Prescribing Standards And Governance Flashcards
Describe the prescribing role of pharmacist prescribers.
The prescriber takes responsibility for the clinical assessment of the patient, establishing a diagnosis, and clinical management required as well as the responsibility for prescribing and appropriateness of any prescribing.
PIP Can Rx any medication as long as it’s within their area of competence.
Able to Rx: Licensed, off-label, unlicensed medicines, Schedule 2-5 CDs including diamorphine, dipapanone or cocaine for tx organic disease of injury.
Unable to Rx: Diamorphine, dipapanone or cocaine for treating addiction.
Rx Scope of practice:
- Prescribing activities a HCP carries out within their professional role.
- Must have required training, knowledge, skills and experience to delivery these activities.
- Must have indemnity cover for their Rx role.
- May be informed by regulatory standards, professional body’s policy, employer, guidance and professional judgement.
Describe concepts to consider when prescribing responsibility.
PIP’s are responsible and accountable for their decisions.
PIPs must communicate effectively.
To prescribe safely, it’s important to access medical records.
Other considerations.
Must only Rx within their area of competence.
HC literacy of px and safety netting.
Monitoring
Report px safety incidents.
Escalate where appropriate
Assess outcomes to ensure safe and effective care.
Describe how to keep up to date and how to prescribe within your competence.
PIPs must maintain, develop and use professional knowledge and skills relevant to their role and prescribing area to ensure the px receives safe, appropriate and updated care.
Scope of practice:
- Restriction of Rx to medicines e.g. comorbidities e.g. chronic pain/depression. A new service e.g. minor ailments to switch to pain management, changing job role - ICCu switch to CVD, Changing setting - secondary to primary care.
Expanding scope of practice:
1. Reflect: The consultation (Assess px, identify evidence based tx options, present options and reach shared decision, Rx, provide information and monitor/review) , Rx governance (Rx safely/professionally, improve Rx practice and prescribe as part of a team)
- Plan: After assessing competencies, PIPs may identify learning needs. Discussed with a person who is prescribing in the same therapeutic area. PIPs should ensure they document the inclusion/exclusion criteria for px groups. They will include in their new scope of practice before starting to Rx. Need to set SMART targets.
- Act: Undertake learning activities in the desires area for further development. E.g. self-directed learning, peer review, observing best practices.
- Evaluate: Learning needs, conclude that learning needs have been met. Undertake or repeat CPDs. Documentation required.
Describe how to work in partnership with HCP and people seeking care when prescribing.
Rx decision based on px’s best interest.
Make risk assessment and records.
Demonstrating leadership.
Professional judgement
Px consent, capacity.
SCP - Shared care protocols ‘provides information required to support safe and effective shared care for specified medicines’ Shows a clear line of responsibility for HCP.
A DPP (Designated Prescribing Practitioner) - ‘ HCP with independent prescribing right who supervises a HCP during their independent prescribing course and gives sign off on their competency to Rx.
DPP: Roles:
- Assess to clinical experience:
- Supervision in practice (90hrs in practice)
- Multi-professional supervision
- Assessment: Monitors learner’s practice against their prescribing scope.
- Accountability
- Assure competency: sign off.
If acting as a DPP: PIP must:
- Suitably trained (3 yrs) and qualified to be a supervisor.
- Active prescriber who makes prescribing decisions.
- Have appropriate knowledge and experience relevant to learner’s scope of practice.
- Have experience of teaching +/or supervising practice
- Be in a px facing role.
Describe prescribing considerations and clinical judgement.
- Prescribing for self, family and friends: Must not Rx for themselves or close relations unless exempted (no other available Rxer, immediate tx required for saving one’s life). Need to justify decisions, professional judgement, refer to another Rxer, make a clear record.)
- Prescribing and supplying: Initial Rxer separate from supplying the medicines, second trained professional should complete clinical and accuracy check. Professional judgement (Take Rx elsewhere, robust procedures and arrangements, Rx in px’s best interest, indemnity insurance)
- Prescribing non-surgical cosmetic products e.g. Botulinum toxin and medical devices: Act is px’s best interest and ensure appropriate training, ensure services provided meet relevant registration, if delegated administration, still responsible for ongoing oversight of person.
- Online prescribing and safeguards for online prescribing of certain medicines: Not compromise safety especially in vulnerable, at risk of addiction or may not have capacity, unsuitable meds e.g. non-surgical products and high risk drugs. Consider whether they have full knowledge of person’s health. Indemnity insurance required e.g. verify identity, limitation of communication, physical examination, identify inappropriate requests, who the person should contact, medicines are appropriate (antimicrobials, NT meds, sodium valproate, medcines prone to abuse, medicines requiring monitoring)
Describe how to raise concerns regarding the prescribing of other HCP.
Protection of public/px/communities and colleagues.
Imrproves px safety.
Pharmacist report any wrong doings.
PIDA - protects whistleblowers in the UK who raise concerns and disclose information in the best interest of others.
Describe in detail how to respond to errors.
- Reflect: Proactively reflect on existing knowledge, understand, safety culture and systems to identify gaps around responding to safety incidents and improve delivery of safe and effective person centred care.
- Be open and honest: where px safety incidents occurs to support professional accountability and individuals affected by incident. Just culture ‘wider system issues and fair evaluation of why incidents occurred to enable openness and learning without fear of blame. Duty of candour - tell px something has gone wrong, apologise, offer appropriate remedy/support, explain fully to the px of short-term and long-term effects of what has happened.
- Review: all px safety incidents in a timely manner to identify an appropriate response or action, contributing factors, manage risk and support safety interventions and learning. Root cause analysis (RCA) used to identify areas for improvement.
- Record and Report: in a timely manner using appropriate internal, local and national reporting mechanisms to improve px safety by monitoring and identifying issues that need escalating, enable learning and facilitate the development of local, regional, and national solutions.
Describe what is meant by the term just culture.
Explain how to apply duty of candour.
List and explain what px level errors to report.
List and explain where to report px level errors.
Describe the role of LFPSE and CQC in relation to errors.
Local risk assessment system (LRMS) for recording px safety incidents.
Organisation without LRMS are to record incidents directly to LFPSE.
- Act: Take relevant action in a timely manner to manage risk, strengthen, change, or improve quality of practice or sysetems of care in a sustainable way and minimise recurrence by addressing contributory factors where relevant.
CQC: Care quality commission highlights good practice associated with risk management.
- Share learning: With relevant individuals and organisation to improve px safety and promote learning culture and minimise future risks where relevant.
- Evaluate: systems, interventions, changes made to practice to assess outcomes.
