Prescriptions & Drug charts Flashcards
Prescribers must
- Electronically generate & or write legible unambiguous & complete prescriptions which meet legal requirements.
- Effectively use the systems necessary to prescribe
medicines.=Many systems are now electronic, so you need digital literacy. - Document accurate, legible and contemporaneous clinical records. For e/t in terms of interaction w/ a patient or member of the public.
Prescription
- An instruction written (mostly electronic/online) by a medical practitioner (or nurse or pharmacist etc)
that authorises a patient to be issued with a
medicine or treatment - The action of prescribing a medicine or
treatment
Who can prescribe?
- Medical practitioners:
Doctors and Dentists - Veterinary surgeons ( For the animals under their care)
- Non-medical prescribers (NMPs = independent prescribers ):
Nurses IP/SP
Optometrists IP/SP
Pharmacists IP/SP
Physiotherapists SP/IP
Podiatrist SP/IP
Radiographers IP/SP
Paramedics IP/SP
What are the 2 types of Non- medical prescribers (NMPs)?
- Independent NMPs
- Supplementary NMPs
- have to check the register to see if the person prescribing is allowed to do so
Why do we need this?
- Higher demand
- Specialises have better skills & knowledge
- Patients can get quicker med access
- Increased accessibility
Independent NMPs
- Can prescribe any medicine for any medical condition within their competence
- Responsible and accountable for the assessment of patients with undiagnosed and diagnosed conditions and for decisions about clinical management
Supplementary NMPs
- A voluntary partnership with an independent prescriber to implement an agreed patient-specific clinical management plan with the patient’s agreement
- Can prescribe meds independently but it is based on an agreed plan w/ the doctor, patient & sp.
- i.e. management of a UTI a nurse may be able to prescribe if they can hit the criteria w/i that management plan.
who pays for their prescriptions?
- Approx 90% of prescriptions in England are dispensed free
- Only those in the UK of working age & have no medical conditions pay a
for their prescriptions
How are NHS Prescription documentation designed?
- Minimise the risk of fraudulence
- Reduce error ( automatically adds parts like patient name & address)
- Identify elements of accountability ( code that can be put into the system so you can see e/t the prescriber has issued)
- Facilitate payment for medicines
- Allow for the collection of data on prescribing
patterns and costs ( can help look @ trends in spending & the cost of prescribing overtime - can help NHS find ways to save money)
Legal Requirements
- Patient identification:
Name and address - Age or DOB (if under 12) - include regardless of their age
- Signed ( by prescriber)
- Dated ( by prescriber)
- Name and address (surgery address) of practitioner
- Be written in indelible ink (can’t smudge or erase)
- Additional requirements for controlled drugs
(e.g. Morphine sulfate)
NHS FP10 Prescriptions
England GREEN
GREEN
– FP10SS
– FP10NC
(any medicine on the NHS, including controlled drugs)
can be prescribed by:
- General practitioners
- Hospital practitioners= doctors
- Independent and supplementary prescribers (can prescribe drugs w/i your scope of competence)
Requirements for a SAFE prescription
5 Rights ddrtp
- the right drug
- at the right dose
- by the right route
- at the right time
- to the patient
- consider contraindications, interactions, adverse effects and allergies
patients also have the r - The right
to refuse
NHS FP10 Prescriptions
England BLUE
BLUE = FP10(H)MDA
- Drugs of misuse (Misuse of Drugs Act)
– i.e. those of dependence
– E.g. methadone
Can be prescribed by:
- General practitioners
- Hospital practitioners
- Independent and supplementary prescribers
- These prescriptons usually last a number of days
NHS FP10 Prescriptions
England YELLOW
YELLOW= FP10D
- Dental practitioners= PRESCRIBER
- Defined list of medicines that dentists can prescribe on an NHS FP10D; as stated in the General Dental Formulary NHS FP10 Prescriptions England
- Tends to be painkillers, mouthwash, botox ect .
Requirements of
the FP10
- Patient Name
- Patient Address
- Age or DOB (if under 12)
- Signature of prescriber
- Date
- Name/qualifications of
prescriber (Automated) - Address of practitioner (Automated)
NHS FP10 Prescriptions
England LILAC
- LILAC = FP10P
- Practice nurses =PRESCRIBER
- There is a defined list of medicinal products,
appliances and reagents that nurses can prescribe
on an NHS FP10P; stated in the Nurse Prescribers’
Formulary - Tends to be bandages, incontinence pads
Electronic Prescription Service
- EPS allows the prescription to be sent electronically
from the General Practitioner to a nominated
community pharmacy
– The pharmacist can prepare prescriptions in advance
– The pharmacist can monitor medicine use as they are the consistent supplier for a patient - The legalities of the prescription remain the same
NHS prescriptions in England are regulated by
- NHS Business Services Authority
what is 2ndary care?
- Includes hospital inpatient settings , test & referral centres, specialist centres
What are prescriptions generated for?
- Inpatients ( on the wards) , patient discharge, outpatients
- Account for approximately 55% of the total cost of meds in the NHS ( in England)
Patient-Specific Directions (PSD)
- not legal prescriptions
- just orders to fulfil
- PSDs are issued in hospital
- “written [or electronic] instructions from a doctor,
dentist or non-medical prescriber for a medicine
to be supplied or administered to a named patient after the prescriber has assessed the patient on
an individual basis” [MEP, 2021]
Inpatient Drug Charts:
Contents
Paper-based or electronic
Must allow for the instruction of:
– Regular medicines ( so they can be administerd in hospital)
– Variable regimens
– Single, one-off doses ( antibiotics after surgery
– When required medicines
– Infusions
❑ Must allow for the documentation of all
administration
Prescription Documentation
- no standard documentation for the
PSD in English hospitals - Hospitals design, maintain, monitor and enforce their own documentation (online or paper)
- Single Prescription and Administration Record for
Scotland (SPARS) is in draft form - All hospitals in Wales use the same PSD inpatient
drug chart
Inpatient Drug Charts:
Patient demographics
- Not found on FP10
must also allow for the documentation of:
– Patient-identifiable information
– The allergy status of the patient
– Patient information to inform the calculation
of doses (weight, height, BSA)- s/ drugs prescribed on weight
Requirements of
the PSD= drug chart
(not legal requirements)
- Patient Name
- Patient Address
- Age or DOB (if under 12)
- Hospital number
- Signature of prescriber
- Date
- Name/qualifications of
prescriber - Address of practitioner (Trust name & hospital address)
Inpatient Drug Charts:
Contents
- What is to be given? (drug name, form)
- Why? (indication)
- When? (date and time)
- How? (route)
- How often? (frequency)
- Until when? (for a week, or to continue long-term?)
Outpatients
- Hospital specific outpatient prescriptions can only be dispensed in the Hospital Pharmacy
– Medicines intended to treat the condition for
which the patient was referred to the hospital
– Hospital only medicines= s/ meds not allowed in community due to high risk
– Medicines requiring intensive monitoring
– Medicines required urgently - Or a hospital FP10 may be issued ( may be white or green paper)
Prescribing for Discharge
TTO’s = (To Take Out)
TTH = (To Take Home)
- A direction for pharmacy to supply
- States ALL drug treatments that are to continue
on discharge ( A copy goes home w/ patient , one kept in hospital 7 one emailed to GP)
- States any changes in drug treatment during the hospital stay:
– Why a medicine has been stopped?
– Why a dose has been increased?
– Why a dose has been reduced?
– Why a new drug has been started?
PSD ( Drug chart) documentation
Designed to:
– Facilitate the documentation of a complete prescription
– Reduce the risk of error
– Minimise the risk of fraudulency
– Identify elements of accountability
– Document a patient’s pharmacological history
for a single hospital admission
- It is a legal medical record that can be used in the court of law
Private prescriptions
Who, Why, How?
- Take longer to dispense because of documentation needed
Who?
– Can be issued by any prescribing practitioner
– The patient pays for the cost of the medicines and
for the pharmacists time - may be cheaper to prescribe privately
Why?
– Private healthcare
– Items that cannot be prescribed on the NHS - Any prescriber can prescribe privately if it is in w/i their scope of competence
How?
– There is no standard prescription documentation
Private Prescriptions
- Does not have to be headed paper,
but must detail the name and address of the prescribing practitioner - The registration number of the practitioner must be stated, along with their qualifications ( include professional ID)
- Legal requirements that apply to FP10s apply to private prescriptions
- Have a high risk of fraudulence
why (REAL LIFE EXAMPLE)
- Harold Shipman, General Practitioner
- Shipman killed at least 215 of his patients over a
period of 24 years - Administered lethal doses of diamorphine
- Issued private prescriptions to obtain the
medicines
Private CD Prescriptions = PINK
- Controlled drugs (e.g. morphine)
- PINK = FP10PCD (England)
- Ensures the supply of controlled drugs is
auditable through the NHS Business Services
Authority
