6) Law underpinning prescribing Flashcards
What is a PGD?
A patient group directions:
- is a written direction that allows the supply and/or administration of a specified medicine or medicines, by named authorised health professionals, to a well- defined group of patients who require a treatment for a specific condition
Who can prescribe?
Pharmacists, nurses, midwives and other allied healthcare professionals (AHPs) who have completed an accredited prescribing course and registered their qualification with their regulatory body
What is a supplementary prescriber SP?
- Practitioner who prescribes within an agreed patient specific written clinical management plan (CMP), agreed in partnership with a doctor or dentist.
- Long term conditions require clinical management plans. These are the corner stone for supplementary
prescribers and must be in place before the SP begins prescribing for the patient.
Process
1. Diagnosis of clinical condition by a medical practitioner
2. Agreement by service user (i.e., patient) to be managed by a prescribing partnership
3. Creation of a clinical management plan (CMP) by medical practitioner, supplementary prescriber
and service user
4. Management of the service user would be delegated to SP who would be able to manage patient holistically according to CMP eg prescribing set of meds for that specific condition
What is an independent prescriber (IP)?
Practitioner, who is responsible and accountable
for the assessment of patients with undiagnosed or
diagnosed conditions and can make prescribing
decisions to manage the clinical condition of the
patient.
Legal requirements of a prescription?
- Signature: signed in ink by prescriber. An advanced
electronic signature can be used. - Address of prescribed
- Date: Prescription of POM valid for up to 6 months from the
appropriate date. See special requirements for CDs
schedule 2, 3 or 4.
For private prescriptions the appropriate date is the date
the prescription was signed. For NHS prescription the date
is the later of either the date the prescription was signed
or another date as indicated by the prescriber - Particulars eg doctor or dentist that indicate the type of appropriate
practitioner - Name of the patient
- Address of the patient
- Age of patient if under 12
The RPS’s Prescribing Competency Framework
- applicable to all prescribers so not just those working within pharmacy
Aim of this is to
• Support prescribers to expand their knowledge, skills, motives and personal traits
• Improve performance, work safely and effectively
• Sets out what good prescribing looks like
• Used by:
– Prescribers to underpin professional responsibility.
– Self-assessment tool.
– Regulators, education providers, professional organisations etc. to inform standards and develop education.
– Individuals and organisations to analyse how they do their jobs
– To evidence delivering competencies required of the role.
• Used along side own, professional prescribing standards
• All prescribers should recognise the limits of their own knowledge and skill and prescribe within their own competence and clinical expertise.
Competency Framework has how many domains?
2, with the centre being the patient
1. The consultation. The domain looks at the competencies that
the prescriber should
demonstrate during the
consultation eg confidentiality, effective communication and appropriate prescribing
2. Prescribing governance. The domain focuses on the
competencies that the prescriber
should demonstrate with respect to prescribing governance eg prescribing as part of a team
Prescribing standards?
- Prescribes a medicine only with adequate, up-to-date awareness of its actions, indications, dose, contraindications, interactions, cautions, and side effects.
- Understands the potential for adverse effects and takes steps to avoid/minimise, recognise and manage them.
- Prescribes within relevant frameworks for medicines use as appropriate (eg, local formularies, care pathways, protocols and guidelines).
- Prescribes generic medicines where practical and safe for the patient and knows when medicines should be prescribed by branded product.
- Understands and applies relevant national frameworks for medicines use (eg, NICE, SMC, AWMSG and medicines management/optimisation) to own prescribing practice.
- Accurately completes and routinely checks calculations relevant to prescribing and practical dosing.
- Considers the potential for misuse of medicines.
- Uses up-to-date information about prescribed medicines (eg, availability, pack sizes, storage conditions, excipients, costs).
- Electronically generates or writes legible unambiguous and complete prescriptions which meet legal requirements.
- Effectively uses the systems necessary to prescribe medicines (eg, medicine charts, electronic prescribing, decision support).
- Only prescribes medicines that are unlicensed, ‘off-label’, or outside standard practice if satisfied that an alternative licensed medicine would not meet the patient’s clinical needs.
- Makes accurate legible and contemporaneous records and clinical notes of prescribing decisions.
- Communicates information about medicines and what they are being used for when sharing or transferring prescribing responsibilities/ information.
Can pharmacist independent prescribers prescribe schedule 2 to 5 CDs?
Yes – but not cocaine, diamorphine or
dipipanone for treating addiction
Can pharmacist independent prescribers prescribe unlicensed and/or off-
label medicines?
Yes
Can pharmacist independent prescribers authorise an emergency supply for
items which can be prescribed?
Yes- includes phenobarbital for epilepsy
but no other schedule 1, 2 or 3 CDs
Requirements for prescribing CDs?
- in addition to standard prescription requirements for POMs
- patient name
- patient address
- name of CD
- formulation eg tablet, capsule liquid formulation etc
- strength
- dose (needs to be specific, so not just prn, so how many units prn)
- total quantity, given in words AND figures
- quantity prescribed, no more than 30 days supply for schedule 2, 3 and 4 meds unless theres a specific reason to do so and again, must justify the reason
- dental wording where appropriate
- instalment wording where appropriate
- signature of prescriber
- date, specific requirements and it pertains to the schedule of the drug, so sched 2, 3 and 4 theres a 28 day restriction so must supply that med within 28 days of the appropriate date on the prescription, sched 5 would fall under the six-month rules and same as for a pom
- address of prescriber
