Law underpinning prescribing

What was the change to the cumberledge report in 1992?

certain nurses are allowed to prescribe a limited range of products

When were PGDs indroduced and by which report?

1993 Crown report

What is a PGD?

a written direction that allows the supply and/or aministration of a specific medicine or medicines, by named authorised health proffessionals, to a well-defined group of paitents requiring treatment for a specific condition

When was the second crown report reccomendation and what did it say?

1999 extended prescribing rights to other HCPs

When was the Health and social care act published?

2001

In regards to prescribing, what happened in 2006?

there was an amendment to NHS Regulations so that suitibly trained nurses and pharmacists could prescribe any licenced medication for any medical condition within their own competence as ‘Non-Medical Prescribers’

What are non-medical prescribers?

pharmacists, nurses, midwives and other allied healthcare proffessionals who have completed an accredited prescribing course and registered their qualification with their regulatory body, are able to prescribe

What is a supplementry prescriber?

a practitioner who prescribes whithin an agreed patient specific written clinical management plan, agreed in partnership with a doctor or dentist

What does CMP stand for?

clinical management plan

What is the prossess of supplementary prescribers?

1. Diagnosis of clinical condition by a medical practioner

2. Agreement by service user to be managed by a prescribing partnership

3. creation of a clinical management plan (CMP) by medical practitioner, supplimetry prescriber and service user

4. Management of the service user within the terms if the CMP

What is an inderpendent prescriber?

a practitioner who is responsible and accountable for the assessment of patients with undiagnosed or diagnosed conditions and can make prescribing decisions to manage the clinical condition of the patient

What is the prescribing competancy framework?

produced and maintained by the RPS, a prescribing framework for all prescribers, describes knowledge, skills, characteristics and behavoirs for safe and effective prescribing role

What are the 2 domains of the prescribing competency framework?

the consultation and prescribing governance

What are the different prescriber types?

Doctors, dentists and vets can prescribe at the point of registration (now pharmacists too)
indepedent and supplement prescribers require extra training

What are the 12 steps of the RPS Guidence on Safely Prescribing?

personal development, reflect, keep up to date (CPD, revalidation), professional judgement, speak up, professional indemnity, improving practice, audit, errors/near misses, remote prescribing, prescribing legally, document, support others

What does the law say about scope of practice for prescribing?

prescribes within own scope of practice, and recognises the limits of own knowledge and skill
must have required training, knowledge, skills and experience and indemnity cover for prescibing role

How do you expand or change your scope of practice? What can you change it to?

reflect, plan, act, evaluate
prescribe greater range of medicines, need to better support pacient care, deliver new service, change of job or setting

What do you need to take into account when using professional judgement in prescribing?

person centred care, safety, duty of care, legal, regulatory and proffessional obligations, contractual and company proceedures

What is remote prescribing?

where the consultation is online or on the phone

What are the questions you need to take into account when prescribing remotely?

Can you recognise when a person may need a physical or in-person assesment?
Do you know where to signpost them to?
Is there a process for when you can refer a person to a medical prescriber while working remotely?
How can you gain concent?
should feel both competent and safe to prescribe

When are remote consultations/prescribing not appropriate?

lack of patient access or ability to use technology, impared capacity to participate, red flags suggest a need for urgent medical attention, insufficent access to required information such as records or resources

What are the legal and good practice considerations around prescribing and dispensing the same medicine?

wherever possible should be seporate functions, peformed by seporate HCPs - this improves safety as it reduces likelihood of errors, however there is no legal restriction on this

If you are prescribing and dispensing a medicine to a patient what else do you need to do/follow?

conduct a risk assement, follow a procedure, best interest of the patient, take a mental break between activities, maintain an audit tratin and rationale for decision, report errors and near misses to learn and change practice

Can you prescribe for yourself, freinds and family?

Leagally yes, but it is poor practice, if exceptional situations occur: objectivity, documentation and monitoring, external input

Can pharmacist IPs prescribe CDs? What CDs?

yes, schedule 2-5 but not cocaine, diamorphine or dipipanone for treating addiction

Can pharmacist IPs prescribe unlicensed/off-label medicines?

yes

Can pharmacist IPs authorise an emergancy supply for items which can be prescibed?

yes, but no schedule 1,2,3 CDs aside from phenobarbital for epilepsy