Cross-Sector Roles

What is the process called when comparing a list of patients current medication to that on a drug chart/prescription to ensure it is accurate and up to date?

Medicines reconciliation/drug history

What sources can be used when making a drug history?

Repeat prescription forms, patients own medication, contacting patients GP or community pharmacy, asking the patient, NHS summary care record, clinical correspondence e.g., referral letters, medical questionnaires

How many sources should be used for an ideal medicines reconciliation?

2 at least

What are some examples of medicines information related queries?

• Drug alerts

• Formulation availability

• Suitable solutions for admin of IV injection e.g., use in central lines

• Dose adjustments for special patient groups

• General wellbeing and healthy lifestyle

• Discharge medicine queries from community or GP

How are drug alerts received?

Through MHRA and require a form of action

How many levels of drug alerts are there?

5

What are the 5 levels of drug alerts?

National patient safety, class 2, 3, 4 meds recalls, company led recall

What must you do for a national patient safety drug alert?

Alert patients and eat them to bring drugs back!

What type of drug alert is most common?

Class 4 - issue with PIL, provides up to date advice

What information will drug alerts provide?

What the issue is, the batches affected and the action that is needed

What are some resources that can be used to respond to medicines queries?

• BNF

• Medicines complete - handbook of injectable drugs

• Renal drug handbook

• Stockley’s

• Meds compendium - contains SMPCs, PILs

• Microguide

• Manufacturers

• Specialist pharmacy service

What is an advanced clinical pharmacist?

For experienced pharmacists with an area of expertise, involving a high degree of autonomy and complex decision-making and manages clinical care for patients

What further education is needed to become an advanced clinical pharmacist?

Further Masters degree or clinical diploma, as well as professional portfolio

What is the term to describe prescribing of POMs by health professionals other than doctors or dentists?

Non-medical prescribing

What are the 2 types of NMP prescribers?

Supplementary or independent

What are the aims of non-medical prescribing?

• Improve pt care without compromising safety

• Make it easier for patients to access the medicines they need

• Increase pt choice in accessing medicines

• Make better use of skills of health professionals

• Contribute to more flexible team working across NHS

What is the act that introduced the concept of nurse prescribers?

Medicinal products: prescription by nurses etc Act 1992

What is the act and section that extended prescribing responsibilities to other professions such as pharmacists and also introduced the role of supplementary prescribers?

Section 63 of health and social care act 2001

What was the amendment to the health and social care act 2001?

Introduced non-medical independent prescribers

What is the term to describe a voluntary partnership between an IP and a supplementary prescriber who implement an agreed patient-specific clinical management plan within the patients agreement?

Supplementary prescribing

What professions can practice as an SP?

Pharmacists, nurses, optometrists, chiropodists, podiatrists, physiotherapists, radiographers and dieticians

What is required to write when doing supplementary prescribing?

Clinical management plan relating to patient and specific medical conditions

What details must the CMP include?

Individual patient, conditions to be treated, the medicines that can be prescribed by SP, any monitoring needed, when to refer to IP

Who must agree to the CMP?

IP, SP, patient

What is the term used to describe prescribing by a practitioner who is responsible and accountable for assessment of patients with undiagnosed/diagnosed conditions and for decisions about clinical management required, such as prescribing?

Independent prescribers

What professionals can become independent prescribers?

Pharmacists, nurses, optometrists, physiotherapists, podiatrists, radiographers

What is required for independent prescribing to take place with a patient?

Initial patient assessment, interpreting assessment, decision on safe and appropriate throw and process for ongoing monitoring

What are community practitioner nurse prescribers limited to in independent prescribing?

Nurse Prescribers Formulary

What can nurse independent prescribers and pharmacist independent prescribers NOT prescribe?

Diamorphine, cocaine and dipipanone for treating addiction

What can nurse independent prescribers prescribe??

Any licensed medicine including schedule 2-5 CDs

What can optometrist independent prescribers prescribe for?

Any licensed medicine for ocular conditions affecting the eye or tissue surrounding the eye

What can optometrist IPs not prescribe?

Controlled drugs, medicines for parenteral administration

What can pharmacist independent prescribers prescribe?

Any licensed medicine within clinical competence, including schedule 2-5

What must organisations ensure for pharmacists wishing to become independent prescribers?

Pharmacist must be competent to prescribe in area they will be a prescribe, pharmacist should have suitable education and training

What should education and training to become a pharmacist prescriber consist of?

Minimum of 26 days of structured learning activities, can be online and at least 12 days - 90 hours - learning in practice under supervision

What must education and training for independent prescribing for pharmacists include?

32 learning outcomes by GPHC - covers legal, ethical, professional aspects, clinical exam, diagnosis, communication, consultation skills and evidence based medicine

What are the 10 competencies set out by the RPS for pharmacists undergoing IP training?

Consultation involves assessing pt, considering options, reaching a shared decision, prescribing, providing information and monitoring and review, prescribing governance includes prescribing safely, professionally, improving practice and prescribe as part of a team

Who should pharmacists register with to say they can undertake a prescribing role?

GPHC

What regulations cover the sale and supply of medicines?

Human Medicines Regs 2012, misuse of drugs act 1971/regulations 2001

What act established the GPHC as the regulator for pharmacy?

GPHC

What is the main representative body of pharmacy in the UK?

Royal pharmaceutical society

What is the term to describe the system of rules which a country/community recognise as regulating actions of its members and can enforce penalties?

Law

Where does accountability for actions come in relation to law for pharmacists?

Common law

What part of law relates to negligence and trespassing laws in pharmacy?

Civil tort

What are the 3 criteria related to negligence in civil tort law?

Person owes a duty of care to anyone can be seen to cause harm to someone, breach duty of care and damage has occurred

When does negligence occur in relation to civil tort law?

When harm occurs due to failure to take care of

What acs govern how you use sensitive data as a pharmacist?

• general date protection regulation/data protection act 2018

• Freedom of info act 2000

• Human rights act 1998

• NHS act 2006

• Health and social care act 2012

• Access to health records act 1990

• NHS data security and protection toolkit

• GPHC standards

What are secondary uses of patient data?

Use of patient data in review and development of NHS, such as commissioning services or conducting audits - MUSTN’T BE USED TO IDENTIFY PATIENTS

What is the term to describe the basic rights and freedoms that belong to every person in the world?

Human rights

What was included in the human rights act 1998, introduced in 2000 that is related to healthcare?

Right to life, freedom of thought and expression, liberty and security, right to fair trial, respecting private and family life, to home and correspondence, prohibits slavery and forced labour, prohibits torture, inhuman or degrading treatment or punishment

What does the human rights act 1998 define public authorities as?

Government departments, local authorities, police, prison and immigration officers, public prosecutors, courts and tribunals, non-departmental public bodies, any person exercising a public function

What is the self-assessment tool that all organisations with access to NHS patient data and systems use?

NHS data security and protection toolkit

How many standards are there that the department for health and social care issue that focus on areas such as requirement for named person to be responsible for data handling in an organisation, training required of staff, data for mapping and how to report breaches?

10 standards

What are the names of the 10 standards by the department for health and social care that focus on data handling?

Caldicott guardian

What are the 3 obligations under the Caldicott Guardian?

• People - ensure staff are equipped to handle info respectfully and safely

• Process - ensure organisation proactively prevents data security breaches and responds appropriately to incidents/near misses

• Technology - ensure it is secure and up to date

What is the act related to capacity?

Mental Capacity Act 2005

What are the 5 criteria in the mental capacity act?

• People are assumed to have capacity

• Person is not treated as unable to have capacity unless they are helped with no success

• Nobody is treated as incapable even if they have previously make an unwise decision

• Everything is done in the patients best interests

• Before an act is done it must ensure it is the patients best interest and their is no other way it can be done to not restrict the patients freedom less

How many duties do employees have under the health and safety act 1974?

4

What are the 4 employee duties in the health and safety act 1974?

Follow training, take care of their health and safety, comply with their companies policies and report inadequacies in health and safety

How many responsibilities do employers have under the health and safety act 1974?

10

What are the summaries of employers responsibilities under the health and safety act 1974?

Risk assessments perform, steps must be made to ensure employees safety, provide free safety equipment and provide washing facilities and drinking water

What is KEY to get from all patients before initiating anything?

CONSENT