short-term health of the athlete can become compromised very easily. By its nature, sports medicine and illness of athletes can frequently lead to quite aggressive drug interventions in order to try to hasten recovery to achieve performance deadlines. This can result in medications such as antibiotics being used more quickly than they might be amongst the general population, both to speed up an athlete’s recovery, and to try to limit the spread of an infection amongst colleagues.
Additionally there are the risks to medical staff of potential prosecution under the Medicines Act 1968 and its “descendant”, The Human Medicines Regulations 2012, and disciplinary action by the regulators for doctors (the General Medical Council) or for physiotherapists, (the Health Care Professionals Council), as well as potential financial or other penalties against the clubs or organisations. Also, there is the ever-attendant threat of unwanted media attention that teams or sport organisations could suffer from an untoward therapeutic drug-related incident.
Outside of this, if a player or athlete suffered a career-impacting injury as a result of such an incident, the club would find its defence weakened if they were not able to provide evidence to show that proper drug management policies were in place and had been followed. The litigious environment of professional sport could result in action brought by the athlete’s representatives or family.
Encouragingly, a number of teams, governing bodies and sports organisations are taking the situation seriously, and have already put into place not only these medicines management policies, but also ongoing audit and review of medicines handling practices, and staff training to establish competencies in the area of medicines management. Those using electronic medicines tracking software are able to produce medicines usage reports. These aid practice review, and additionally using software to record medicines issued can a) provide a stock management and re-order facility and b) provide a list of recently taken medicines at the touch of a button for athletes selected for drug testing.
The tide is undoubtedly turning for the better as more and more doctors and physiotherapists in sport are gaining clarification of their responsibilities, but there is still a way to go.
