Prescribing & Principes Of Prescirbing

Question 1

What is supplementary prescribing ?

Answer 1

Supplementary – Prescribe under a specific Clinical Management Plan (CMP) set out under a doctor stating what can and can’t be prescribed and under what circumstances. The Doctor is the overall responsible clinician accountable for care of the patient(s)

Question 2

What is independent prescribing ?

Answer 2

Independent – Can prescribe any medication independently for any condition within scope of practice and competence. EXCEPT Cocaine, diamorphine and dipipanone for addiction. Pharmacist is accountable clinician for care of the patient.

Question 3

What is meant by prescribing ?

Answer 3

• Healthcare practitioner authorises the use of a medicine or treatment for an individual patient.
• Enables patient to obtain treatment required for their condition e.g. Abx for tonsillitis
• Usually by writing a legally valid prescription form e.g. FP10/WP10

Question 4

What is clinical decision making ?

Answer 4

• A process that involves gathering and understanding of information e.g. from, patient, diagnostic test
• it involves the application of clinician knowledge and provides the most appropriate treatment that will benefit treatment and reduce harm

Question 5

What are the 5 steps that lead to whether a pharmacist will either prescribe or not prescribe ?

Answer 5

1) History taking
2) observations
3) physical examination
4) diagnostic tests and results
5) clinical experience, professional judgement and decision making

Question 6

What are the 10 principles of prescribing ?

Answer 6

1) Be clear in the reasons for prescribing
-Clear diagnosis
- Benefit vs. risks to the patient

2) Consider patient medication Hx before prescribing
-Drug Interactions, Adverse Drug Reactions, Allergies

3) Consider factors that might affect benefit & risk of treatment
-Age, Pregnancy, Kidney/Liver Function, Heart failure

4) Consider patient ideas, concerns, beliefs and expectations
-Partnership with the patient – Shared Decision Making
- Gauge understanding and reasoning

5) Use safe, effective, cost effective, evidence based treatments
-Benefit of use should outweigh harms
-Published peer reviewed evidence supporting safety & efficacy
-Licensed medicines as first option
-Most appropriate formulation, dose, frequency etc.

6) Prescribe in accordance with National & Local guidelines/formularies
-NICE, AWMSG, LHB Abx guidelines, LHB formulary, BNF, SIGN

7) Write clear, unambiguous legal prescriptions
-No ambiguity with instructions to patient
-Legible, clear to read
-Indelible ink
- Legally valid

8) Monitor beneficial & adverse effects of treatment
- Assess for benefit – review & follow up
- Make alterations if needed
- Report ADRs

9) Communicate & document prescribing decisions & reasoning for them
- Clear communication with patient, carers, colleagues
- Provide patient with info. On medicine – how to take, SEs
- Document in patient record
- Document even when deciding not to prescribe treatment

10) Prescribe within limits of knowledge, skills & experience
-Keep up to date with knowledge & skills
- Seek advice & support from qualified colleagues if needed
- Do not prescribe unfamiliar or unlicensed treatments where possible