Improving prescribing practice needs culture change
The benefits of pharmacist and nurse prescribing will be limited unless changes are made to the structure and culture of the health service, according to Professor Sir Michael Rawlins, chairman of the National Institute for Clinical Excellence.
In an article co-authored with Professor Nick Barber and Dr Bryony Dean
Franklin, of the School of Pharmacy, University of London, Professor
Rawlins predicts that practices and hospitals will have directors of
prescribing who monitor and develop prescribing and prescribers. The
authors also suggest that routine prescribing will be taken over by specialists,
generally pharmacists, and by improved technology. “The doctor,
instead of deciding what should be done and delivering it, will define
the ethos and the ends of treatment, and use others to deliver them.”
The authors recommend ways in which prescribing can be improved, including
the introduction of standardised National Health Service prescription
charts along with computerised prescribing and decision support. They
argue that having decisions made by computers does not necessarily mean
that prescribers will lose skills. “It just means that the skills
must be taught and learned in different (and better) ways,” they
add. “Until such fundamental differences in structure and culture
are achieved, the benefits of devolving prescribing will be limited,” they
conclude.
The article is published in Quality & Safety in Health Care (2003;12:i29). |
