Pharmacists positive about supplementary prescribing
| Pharmacists who are the first to join supplementary prescribing courses tell Clare
Bellingham what they think about the contents |
Clare Bellingham is on the staff of The Pharmaceutical Journal
|
The first supplementary prescribing courses
are drawing to a close. New courses will start at the beginning of next
year, and the pharmacists
who have successfully completed this term’s courses will start
prescribing in January or February.
At King’s College in London, the taught part of the supplementary
prescribing course is scheduled to finish in the middle of December.
Exams will be held in January.
Felicity Davies: course has helped break down professional boundaries |
Felicity Davies, a community pharmacist in Pulborough,
West Sussex, is on the King’s course. “Overall, the course has been really
good,” she says. Aside from the course content, she highlights
the benefits of networking with colleagues and also improving relationships
in her workplace.
“The fact that I have to go away, look at guidelines for prescribing and
then talk to GPs about them is really good. It has helped me form better
relationships and has broken down professional boundaries,” she
says. Learning in practice
“We had to start the period of learning in practice from day one of the
course — in order to fit the 12 days in over the three-month period,” she
explains. Mrs Davies spent half her period of learning in practice working
within the speciality clinic in which she will prescribe and half in
general practice with her mentor, a GP.
She explains: “I’ve spent half the time in a diabetes clinic,
sitting with the practice nurse who specialises in the condition. I have
been involved in changing medicines from the word go and I have also
learned how to carry out finger pricking and blood monitoring.”
The time spent with her mentor during consultations has also been useful. “Watching
him has taught me how to open consultations, how to
extract information about the patient’s condition and for prescribing,
and how to ask about the patient’s family all within a 10-minute
consultation,” Mrs Davies says.
Her mentor has been keen for her to have an input into the consultation,
rather than just observing. “From the word go he has assumed I
will help with decisions,” she says.
At the start of the course, Mrs Davies and her mentor agreed a learning
contract. “My number one priority was learning how to translate
what I know I can do on paper — in other words seeing the patients’ notes
and advising what actions are needed, and then translating this into
face-to-face practice with a patient.”
Meanwhile, her mentor’s primary learning objective for her was
how to prescribe safely.
“In fact, the course has not been that challenging: I have had some frustrations
with downloading course files from the internet and finding the time
to study has been difficult.”
But some aspects of the course, which is open to both pharmacists and
nurses, has been easy for the pharmacists, for example the sessions dealing
with pharmacokinetics.
“The hardest thing will be the first day I have a prescription pad in
my hand and writing that first prescription,” she says.
So overall, would Mrs Davies recommend the course and the supplementary
prescribing role to other pharmacists? “Yes. It’s as if I’ve
died and gone to heaven. This is what pharmacists are made for and patients
love it,” she says. Hospital perspective
Four pharmacists at Southampton General Hospital are also
on the supplementary prescribing course at King’s College, London.
Two are specifically interested in parenteral nutrition, one in parenteral
nutrition and therapeutic drug monitoring, and one in HIV treatment.
Peter Austin, a senior pharmacist with the hospital’s nutrition
support team, says that the course is progressing well. “One topic
of particular personal interest was appropriate appraisal of the literature,
helping to provide an evidence-base for prescribing decisions,” he
comments.
The pharmacists began the period of learning in practice shortly after
the course started. Following discussions with mentors about what needed
to be covered, a programme of tutorials with senior medical staff was
designed to help meet these learning objectives.
Topics included general prescribing issues such as ethics and prescribing
responsibilities, as well as sessions about the specific clinical areas
in which the pharmacists plan to prescribe.
“The aim was to ensure accreditation both for the course requirements
but also for local assessment of prescribing competency in our specialist
areas,” Mr Austin explains. Building on current practice
Mr Austin says that it has been interesting and beneficial
to discuss issues both during the course programme and also with his
mentor. “Our
current practice is well-established but the course is building on
this by exploring topics to allow the transition to final authorisation
of prescribing decisions.”
He comments that both the pharmacy department at the hospital and his
mentor have been supportive. “The specific tutorial time with senior
medical staff has provided a valuable opportunity to discuss topics with
staff who are busy but supportive of the development of pharmacist supplementary
prescribers,” he says.
“Travelling to King’s College every week does take time, but the
course tutors have continually kept us up to date with information by
e-mail,” he says.
Mr Austin is also positive about the future. “Following on from
our excellent experiences so far at King’s College we are actively
looking to expand our numbers of pharmacists undertaking supplementary
prescribing courses,” he says. Clinics already running
Fiona Reid takes a blood sample from a
patient at a hypertension clinic |
Fiona Reid is a pharmacist at Newbyres Medical Group surgery
in Gorebridge, Midlothian. She is training to become a supplementary
prescriber at
the Robert Gordon University in Aberdeen.
Her general impression of the course is positive. “I’m
happy with the course. So far I have completed three out of four modules
and
by Christmas will have completed the 12 days in practice too.”
Completing the period of learning in practice has been relatively easy
for Mrs Reid because she has been running hypertension clinics in the
GP surgery for a couple of years.
She has recently set up additional clinics for patients with heart failure.
Within these two therapeutic areas, Mrs Reid undertakes all the medicines
management for patients, including monitoring, dose titration and starting
new drugs.
“The GPs and I are looking forward to me qualifying as a supplementary
prescriber. They say that I am the expert and think it is ridiculous
that at the moment they have to sign prescriptions for me,” she
says.
However, because the clinics have been running for a while, the transition
to supplementary prescribing should be fairly straightforward.
“I expect my clinical management plans will be quite broad, saying for
example to follow a SIGN guideline rather than limiting prescribing to
a particular drug class. This is because the GPs have had experience
of working with me.” Consultation skills
Mrs Reid says that the most interesting part of the course
has been the consultation skills session. “It was run by a clinical psychologist
and looked at different aspects of consultations such as body language,
how to speak to patients and what patients bring into consultations.
It certainly changed my practice,” she says.
“It also gave me an opportunity to ask about how to deal with difficult
consultations, such as patients who are anxious or talkative.”
She highlights that the course has provided guidance on how to structure
clinical consultations and that this is particularly useful for someone
setting up clinics for the first time.
However, certain aspects of the course, such as recording a consultation
with a patient, have been difficult for pharmacists who are not already
practising in a clinic setting, she says. “Although community pharmacists
see patients every day, it is not in this type of one-to-one setting,” she
explains. Take the profession forward
“The therapeutics module was the easiest part of
the course, and nothing has been that hard,” she says. Each pharmacist
selects a therapeutics module according to the area they are planning
to prescribe in, and Mrs
Reid chose the module about hypertension and heart failure.
“I would encourage as many pharmacists as possible to complete the
supplementary prescribing course to take the profession forward,” she
emphasises. |
