Top Tips for prescribers working in Secondary Care 19th May 2011

Policy and Legal Considerations
What is the local policy for recognising pharmacist prescribers? / Different Boards may have different policies regarding whether or not you can prescribe. In addition to registering with the GPhC, you may have to register with whoever is responsible for non-medical prescribing. Ideally your job description should reflect your prescriber status. You probably also want to take out third-party insurance, e.g. through the Guild.
Does your department have a strategy for the implementation of pharmacist prescribing? / Some departments or specialities within departments may include pharmacist prescribing as part of their service. This may help identify areas of prescribing practice.
Getting started / Developing prescribing practice
Are there any pharmacists practicing as prescribers in your hospital? / Even if you are working in a different specialty, other pharmacist prescribers may be practicing in a way that is transferable.
Are there any clinical specialists in your area prescribing locally or elsewhere? / Look further a field if need be. Others within your specialty may be able to help you get started. This could involve sharing CMPs when starting out as an SP.
Are you planning on prescribing for in-patients/daycases or out-patients? / Most hospital pharmacists will work on wards ordaycase units. This will involve prescribing on inpatient prescription sheets, daycase treatment records and discharge prescriptions.
If you plan on prescribing for out-patients, what type of prescriptions will you use, and are there funding issues that need to be resolved (e.g. if using GP10(P) prescriptions)?
What is the local policy for recognising prescribers who use in-patient/daycase prescription forms (e.g. Kardex) and discharge prescriptions? / Local policy may dictate how you identify yourself as a pharmacist prescriber to nursing staff administering medicines or to pharmacy staff issuing medicines.
If you intend prescribing for out-patients, what type of prescriptions will you be using? / Although in-patient prescribing will be more common, certain roles may involve out-patient or day case prescribing. The appropriate type of prescription will need to be identified and sourced. Out-patient prescribing in Scotland is not common but different prescription pads exist. There are pharmacist versions of the blue pads sometimes used by A&E departments or GP(10)P pads used in primary care (see above regarding funding).
Does your area of clinical practice lend itself to practice as an SP or IP? / The main advantage of supplementary prescribing (at least for now) is the ability to prescribe controlled drugs (including low dose codeine). Clearly if these are an essential part of your practice then practicing as an SP is preferable. The advantage of IP practice is the lack of need for pre-agreeing the range of medicines that can be prescribed and its flexibility.
Another consideration is that of confidence. New prescribers may like the presence of an agreed CMP to support their practice in the early days. This can then be expanded or replaced by IP practice in time.A CMP may be used by an IP as guidance until experience is gained.
If you are unsure of the role you can adopt, consider the following:
  • Does the designated medical practitioner who signed you off have any ideas?
/ I you feel that there may be resistance among your senior doctors, speak to your DMP. He may well have ideas about what you can do and can help with discussions within the team. These can then be discussed with your Clinical Manager.
  • What are the most common interventions you make as a pharmacist?
/ Think about what you do each day. Many of your interventions could be dealt with by prescribing, rather than asking a junior doctor to sort things out. You may want to systematically record your interventions to get some ideas. Thesecould include: missing medicines on admission (e.g. inhalers), omitted routine medicines (e.g. GTN sprays), dose adjustments based on interactions (simvastatin), renal function (enoxaparin) or TDM (antibiotics).
What medicines would you feel competent to prescribe initially? / Initially, the list of medicines you prescribe may be limited and uninspiring! However, with time (and experience) you, and the rest of the team, will become more comfortable with the role you are assuming. At this point you can review the range of medicines, and prescribing circumstances, you are responsible for.
Where should I record my prescribing decisions? / Practice as an SP requires an entry to be made in the patient’s case notes as soon as is practical. It could be argued that the in-patient prescription sheet is a part of the case note, but it does not give the opportunity to explain the prescribing decision. For IPs, it is considered good practice to document all prescribing decisions in a form that allows other members of the team to understand why the prescription was written. Local policy may dictate thata record is made in the case notes.
What if some of my Consultants don’t want me to prescribe? / This is a possibility. If this happens, consider restricting what you want to do initially. If they are not convinced then you may want to start with those Consultants who are happy, hopefully including your DMP if possible. This may mean restricting the patients you prescribe for. It is not necessary to prescribe for all patients and there is value in limiting prescribing to one team who can feed back on your performance.
Ongoing Support
Where can I access help and support to aid in my prescribing practice? / Some organisations will have local non-medical prescribing fora to help new prescribers irrespective of their profession. Your non-medical prescribing lead will know if these exist.
Departmental peer review meeting would be an appropriate place to discuss prescribing practice.
Local or national clinical specialist groups (e.g.’ cancer, critical care etc) would best support practice within that specialty. Some of these groups have developed national standards for practice.
The NES website
contains support material as does the National Prescribing Centre.
NES also run courses on consultation skills and clinical assessment skills. These courses will help your confidence in obtaining the appropriate information you need to make prescribing decisions.
NES also employ Regional Practice Education Co-ordinators (PECs) detailed below to facilitate the introduction and support of pharmacist prescribing. Make contact with your Regional PEC for support. They will also help put you in touch with others who can help you!
East region / Fiona.Reid /
West region / Leon Zlotos /
North region
Grampian and Highland / Airlie Bryce /
North region
Tayside / Eileen Peebles /

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