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Applied Pharmacy Practice > Prescriptions & Drug charts > Flashcards

Prescriptions & Drug charts Flashcards

1
Q

Prescribers must

A
  • 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.
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2
Q

Prescription

A
  • 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
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3
Q

Who can prescribe?

A
  • 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
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4
Q

What are the 2 types of Non- medical prescribers (NMPs)?

A
  • Independent NMPs
  • Supplementary NMPs
  • have to check the register to see if the person prescribing is allowed to do so
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4
Q

Why do we need this?

A
  • Higher demand
  • Specialises have better skills & knowledge
  • Patients can get quicker med access
  • Increased accessibility
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5
Q

Independent NMPs

A
  • 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
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6
Q

Supplementary NMPs

A
  • 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.
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7
Q

who pays for their prescriptions?

A
  • 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
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7
Q

How are NHS Prescription documentation designed?

A
  • 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)
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8
Q

Legal Requirements

A
  • 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)
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9
Q

NHS FP10 Prescriptions
England GREEN

A

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)

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10
Q

Requirements for a SAFE prescription
5 Rights ddrtp

A
  1. the right drug
  2. at the right dose
  3. by the right route
  4. at the right time
  5. to the patient
    - consider contraindications, interactions, adverse effects and allergies
    patients also have the r
  6. The right
    to refuse
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11
Q

NHS FP10 Prescriptions
England BLUE

A

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

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12
Q

NHS FP10 Prescriptions
England YELLOW

A

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 .

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13
Q

Requirements of
the FP10

A
  1. Patient Name
  2. Patient Address
  3. Age or DOB (if under 12)
  4. Signature of prescriber
  5. Date
  6. Name/qualifications of
    prescriber (Automated)
  7. Address of practitioner (Automated)
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13
Q

NHS FP10 Prescriptions
England LILAC

A
  • 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
14
Q

Electronic Prescription Service

A
  • 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
15
Q

NHS prescriptions in England are regulated by

A
  • NHS Business Services Authority
16
Q

what is 2ndary care?

A
  • Includes hospital inpatient settings , test & referral centres, specialist centres
17
Q

What are prescriptions generated for?

A
  • Inpatients ( on the wards) , patient discharge, outpatients
  • Account for approximately 55% of the total cost of meds in the NHS ( in England)
18
Q

Patient-Specific Directions (PSD)

A
  • 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]
19
Q

Inpatient Drug Charts:
Contents

A

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

19
Q

Prescription Documentation

A
  • 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
20
Q

Inpatient Drug Charts:
Patient demographics

A
  • 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
21
Q

Requirements of
the PSD= drug chart
(not legal requirements)

A
  1. Patient Name
  2. Patient Address
  3. Age or DOB (if under 12)
  4. Hospital number
  5. Signature of prescriber
  6. Date
  7. Name/qualifications of
    prescriber
  8. Address of practitioner (Trust name & hospital address)
22
Q

Inpatient Drug Charts:
Contents

A
  • 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?)
23
Q

Outpatients

A
  • 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)
24
Q

Prescribing for Discharge

A

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?

25
Q

PSD ( Drug chart) documentation

A

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

26
Q

Private prescriptions
Who, Why, How?

A
  • 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
27
Q

Private Prescriptions

A
  • 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
28
Q

why (REAL LIFE EXAMPLE)

A
  • 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
29
Q

Private CD Prescriptions = PINK

A
  • Controlled drugs (e.g. morphine)
  • PINK = FP10PCD (England)
  • Ensures the supply of controlled drugs is
    auditable through the NHS Business Services
    Authority

Applied Pharmacy Practice (19 decks)

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