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To Audit – A Pharmacist Independent Prescribers Experience where did I start? Non Medical Prescribers Conference 2012 Graham Rodgers Pharmacist IP.

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Presentation on theme: "To Audit – A Pharmacist Independent Prescribers Experience where did I start? Non Medical Prescribers Conference 2012 Graham Rodgers Pharmacist IP."— Presentation transcript:

1 To Audit – A Pharmacist Independent Prescribers Experience where did I start? Non Medical Prescribers Conference 2012 Graham Rodgers Pharmacist IP

2 Introduction Clinical governance requires auditing, monitoring and evaluating our own prescribing practice General Pharmaceutical Council’s standards of Conduct, Ethics and Performance

3 Background information By the beginning of 2010 – 9 acute sector Pharmacists In Grampian qualified as Independent Prescribers (PIP) My regulatory body requires I audit my own prescribing practice My indemnity insurance also requires my prescribing practice follows my regulatory bodies guidelines I also wanted to see where and what prescribing activities were undertaken by pharmacists to help plan a strategy for pharmacist prescribing in the acute sector

4 Aim To evaluate the development of the prescribing practice of Pharmacist Independent Prescribers within the acute Grampian sector after 1 year of qualification

5 The main objectives of the audit were: To identify how Pharmacist Independent Prescribing is being developed within the acute sector in NHS Grampian To identify the range of drugs being prescribed and the reasons for prescribing by Pharmacist Independent Prescribers (PIP)

6 Objectives breakdown to know what other pharmacist independent prescribers were prescribing in the acute sector and …. Where they were prescribing? What drugs? Why they were prescribing? And was I doing the same as them?

7 Method and Sample Which Areas/patients covered/ included in the audit e.g. ARI, Woodend, RACH and/or surgical/kids/elderly How the data was collected? e.g. weekly/monthly How to record data collection?

8 Methodology breakdown First, I needed a recording sheet for my results and one that everyone else could use I developed a prescribers log sheet I piloted this in my own clinical area for a week and reviewed my results and how well the log sheet worked

9 Example of draft Pharmacy Non medical Prescriber (NMP) Prescribing Log DatePatient initials/ CHI Medicine prescribed Continuation of existing therapy, Amendment, New prescription, Discontinuation Reason for prescription Prescription document Time taken

10 Next step I persuaded 9 colleagues to participate in the audit We chose a week Carried out the self audit I collated the data and produced two tables I presented back to my colleagues and pharmacy management

11 2011 Pharmacist Independent Prescribers (PIP) audit Results table 1 Total No. of drugs prescribed Non Formulary drugs changed (%) Continuation of existing therapy e.g. IV to oral (%) Amendment of therapy (%) New Prescription (%) Discontinuation (%) Number of wards audited 374 (100%) 3 (0.8) 113 (30.2) 54 (14.5) 134 (35.8) 70 (18.7) 18+

12 Results table 2 Break down of reasons for new or amended prescribing by PIP New diagnosis45% Titration of dose13% Change to guideline 7% New drug 7% Omissions 6% TPN 6% Switch Route of administration 6% Change to renal dose 5% Frequency switch 3% Medical staff unavailable 2%

13 Results summery 9 PIPs carried out audit over 1 week 18+ wards covered in ARI and RACH (TPN covered several surgical and medical wards) 63 different drugs were prescribed 374 prescriptions were signed by a PIP More than a third (35.8%) of PIP prescription involved new medications Nearly half (45%) of Pharmacist prescribing was for newly diagnosed conditions

14 Discussion This audit shows that all the Pharmacist independent prescribers involved have developed the role within their clinical areas (18+ wards) Medications prescribed have varied from simple laxatives and analgesics to chemotherapy Pharmacist independent prescribers are confident independent prescribers and able to start new drug therapies for newly diagnosed conditions

15 Conclusion This audit is self limiting and generates more questions? Future Audit ideas With the expansion of the number of Pharmacist independent prescribers within the acute sector a more structured audit is required to independently review the prescribing practice of Pharmacists which may focus on reasons for not prescribing, training and support requirements, safety, patient and service needs, strategy and development of pharmacist independent prescribers etc Watch this space

16 Action Plan The action plan should reflect what was discussed and concluded. Also an agreed date for each action to be completed and who to complete the action Action PointDate Action to be completed by Actioned by whom Dissemination of results2011 GR + team To request Clinical Governance & Risk Management Unit support for Repeat audit (more PIP registered 2012-13) End of 2012GR + pharmacy management help To identify what should be audited in collaboration with Pharmacy and Clinical Governance & Risk Management Unit On goingGR + help from team and management Continue and evaluate future audit data 2013Audit group

17 References General Pharmaceutical Council’s standards of Conduct, Ethics and Performance

18 Acknowledgements Thank you to the 8 other guinea pigs from the pharmacy team who helped with the audit

19 Any Questions?


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