Prescribing & Principles of Prescribing Flashcards
GP known as prescribers
Who are non-prescribers
- Dentists
- Nurses
-Optometrists - Paramedics
- Physiotherapists
- Podiatrists
- PHARMACISTS
LAW change 2006 - pharmacists prescribers
[initially only supplementary prescribers (PSP)]
Non PSPs and PSPs could then train to become Independent Prescribers (PIP)
Supplementary prescribing
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)
Independent prescribing
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.
Initially PIPs were not allowed to prescribe Controlled Drugs (CDs)
1) Independent v 2) Supplementary prescribing
1) Pharmacist responsible for patient assessment & diagnosis
Can prescribe any drug within their scope
Pharmacist decide on management for patient/ overall accountable
2) Doctor responsible for assessment & diagnosis
Only prescribe drugs listed within CMP
Doctors decides on management and plan for patient
Doctor is overall accountable
INDEPENDENT prescribers (IPs)
July 2027
When you complete your foundation year
You will be qualified and have the skills/competence to be
What is meant by Prescribing??
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
Consultation, diagnosis, decision making = Clinical decision making
A process that involves gathering and understanding of information e.g. from, patient, diagnostic test
Application of clinician knowledge
Provide the most appropriate treatment that will benefit treatment and reduce harm
Steps for the process of prescribing:
- History taking
- Observations
- Physical examinations
- Diagnostic tests & Results
- Clinical experience, professional judgement, decision making [precribe/ not to prescribe]
Principles of prescribing
a) Be clear in the reasons for prescribing
Clear diagnosis
Benefit vs. risks to the patient
b) Consider patient medication Hx before prescribing
Drug Interactions, Adverse Drug Reactions, Allergies
c) Consider factors that might affect benefit & risk of treatment
Age, Pregnancy, Kidney/Liver Function, Heart failure
d) Consider patient ideas, concerns, beliefs and expectations
Partnership with the patient – Shared Decision Making
Gauge understanding and reasoning
e) 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
Principles of prescribing
continued
a) Prescribe in accordance with National & Local guidelines/formularies
NICE, AWMSG, LHB Abx guidelines, LHB formulary, BNF, SIGN
b) Write clear, unambiguous legal prescriptions
No ambiguity with instructions to patient
Legible, clear to read
Indelible ink
Legally valid
c) Monitor beneficial & adverse effects of treatment
Assess for benefit – review & follow up
Make alterations if needed
Report ADRs
d) 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
e) 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
Pharmacist IP Education & Training
Increasing demand for Pharmacists to train as IP to prescribe for patients
Use of knowledge and expertise around medicines to improve patient care and outcomes
Prior to 2022 – Minimum of 2 years of practice and ‘relevant experience’ required to enrol on IP course
October 2022 – Requirement removed
GPhC standards for education and training of Pharmacist IPs sets out the training standards for IP courses at accredited institutions
NMP course at Swansea University is one of these courses
Pharmacist IP Education & Training
how many hrs of supervised practice?
90hrs (+competency sign off a and coursework) - from 2025
after signed off - have an annotation as an IP
scope of practice
the area/field/clinical condition(s) you are going to prescribe within and for
how is competence assessed?
1) Knowladge
2) Skills
3) Attitudes
