| · Prescribing (2)
· Compliance (2)
· Residential care
· Metered dosage systems
· Reciprocity
· Proton pump inhibitors
· Registration examination
· The Society (3)
· New pharmacy contract
Letters to the Editor
|
Prescribing
Supplementary prescribing — the future for pharmacists
From Mr N. J. Keen, MRPharmS
I recently embarked on a study tour of various UK hospital and primary
care pharmacy prescribing sites to observe and assess the UK model of
supplementary prescribing. My tour was partly directed by the article “Opportunities
in primary care: diary of a pharmacist primary prescriber” (PJ,
5 February, p151).
At present, Australia does not have legislation permitting pharmacist
prescribing. However the relevant state-based laws are poised for change.
Australian practitioners are therefore looking to models established
overseas to help shape development of the most appropriate model for
the Australian health system.
I was impressed and inspired by the supplementary prescribing practitioners
I encountered. These pharmacists displayed excellence in knowledge, skills
and practice. They uniformly shared a passion and commitment to the vision
of improving health outcomes with safe and appropriate use of medicines.
I observed just how highly these services are valued by primary prescribers
and patients alike.
Although other pharmaceutical services will always remain important to
the profession, prescribing makes full use of our unique education and
training. If we truly wish to achieve better outcomes with medicines,
prescribing is clearly the future for cognitive pharmacy services. UK
pharmacists should be rightly proud of the pioneers driving this new
and challenging area of practice.
I urge the Royal Pharmaceutical Society and all members to fully support
these practitioners by actively advocating to maintain the profile of
these new services and to achieve full, widespread funding of positions.
In addition, other needs of supplementary prescribers such as professional
support networks and quality continuing education and development should
not be forgotten.
Neil Keen
Senior Pharmacist
Sir Charles Gairdner Hospital,
Perth,
Western Australia
Continually frustrated
From Mrs F. Smith, MRPharmS
I am writing in response to Hugh McGavock’s thoughts
on independent prescribing (P&MM, 17 September, pPM3). As a qualified supplementary
prescriber working in a hospital I have found that I am unable to use
fully my prescribing skills. This is in part due to the transient nature
of patients in hospital and also the difficulty in implementing clinical
management plans. I have no doubt that pharmacist prescribing can work
in an acute hospital and think that independent prescribing status will
allow many pharmacists to work in partnership with doctors to ensure
medicines are prescribed appropriately from admission through to discharge.
I am continually frustrated by my inability to prescribe and frequently
have to leave notes for junior doctors to add medicines, amend doses,
review course lengths and follow up treatment plans which have been agreed
on ward rounds. I freely admit that I do not have the diagnostic skills
of a doctor, but as an active member of the multidisciplinary team I
have access to medical notes, ward round discussions, doctors and nursing
staff who provide me with all the relevant information. I think the key
to successful independent prescribing for hospital pharmacists is to
know your own limitations and work closely with doctors to ensure that
treatment plans are carried out successfully.
My prescribing experience is limited at present and for me to titrate
the dose of ACE inhibitors for patients on stroke rehabilitation wards
involves discussion with the consultant, obtaining agreement for supplementary
prescribing to occur, completing a clinical management plan (CMP), obtaining
patient consent, documenting the notes, monitoring blood pressure and
renal function and, finally, prescribing. Unfortunately it is quicker
for me to ask a doctor to increase the dose. As an independent prescriber
the process would be the same, without the need for a CMP and obtaining
patient consent — although I would discuss the medication change
with the patient, something doctors often omit to do.
I fully supported the option, in the recent consultation document on
independent prescribing, for hospital pharmacists to have full access
to the range of drugs in the British National Formulary and be able to
prescribe for any condition. I do think that there should be some control
exercised for individual pharmacists and think that this should be in
the form of an agreement between the prescribing consultant and the prescribing
pharmacist, which defines the scope of medicines to be prescribed. I
can only give my views as a hospital pharmacist, but I am sure my colleagues
working in primary care can defend their equally valid right to prescribe
independently.
Fiona Smith
Halifax, West Yorkshire
|
The
Pharmaceutical Journal