POMs 5 - Prescibers Flashcards
What are the 2 different types of non-medical prescribers? (2)
Independent prescribers (IP)
Supplementary prescribers (SP)
Give e.g. of HCP that can be non-medical prescribers. (2)
Nurse
Pharmacist
What is the main role of the IP? (1)
Responsible for initial clinical assessment and preparation of a clinical management plan of patient.
What is the main role of the SP? (1)
Can take responsibility for management of a patient who has been assessed by the independent prescriber.
What criteria applies for supplementary prescribing to occur? (5)
Supplementary prescriber must be a nurse, midwife, pharmacist, chiropodist, dietician, physiotherapist, podiatrist, optometrist or radiographer who has undertaken an extra period of training and is working in a partnership with an IP.
IP must be a doctor / dentist, can’t be nurse/pharmacist.
Voluntary partnership with prescribers with px’s agreement.
Clinical management plan (CMP) must be patient specific and condition and sets out what responsibility is delegated, agreed and signed by both prescribers.
Communication and record access is needed.
What is the framework for supplementary prescribing? (4)
No legal restriction on medicine range or on conditions that can be treated.
Any medicine can be prescribed e.g. CDs, unlicensed, off-label use as long as the medicine is included in the CMP.
No restriction on location of supplementary prescribing.
Offer greater flexibility.
What is a CMP? (2)
Written plan relating to the treatment of an individual patient.
Agreed by the patient, doctor or dentist who is the IP and SP.
What particulars must be included in the CMP? (9)
Patient name
Illness and conditions to be treated
Start/Review Dates
Reference to the medicine class to be prescribed.
Any prescribing restrictions.
Patient sensitivities
Adverse effects to be reported
Any circumstances when SP should refer to IP or seek advice to IP
What are the criteria for IP? (6)
Nurse and pharmacist may be empowered to prescribe any drug for any conditions provided they:
- Are fully trained and accredited.
- Prescribe within area of competence.
- Have access in normal circumstances to patient records.
- Take responsibility for their actions.
N/A to nurses and pharmacists.
What does prescribing within competence mean? (4)
Must be aware of limits of skills, knowledge, competence and work.
Must seek advice and make referral where appropriate.
Accountable for own actions.
Civil and criminal laws applies.
What are the 3 types of Nurse prescribers? (3)
Community practitioner nurse prescribers.
Nurse SP
Nurse IP:
- Can Rx any meds (licensed, unlicensed, off-label) as long as within their area of competence.
- No CD restrictions.
- Allowed to mix medicines prior to administration or direct others to do so.
What medicines can the pharmacist IP Rx? (2)
Can Rx any medicines (licensed, unlicensed, off-label) as long as within their level of competence.
No CD restrictions.
What medicines can the optometrist IP Rx? (2)
Can only Rx licensed medicines (off-label use allowed) for ocular conditions affecting the eyes or tissues around the eye).
Not allowed to prescribe CDs or parenteral products.
What medicines can the physiotherapist IP Rx? (3)
Can Rx any licensed medicine within national and local guidelines for any conditions within their area of expertise and competence relating to human movement and function.
CD - only diazepam, dihydrocodeine, lorazepam, oxycodone and temazepam (oral). Morphine (oral/injection). Fentanyl (transdermal)
Can Rx off-label if accepted clinical good practice. .
What medicines can the podiatrist IP Rx? (3)
Prescribing limited to disorders affecting the foot, ankle and associated structures.
CD’s - Diazepam, Dihydrocodeine, Lorazepam and Temazepam (oral).
Can Rx off label if accepted clinical good practice.
What medicines can the therapeutic radiographer IP Rx? (3)
Can Rx any medicines for any medical condition within their competence.
Can prescribe off label if accepted clinical good practice.
Can Rx certain CDs.
What medicines can the therapeutic paramedic IP Rx? (3)
Can Rx any medicines for any medical condition within their competence.
Can prescribe off label if accepted clinical good practice.
Can Rx certain CDs.
How do you check the RX status of a non-medical prescriber? (2)
Professional register will be annotated to show what prescribing rights the HCP has.
Pharmacist should verify the prescriber’s status before dispensing a Rx.
What are the main features of self-prescribing and prescribing for family or friends? (3)
GPhC advises that pharmacists must not prescribe for themselves or for anyone with whom they have a close personal relationship (e.g. family members, friends, colleagues) Place importance in cases of CDs and drugs liable to misuse = notify local CD accountable officer if present.
In an emergency, a pharmacist may decide that it’s appropriate to dispense a medicine that has been self-prescribed or prescribed for family of friends of the prescriber.
When refusing supply, pharmacist may need to be aware that the person requesting the supply is likely to be disappointed. Explain to the person concerned why the supply is refused.
What are the main features of prescribing and dispensing by the same person? (3)
Patient safety is improved by having a second HCP to check the clinical appropriateness of the medicines and interact with the patient.
It’s good professional practice that the same person shouldn’t Rx and dispense a medicine to a patient. A risk assessment is to be considered.
The patient should always have the choice where the Rx is dispensed.
What does self-checking mean? (1)
Same person dispensing the Rx and performing the accuracy check.
What are the main features of self-checking the dispensing of Rx? (3)
It’s good professional practice to have 2 people to be involved in the dispensing process to reduce the risk of errors and maximise patient safety.
The person performing the accuracy check shouldn’t be involved in the assembly process to reduce potential patient risk of dispensing error.
Consider taking a short mental break between dispensing and accuracy checking.
