Evaluating Prescribing Practice

Introduction

Evaluating prescribing practices is a critical aspect of pharmacy and healthcare, ensuring quality, safety, and effectiveness. This presentation outlines the importance of evaluation, what aspects to evaluate, how to evaluate, when to evaluate, and what to do with the evaluation data.

GPhC ILOs and Prescribing Competencies

The General Pharmaceutical Council (GPhC) emphasizes several key points:

• GPhC, 2021
  • 41. Effectively use local and national health and social care policies to improve health outcomes, public health, and address health inequalities.
  • 53. Reflect upon, identify, and proactively address their learning needs.
  • 55. Participate in research activities, audit, service evaluation, and quality improvement, demonstrating how these are used to improve care and services.
  • These points are part of the standards for the initial education and training of pharmacists.

RPS Competency Framework

The Royal Pharmaceutical Society (RPS) provides a competency framework for all prescribers:

• RPS, 2021
  • 9.1. Improve by reflecting on own and others’ prescribing practice and acting upon feedback and discussion.
  • 9.3. Understand and use available tools to improve prescribing practice.
  • 9.4. Take responsibility for own learning and continuing professional development relevant to the prescribing role.

Learning Outcomes

Upon completing these learning activities, one should be able to:

• Explain the need for evaluation.
• List five aspects of prescribing practice that need evaluation.
• Detail relevant tools to evaluate different aspects of practice.
• Evaluate their practice.

Overview of Evaluation

The evaluation process includes:

• Why we need to evaluate.
• What we are evaluating.
• How we can evaluate.
• When we evaluate.
• What we do with this evaluation data.

Why Evaluate?

Evaluation is essential because:

• The GPhC mandates it.
• It aligns with leadership principles.
• It ensures person-centered care.
• It promotes partnership working.
• It encourages speaking up about concerns.
• It maintains confidentiality and privacy.
• It ensures safe and effective care.
• It fosters effective communication.
• It enhances professional knowledge and skills.
• It supports professional behavior and judgment.

NHS Long Term Plan

The NHS Long Term Plan (2019a) emphasizes:

• Systematic methods of Quality Improvement (QI) provide an evidence-based approach for improving every aspect of how the NHS operates.
• Developing improvement capabilities enables systems to adopt new innovations and service models and implement best practices, improving quality and efficiency, and reducing unwarranted variations in performance.
• A program to build improvement capability is established in around 80% of the trusts rated ‘outstanding’ by the Care Quality Commission.

NHS Patient Safety Strategy

The NHS Patient Safety Strategy (2019b) highlights that the NHS:

• Must support continuous and sustainable improvement, with everyone habitually learning from insights to provide safer care tomorrow than today.
• Quality Improvement provides the necessary coherence and aligned understanding of this shared approach to maximize its impact.
• It offers tools to understand variation, study systems, build learning and capability, and determine evidence-based interventions and implementation approaches to achieve the desired outcomes.

Benefits of Evaluating Practice

Evaluating practice leads to:

• Improved performance and outcomes.
• Evidence-based decision-making.
• Resource optimization.
• Continuous improvement.
• Accountability.
• Learning and knowledge sharing.
• Justification of spending and funding.
• Enhanced communication and marketing.
• Better patient outcomes.
• Understanding the impact of development and learning methods.
• Effectiveness of therapeutic interventions.
• Meeting the needs of service users.
• Achieving goals and monitoring progress.

What to Evaluate? - The Consultation

All aspects of the prescribing process should be evaluated, focusing on two main domains:

Domain 1: The Consultation

This includes:

• Assessing the patient.
• Identifying evidence-based treatment options.
• Presenting options and reaching a shared decision.
• Prescribing.
• Providing information.
• Monitoring and review.

Domain 2: Prescribing Governance

This includes:

• Prescribing safely.
• Prescribing professionally.
• Improving prescribing practice.
• Prescribing as part of a team.

Evaluation Tools

Various tools can be used for evaluation:

• RPS, 2021
  • Supervision
  • Observation of practice and clinical assessment skills
  • Portfolios
  • Workplace competency-based assessments
  • Questionnaires
  • Prescribing data analysis
  • Audits
  • Case-based discussions
  • Personal formularies
  • Patient and peer feedback

Tools and Techniques

Tools and techniques from Scope CCL include:

• Competence self-assessment and learning contract
• Personal formulary
• Records of training and clinical supervision
• Service user feedback
• Reflections on key cases and interventions
• Portfolio of evidence for prescribing competencies
• Audits of clinical effectiveness

Post-Registration Evaluation Tools

Direct SLE

• Acute Care Assessment Tool (ACAT)
• Case presentation (CP)
• Direct Observation Non-Clinical Skills (DONCS)
• Direct Observation of Procedural Skills (DOPS)
• Journal Club Presentation (JCP)
• Mini-Clinical Evaluation Exercise (Mini-CEX)
• Teaching Observation (TO)

Indirect SLE and Other

• Case-based Discussion (CbD)
• Clinical leadership assessment skills
• Quality improvement project assessment tool (QIPAT)
• Multisource feedback (MSF)
• Patient survey (PS)
• Reflective Account (RA)
• Prescribing data analysis
• Personal formularies
• Audits

Prescribing Data Analysis

Analyzing prescribing data involves examining:

• Payment for items
• Net ingredient cost (NIC) (£)
• Actual cost (£)
• Out-of-pocket expenses (OOPE) (£)
• Containers (£)
  Analyzing data by BNF chapter, such as:
• Gastro-Intestinal System (01)
• Cardiovascular System (02)
• Respiratory System (03)
• Central Nervous System (04)
• Infections (05)
• Endocrine System (06)

Personal Formularies

Personal formularies:

• Demonstrate awareness of local formularies and guidelines.
• Define scope of practice.
• Assure governance within the organization.
• Are planned according to a framework for prescribing considerations.
• Develop confidence.

According to WHO, 1994:

1. Define the diagnosis
2. Specify the therapeutic objective
3. Make an inventory of effective groups of drugs
4. Choose an effective group
5. Choose a drug

Incentive Schemes

Incentive schemes include:

• Quality and Outcomes Framework (QOF)
• Investment and Impact Fund (IIF)
• Pharmacy Quality Scheme (PQS)
• Pharmacy First Service
• New Medicine Service (NMS)
• Pharmacy Access Scheme (PhAS)

Audit

Clinical audit is defined by HQIP 2020 as:

• “A quality improvement cycle that involves measurement of the effectiveness of healthcare against agreed and proven standards for high quality, and taking action to bring practice in line with these standards so as to improve the quality of care and health outcomes.”

Community Pharmacy Contractual Framework

Examples include:

• Pharmacy-chosen clinical audit
• NHS England mandated 2022/23 - valproate
• 2018/19 - flu vaccination for people with diabetes
• 2014/15 - emergency supply Asthma Out of stock Smoking cessation Waste

Secondary Care and Other Sectors

• Conduct or be involved in clinical audits to contribute to national priorities or the performance of your Trust
• NMP audit might be a part of this and serves multiple purposes
• NICE quality standards might offer some helpful ideas for relevant audit standards

British Pharmacological Society, 2025

Principles of Good Prescribing:

1. Be clear about the reasons for prescribing
2. Take into account the patient’s medication history before prescribing
3. Take into account other factors that might alter the benefits and risks of treatment
4. Take into account the patient’s ideas, concerns, and expectations
5. Select effective, safe, and cost-effective medicines individualized for the patient
6. Adhere to national guidelines and local formularies where appropriate
7. Write unambiguous legal prescriptions using the correct documentation
8. Monitor the beneficial and adverse effects of medicines
9. Communicate and document prescribing decisions and the reasons for them
10. Prescribe within the limitations of your knowledge, skills and experience

When to Evaluate?

Evaluation should be done:

• Oftentimes
• Normally
• Periodically
• Recurrently
• Repeatedly
• Customarily
• Commonly
• Continually
• Regularly
• Continuously
• Usually
• Constantly
• Often
• Habitually

What to do with Evaluation Data?

Utilize the Gibbs Reflective Cycle:

• Description: What happened?
• Feelings: How did you feel?
• Evaluation: How did things go? (Good + Bad)
• Analysis: What sense can you make of the situation?
• Conclusion: What else could you have done? What have you learned? What can you change in the future?
• Action Plan: If the situation arose again, what would you do? Anything you need to know, or improve?

References

• British Pharmacology Society (BPS). 2025. Ten Principles of Good Prescribing.
• General Pharmaceutical Council (GPhC). 2021. Standards for the initial education and training of pharmacists.
• Healthcare Quality Improvement Partnership (HQIP). 2020 Best practice in clinical audit.
• NHS. 2019a. The NHS Long Term Plan.
• NHS. 2019b. The NHS Patient Safety Strategy.
• Royal Pharmaceutical Society (RPS). 2021. A competency framework for all prescribers.
• World Health Organisation (WHO). 1994. Guide to good prescribing.