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Letters to the Editor
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Pharmacist prescribing
Questions raised
From Mr D. M. Thornton, MRPharmS
I read with interest the Agenda
for 2006 article (PJ, 9 December 2006,
p691) looking at what is needed to take pharmacist prescribing into the
mainstream. I fully support the view that pharmacists can make a positive
contribution to patient care by developing innovative services using
supplementary prescribing (SP). This must always be within the legal
framework applicable at the time. However the case study outlined in
Panel 1 (hospital) raised some interesting questions.
My understanding of the current SP legislation is that the clinical management
plan (CMP) must be an agreement between an individual patient, an SP
and an independent prescriber (IP). Therefore a CMP presigned by a clinical
director (presumably taking collective responsibility for a number of
other IPs) would not be acceptable, especially if the clinical director
was not the IP responsible for the particular patient in question on
the current admission. Additionally, a CMP that allows an SP to prescribe
any existing medicine upon admission to hospital is questionable. In
this case the IP would be the GP and not the secondary care consultant.
Therefore how can the CMP, presigned by the clinical director, cover
this aspect of SP?
These two points form a large part of the argument for IP in secondary
care since the current SP framework, in my opinion, does not allow either.
I would be interested in the view of the Royal Pharmaceutical Society
on both of these relevant and important issues, particularly from the
secondary care perspective.
Dave Thornton
Principal Clinical Pharmacist
University Hospital Aintree, Liverpool
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DANIELLA MURPHY, senior pharmacist adviser in the Royal Pharmaceutical
Society’s fitness-to-practise directorate, responds:
Supplementary
prescribing is a voluntary partnership between an independent prescriber
(IP) and a supplementary prescriber (SP) to implement an agreed patient-specific
clinical management plan (CMP) with the patient’s consent.
An SP can, in accordance with the terms of a CMP, prescribe prescription-only
medicines, or if the product is for parenteral administration, either administer
it or give directions for its administration. The CMP must contain various
particulars, relate to the patient the product is prescribed for,
or is to be administered
to, and the plan must be in effect at the time the prescription is given
or the product is administered.
SPs must have access to the same health records of the patient to whom the
plan relates as the doctor or dentist who is party to the CMP.
Therefore, it would be my understanding that where supplementary prescribing
was to be implemented and a patient was admitted to hospital, a hospital
clinician would become the patient’s IP and would be responsible for the initial
clinical assessment and diagnosis of the patient. Consequently the IP would
agree a CMP with the SP and the patient.
I believe that in order for this requirement to be fulfilled, if a clinical
director signs the CMP as the IP, he or she must be the clinician responsible
for the
care of the patient to whom the CMP refers. It would therefore be his or
her duty to ensure that they make the appropriate evaluation and diagnosis
on admission,
that a CMP is agreed with the SP and patient and he or she must then take
responsibility for the patient’s care. As a result of the clinical assessment and diagnosis,
it may be agreed that the patient’s current medication should be continued. |
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The
Pharmaceutical Journal