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Non -Medical Prescribing in the Northern Health and Social Care Trust Professor Mike Scott Head of Pharmacy and Medicines Management Clotworthy House 27.

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Presentation on theme: "Non -Medical Prescribing in the Northern Health and Social Care Trust Professor Mike Scott Head of Pharmacy and Medicines Management Clotworthy House 27."— Presentation transcript:

1 Non -Medical Prescribing in the Northern Health and Social Care Trust Professor Mike Scott Head of Pharmacy and Medicines Management Clotworthy House 27 th June 2013

2 NHSCT non –medical prescribing committee (ToR 1) Management of non-medical prescribing matters within the NHSCT Management of non-medical prescribing matters within the NHSCT To ensure that the appropriate governance arrangements are in place in respect of non – medical prescribing To ensure that the appropriate governance arrangements are in place in respect of non – medical prescribing To update the Northern Prescribing Forum on non-medical prescribing matters as required To update the Northern Prescribing Forum on non-medical prescribing matters as required

3 NHSCT non –medical prescribing committee (ToR 2) To act as the focal point of contact or liaise with HSC Board,DHSSPS,PHA and BSO as required To act as the focal point of contact or liaise with HSC Board,DHSSPS,PHA and BSO as required To act as the link to the respective professional group in respect of non medical prescribing issues. To act as the link to the respective professional group in respect of non medical prescribing issues. To ensure that all statutory obligations in respect of non medical prescribing are met To ensure that all statutory obligations in respect of non medical prescribing are met

4 Agenda Items Controlled drugs Controlled drugs Unlicensed medicines policy Unlicensed medicines policy Mixing of medicines Mixing of medicines AHP prescribing update AHP prescribing update Electronic database Electronic database Patient group directions Patient group directions Training Training

5 Non- Medical Prescribing Policy(1) Provides the framework for the prescribing of medicines by nurses,midwives pharmacists and AHPs as legislation permits Provides the framework for the prescribing of medicines by nurses,midwives pharmacists and AHPs as legislation permits The purpose of the policy is to enable registered non –medical prescribers to prescribe medicines for patients within the NHSCT The purpose of the policy is to enable registered non –medical prescribers to prescribe medicines for patients within the NHSCT The overall aim of this policy is to significantly improve the accessibility of medicines to patients and to support modernisation and reform of the service The overall aim of this policy is to significantly improve the accessibility of medicines to patients and to support modernisation and reform of the service

6 Non- Medical Prescribing Policy(2) Who May Prescribe Qualifications Qualifications Selection process for Training Selection process for Training Process for approval to practice for qualified non –medical prescribers Process for approval to practice for qualified non –medical prescribers Process for those who change speciality Process for those who change speciality

7 Non- Medical Prescribing Policy(3) Prescribing and Dispensing Process Inclusions and exclusions for prescribing Inclusions and exclusions for prescribing Prescribing process within the Trust Prescribing process within the Trust (a) Patient consent (a) Patient consent (b) Prescription writing (b) Prescription writing (c) Prescription security (c) Prescription security Separation for prescribing,dispensing and administration where appropriate Separation for prescribing,dispensing and administration where appropriate Verification for prescribing status Verification for prescribing status

8 Non- Medical Prescribing Policy(4) Record keeping Record keeping Requests for new products/technologies Requests for new products/technologies Ordering and receiving laboratory tests Ordering and receiving laboratory tests Maintaining competency and service developments Maintaining competency and service developments Area of practice and clinical responsibility Area of practice and clinical responsibility Continuing professional development Continuing professional development accountability accountability

9 Non- Medical Prescribing Policy(5) Clinical and social care governance and audit Supporting designated medical practitioner Supporting designated medical practitioner Who can become one Who can become one Roles and responsibilities working with non medical prescribers Roles and responsibilities working with non medical prescribers Roles and responsibilities of the non medical prescriber Roles and responsibilities of the non medical prescriber Assessment in practice Assessment in practice Mentoring Mentoring Monitoring prescribing Monitoring prescribing

10 Non- Medical Prescribing Policy(6) Incident reporting Incident reporting Adverse drug reactions Adverse drug reactions Legal and clinical liability Legal and clinical liability Trust liability Trust liability Individual practitioner liability Individual practitioner liability Patients and public involvement Patients and public involvement

11 Non- Medical Prescribing Policy(7) Prescribing for self family and friends Prescribing for self family and friends Relationships with pharmaceutical companies Relationships with pharmaceutical companies Equality statement Equality statement

12 Pharmacist Prescribers Independent 141 Independent 141 Supplementary 18 Supplementary 18 Independent Independent 22 community 22 community 2 locum/community 2 locum/community 12 practice pharmacist 12 practice pharmacist 7 prescribing advisor 7 prescribing advisor 95 Hospital 95 Hospital

13 Primary care Nurse prescribers Eastern Area 134 Eastern Area 134 Northern Area 52 Northern Area 52 Southern Area 54 Southern Area 54 Western Area 82 Western Area 82

14 Seven Principles of Good Prescribing (National Prescribing Centre) Consider the patient Consider the patient Which Strategy Which Strategy Consider the choice of product Consider the choice of product Negotiate a contract Negotiate a contract Review Review Record keeping Record keeping reflect reflect

15 Areas of work of Non –Medical Prescribers Palliative care Palliative care Respiratory Respiratory Diabetes Diabetes Urology Urology Family planning Family planning Rheumatology Rheumatology Endoscopy Endoscopy Heart failure Heart failure Anti coagulants Anti coagulants

16 General Treatment plan for pharmacist independent prescribers Admission medicines Admission medicines Amendments to kardexes Amendments to kardexes Minor ailments Minor ailments Product standardisation Product standardisation Discharge prescriptions Discharge prescriptions Medicine titration dosage adjustments Medicine titration dosage adjustments

17 Validation of independent pharmacist prescribing The study was conducted over a 6-week period on a 27-bedded cardiovascular ward. Data was collected at admission during the medicines reconciliation process, by pharmacist independent prescribers who prescribed at warfarin clinics but who did not prescribe routinely at ward level. Details of occasions when the input of medical staff was required to change a patients admission medication that the independent prescribers could have changed themselves were recorded. The time taken to obtain medical input and if the medical staff agreed with the proposed changes were also recorded. Details were not recorded on changes required to: The study was conducted over a 6-week period on a 27-bedded cardiovascular ward. Data was collected at admission during the medicines reconciliation process, by pharmacist independent prescribers who prescribed at warfarin clinics but who did not prescribe routinely at ward level. Details of occasions when the input of medical staff was required to change a patients admission medication that the independent prescribers could have changed themselves were recorded. The time taken to obtain medical input and if the medical staff agreed with the proposed changes were also recorded. Details were not recorded on changes required to: controlled drug prescriptions controlled drug prescriptions unlicensed drugs unlicensed drugs proposed changes to medicines related to the management of the patients acute conditions proposed changes to medicines related to the management of the patients acute conditions

18 Results Table 1: Types of interventions proposed by the pharmacist independent prescribers during the data collection period Intervention Number of times proposed by pharmacist Number of times intervention accepted by medical staff Medication inadvertently omitted (100%) Medication prescribed incorrectly (100%) Medication recommended by other HC professionals 4 4 (100%) Medications prescribed twice 3 3 (100%) Other3

19 Benefits Increased job satisfaction Increased job satisfaction Self –confidence Self –confidence Increased time with patients Increased time with patients Greater recognition of role Greater recognition of role Time saving Time saving More medicines information provided More medicines information provided

20 Barriers Organisational structure Organisational structure Financial problems Financial problems Lack of awareness of the prescribing role Lack of awareness of the prescribing role Restrictions imposed by the CMP Restrictions imposed by the CMP


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