Steve Simbler MRPharm.S – Medicines Management in Sport – Injury Rehab Network Event

The first Injury Rehab Network event of 2023 featured Steve Simbler, Pharmacist and Managing Director of Meds on Track.

Steve’s presentation discussed medicines management in sports. One hundred and ten sports medicine and rehabilitation professionals from the UK and worldwide joined live for Steve’s presentation, which included information and advice for sports rehabilitation professionals about all aspects of the management of pharmaceutical items in sports.

The recording of Steve’s presentation is available to watch here

Steve Simbler MRPharm.S (Meds On Track)

Steve Simbler has worked as a pharmacist in elite sport for over 20 years, initially in a supply capacity, and for the past ten years in providing medicines management consultancy and software to teams in the Premier League and English Football League as well as national governing bodies for football, rugby, athletics, tennis, cricket, rowing, and cycling amongst others.

Steve was one of the lead pharmacists for the London 2012 Olympic and Paralympic Games, then again for the London 2017 Athletics and Para-Athletics World Championships. In 2015 Steve was the pharmacy advisor for the Rugby World Cup. Steve is a member of the British Cycling Clinical Governance Committee.

In 2006, sports doctors approached Steve to advise them on obtaining a reliable source of vitamin D that could pass tests for WADA-prohibited substances. This prompted an association with Synergy Biologics, makers of Pro D3. Steve continues to work with them, heading up their sports division, and has a special interest in vitamin D and its benefits, especially in sports.

Since 2016, Steve has been a pharmacist panel member for the General Pharmaceutical Council’s Fitness to Practise Committee and now works part-time as a clinical pharmacist in a GP practice.

Medicines Management in Sport

Steve’s presentation, “Medicines Management in Sport”, provided insight into Steve’s work as a sports pharmacist, information and advice to improve how medicines are handled.

Steve commenced his career as a Pharmacist by running his own pharmacy business. From this, Steve started a business supplying pharmaceutical items and medical consumables to sports teams. During this time, Steve became aware of how medicines were often poorly managed by sports teams and their medical staff. This led Steve to start Meds on Track, where Steve helps sports teams and organisations to improve how medicines are handled through a combination of consultancy and advice and software to assist with recording and auditing.

Steve Simbler, Elite Sports Pharmacist

Steve has gained experience as a lead pharmacist at several major sports events and works with elite sports organisations as follows:

• London 2012: Steve was one of the lead pharmacists for the London 2012 Olympic and Paralympic Games, where he worked as part of the organising committee and throughout the games in venues, the athlete’s village and at the polyclinic pharmacy.
• Rugby World Cup 2015
• London 2017 – World Athletics Championships
• General Pharmaceutical Council: Steve works on the Fitness to Practise Committee, where he is regularly involved with hearings and regulatory matters.
• British Cycling Clinical Governance Committee
• Commonwealth Games 2022

Documentation, Documentation, Documentation

Steve started his presentation by asking practitioners to consider if they have documented answers to a series of questions in relation to:

• Medication storage
• Ordering, managing and disposing of medicines
• Persons responsible for and authorised to order and manage medicines
• Who can administer medicines?
• The recipients of medicines
• Duration of treatments
• Policy and advice/ guidance for athletes about over-the-counter (OTC) medicines
• Different types and classes of drugs – POMS, Ps, GSLs and Controlled Drugs (CDs)
• Unlicensed medicines and off-label use of licensed medicines
• Therapeutic Use Exemptions (TUEs)
• Procedure for non-compliance with policies and procedures
• Tracking, record keeping and audit of medications
• Stock checks
• Risk assessments

Steve’s advice for sports medicine and sports rehabilitation practitioners is to have good documentation with policies and procedures in place to address all the above. Practitioners should recognise and report mistakes early and never try to cover up mistakes.

Medicines Management

Steve provided a definition of medicines management as follows:

“The entire process by which medicines are selected, procured, delivered, stored, prescribed, administered, disposed of and reviewed to optimise the contribution they make to produce safe, informed, auditable and desired outcomes of patient care.”

Steve described the processes associated with medicines management, including patient needs/ requirements, ordering/ supply, recording and stock. All processes require documentation supplemented by incident reporting, adverse reaction reporting and medicines disposal.

Steve discussed how medicines handling is subject to legislation and regulations, including:

• Medicines Act 1968 (and Human Medicines Regs 2012)
• Misuse of Drugs Act 1971 (and further Controlled Drugs regs post-Shipman)
• Health & Social Care Act 2008

Legal and regulatory responsibility lies with the Care Quality Commission (CQC), Controlled Drugs (CD) Accountable Officers (NHS) and Police CDLO, and professional body regulators such as GMC and HCPC.

Steve described how healthcare professionals should follow guidance issued by healthcare regulators for handling, prescribing, and managing medicines. Failure to follow guidance can lead to a disciplinary proceedings brought about by regulators.

Physiotherapists and Medication in Sport

Steve discussed the role of physiotherapists in medicines management and described how physiotherapists can give medicines advice, supply, and administer medicines to patients under either a Patient Specific Direction (PSD) or Patient Group Direction (PGD).

Steve discussed some of the issues that sports physiotherapists may face, with many linked to cultural norms and habits in sports teams. For example, players/ athletes may expect medicines, and with few full-time doctors based at clubs, the responsibility/ expectation often lies with the physio. Steve provided a cautionary note that if there is no written PSD or PGD, it is illegal for physiotherapists to administer medicines.

Steve discussed the subtleties of terminology and how physiotherapists may ‘administer’ medicines according to PSDs or PGDs but not ‘prescribe’ or ‘dispense’ medicines. Steve noted that physiotherapists can undertake further training to become independent prescribers, but even then, their scope of competency should be carefully borne in mind, as well as the recommendation that prescribers themselves should (wherever possible) have someone else on hand to administer the medications.

Record Keeping

Steve discussed the importance of record keeping in medicines management and the need for records to support an audit trail of:

• Medicines administered
• Patient details
• Safety information e.g., side effects
• Prescriber authority to non-doctors
• Dates administered and clinical justification
• Medicines stock control

Audit and Risk Assessment

Steve considered areas of audit to enable an analysis of medicines usage:

• By medication
• By patient
• By therapeutic category

Steve described the key areas of risk assessment in medicines management, including:

• Storage, security (at the club and for travel), stability, e.g., temperature control
• Remote consultation/ authorisation
• Record keeping
• High-risk medications

In combatting doping in sports, Steve discussed the role of the General Medical Council (GMC) in investigating any incidents where sports doctors have failed to properly record the medicines they are supplying to their athletes.

Steve discussed some of the primary risk areas and threats which relate to standards of storage (at the club and for travel), no prescriber authority (appropriate qualifications and training), no audit of medicines usage and no written policies and procedures.

Risk Factors

In addressing risk factors, Steve described how there should be a clear understanding of the scope of practice, permissions and responsibilities. Therapists in sports often give out medicines, but should they? Steve discussed how Controlled Drugs (CDs) are high risk due to possible dependence, abuse and misuse. Therapists should therefore have an awareness of what constitutes a controlled drug as they cannot afford to contravene the Misuse of Drugs Act.

Steve discussed the need to be vigilant around the unlicensed and off-label use of medicines. Healthcare professionals should clearly explain the dosage and side effects of medicines to athletes.

When travelling, medicines should be stored and kept in safe custody by responsible persons. Steve reiterated the importance of record keeping and how records must be accurate, auditable and contemporaneous. In particular, Steve stressed the importance of maintaining the stability of medicines and the dangers of medicines spoiling if kept in a car on a warm day.

The final point Steve discussed was around risk factors associated with over-the-counter (OTC) medicines. People are often only concerned with prescription medicines. Steve warned of potential risks associated with the dosage of OTC medicines, where the therapeutic dose can easily become toxic. Steve described how NSAIDs can cause gastrointestinal side effects. OTC medicines also have the potential for inadvertent Anti-Doping Rule Violations (ADRV). Some OTC medicines also contain Opioids.

Threats

Steve discussed how the risk factors above can lead to resultant threats to:

• Athlete safety and wellbeing
• Litigation and regulatory scrutiny against the club or organisation
• Criminal or disciplinary action against healthcare staff
• Unwanted media attention

Meds on Track – Management Systems for Medicines in Sport

Steve describes how Meds On Track offer a cost-effective solution that works via an app or web platform, where records of medications administered to players can be made quickly and provide:

• An auditable method of remote authorisation to administer medication to players
• Medication stock control and ordering
• Summary of recent medications when a player has been selected for drug testing
• Comprehensive medication usage reporting
• Drug allergy reminders
• Doping status of drugs

Q&A

Steve kindly answered questions put forward by the practitioners who attended the session.

Q1. What are your top tips for healthcare professionals working in sports?
A1. To report any mistakes or issues immediately and to ensure written policies are in place.

Q2. What are the symptoms of paracetamol toxicity?
A2. Liver damage with signs of jaundice, nausea, vomiting, confusion and liver tenderness. Symptoms are cumulative and may take time to develop due to taking over a sustained period.

Q3. Is it safe for therapists to carry OTCs?
A3. As discussed, therapists can administer OTCs but should follow instructions and check with the club doctor/ medic.

Q4. How can sports rehabilitators address sharing of medicines among athletes?
A4. It is dangerous to share any medicines and there is an opportunity to educate players/ athletes around medicines use, sharing of medicines and risks. Those working in sport can address some of the rituals that players or groups of players may have around use of medicines associated with training and performance/ competition.

Q5. Why are some doses for medicines for age 16+ with weight categories for below age 16 when some adults may weigh a lot less than a 16-year-old?
A5. Always use the weight category where available for dosage for children and young people up to the age of 16. For small adults the weight range dosage can be used where available and is safer.

Presentation Recording

The recording of Steve’s presentation is available to watch here

Follow Steve Simbler and Meds on Track

• Website – Meds on Track
• Email – steve@medsontrack.com

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