non-medial prescribing and patient group directions

Question 1

who can prescribe a POM?

Answer 1

Prescribing historically restricted to ‘appropriate practitioners’ –originally doctors and dentists- now more medicals professions can do so

Question 2

why do we need new routes of access to medicine?

Answer 2

Growth in volume of Rx and complexity of drug therapy
•Emergence of multidisciplinary team approach to health care
•NHS targets for access
•Expansion of patient choice
•Making best use of skills of NHS workforce
•Professional aspirations of nurses, pharmacists and others
•Public expectations surrounding access and choice

Question 3

what is a patient group direction?

Answer 3

a written instruction for the sale, supply and/or administration of named medicines in an identified clinical situation. It applies to groups of patients who may not be individually identified before presenting for treatment”

Question 4

when should PGD be used?

Answer 4

PGDs should be reserved for limited situations where there is an advantage for patient care without compromising safety

Question 5

who may administer or supply a PGD?

Answer 5

; chiropodists and podiatrists, dental hygienists, dental therapists, dieticians, midwives, nurses, occupational therapists, optometrists, orthoptists, orthotists and prosthetists, paramedics, pharmacists, physiotherapists, radiographers, speech and language therapists but only as named individuals

Question 6

is PGD prescribing?

Answer 6

Working under a PGD is not prescribing –it is the supply and/or administration of a medicine

Question 7

what medicines can be included on a PGD?

Answer 7

• All POMs, Ps, GSLs
• CDs
• Sch2, only diamorphine and morphine(only registered nurses and pharmacists for the immediate necessary treatment of a sick and injured person) and ketamine
• Sch3only midazolam
• Any S4 except anabolic steroids and injectablesused for treating addiction
• Any S5

Question 8

what medicines can you not use in PGD?

Answer 8

off licensed

Question 9

what are the most common applications of PGD?

Answer 9

• Emergency hormonal contraception
• Antimicrobials for impetigo, conjunctivitis, urine infections etc
• Analgesia (acute)
• Immunisation (e.g. flu, travel)
• Antiviral medicines for treatment or prophylaxis of influenza

Question 10

when should you not use PGD?

Answer 10

Less suitable for long term conditions such as diabetes, asthma, hypertension, heart failure etc

Question 11

what are the key principles of non-medical prescribers?

Answer 11

• Patient safety
• Improving patient access to medicines
• Making best use of professional expertise
• More flexible working within a multi-disciplinary team
• Close collaboration with professional regulatory bodies for further education and training
• Professionals working within their personal competence and clear clinical governance frameworks
• Professional responsibility and legal liability

Question 12

what is non medical prescribing?

Answer 12

Non-medical prescribing is prescribing by healthcare professionals who are not doctors or dentists

Question 13

how many types of non-medical prescribing are there and what are they?

Answer 13

2 different types of non-medical prescribers:
•Supplementary prescriber (SP)
•Can take responsibility for management of a patient who has been assessed and diagnosed by an independent prescriber

• Independent prescriber (IP)
• Responsible for the initial clinical assessment, diagnosis, prescribing and follow-up

Question 14

what must you be to be able to to SP?

Answer 14

Supplementary prescriber must be a nurse, midwife, pharmacist, physiotherapist, chiropodist, podiatrist, optometrist, radiographer, dietician or paramedic who has undertaken an extra period of training

Question 15

what other crieteria applies to SP?

Answer 15

• A written Clinical Management Plan (CMP) must be in place which is specific to the patient and condition and sets out what responsibility is delegated, agreed and signed by both SP and IP
• Independent prescriber must be a doctor (or dentist) –can’t be a nurse or pharmacist
• Communication and access to medical records are needed
• Voluntary partnership, with patient’s agreement

Question 16

what is the framework for supplementrary prescribing?

Answer 16

No legal restriction on range of medicines or on medical conditions•
No restriction on location of supplementary prescribing
•Therefore, offers great flexibility •Medicines that can be Rx

Question 17

what is a clinical management plan?- cmp

Answer 17

• Format, structure or content not defined in law
• May refer to national or local guideline and/or to BNF (does not need to repeat information –just reference where to find it)
• Must specify the range of meds that may be Rx including limits of variation and when to refer back to the IP
• Must state date of commencement for the patient and date for review (which should not normally exceed one year)•Prescribers can use or amend templates or develop their own

Question 18

what are the criteria for non-medical IP?

Answer 18

• fully trained, accredited and registered as such with their healthcare regulator
• prescribe within their area of competence
• access, in normal circumstances, to the patient record and, therefore, to patients’ medica lhistory, allergies etc
• responsibility for their actions
• Must adhere to any legal restrictions (if any) regarding what they can prescribe

Question 19

what does prescribing within area of compliance mean?

Answer 19

Must be aware of limits of skills, knowledge, competence and work within these
•Must seek advice and make referrals where appropriate•Accountable for own actions

Question 20

how many types of nurse prescribers are there?

Answer 20

3 types of nurse prescriber
•Nurse supplementary prescribers
•As for supplementary prescribing

• Nurse independent prescribers
• Can Rx any medicine (licensed, unlicensed, ‘off-label’) as long as within their area of competence
• Norestrictions on CDs
• Allowed to mix medicines prior to administration or direct others to do so
• Community practitioner nurse prescribers
• Usually District Nurses or Health Visitors
• Can only Rx from the Nurse Prescribers’ Formulary for Community Practitioners (see BNF) using FP10P

Question 21

what are the other types of independednt prescribers?

Answer 21

Pharmacists
•Can Rx any medicine (licensed, unlicensed, ‘off-label’) for any condition as long as within their level of competence. No restrictions on CDs.
•Optometrists
•Can only Rx licensed medicines for ocular conditions affecting the eye or tissues around the eye. Cannot prescribe unlicensed medicines –only ‘off label’ medicines subject to good clinical practice.
•Physiotherapist IP
•Can Rx any licensed medicine within national and local guidelines for any condition within their area of expertise and competence relating to human movement and function

Podiatrist IP•Limited to prescribing for disorders affecting the foot, ankle and associated structures•Can only Rx certain specified CDs (see MEP)•Cannot Rx unlicensed medicines – can prescribe ‘off label’ medicines subject to good clinical practice
•Therapeutic Radiographer IP
paramedic IP

Question 22

How do you check the prescribing status of a non-medical prescriber?

Answer 22

• The professional register will be annotated to show what prescribing rights (if any) the healthcare professional has
• Pharmacists should verify the prescriber’s status before dispensing a Rx
• MEP includes a table including telephone numbers and web addresses of regulatory healthcare professional organisations