Supplementary prescribing provides a great deal of professional
satisfaction
| Pharmacists have come a long way
in a short time since they were allowed to become supplementary
prescribers, says Debbie Andalo |
North Tyneside hospital pharmacist Neil Frankland became
the first pharmacist to write his own prescription when he prescribed
a laxative for an elderly
patient on a surgical ward in March. Now, only six months later, a pharmacist
at another hospital in West Yorkshire has taken on this new clinical
role to help relieve anxiety in cancer patients undergoing chemotherapy.
Professional frustration
How supplementary prescribing works at Airedale hospital
Airedale
General Hospital in Streeton has set up a chemotherapy
consent clinic that helps prepare patients before they embark on
a course
of chemotherapy. The patient visits the clinic a couple of days
after being diagnosed with cancer by the oncologist, having already
given verbal consent to chemotherapy. At the clinic the patient
sees the oncologist and the senior nurse who will together explain
about chemotherapy and its possible side effects and obtain written
patient consent for treatment.
The patient then moves on to be seen by the
supplementary prescribing pharmacist. At this point the pharmacist
takes a full drug history
and makes sure the patient is happy with the information given
about the treatment. The patient’s weight and height are
recorded at this stage so that the pharmacist can work out the
drug dosage.
The pharmacist works to a standard clinical management plan which
has been drawn up in advance with the oncologist. The patient is
then asked to sign the plan giving consent for the pharmacist to
take on the responsibility for prescribing the treatment. The pharmacist
can prescribe for two cycles of drugs before the treatment needs
to be reviewed by the oncologist. |
Clinical pharmacist Carl Booth has been the supplementary
prescriber leading the initiative at Airedale General Hospital (see Panel).
The
idea for the clinic first came about last autumn at the same time as
the doors were beginning to open for pharmacists to become supplementary
prescribers. Mr Booth explained how the scheme has evolved since then.
He said: “Pharmacists had been involved in prescribing for chemotherapy
for a few years at Airedale. We had an electronic prescribing system
for these patients and pharmacists would prepare the prescription for
doctors to sign. It was similar to the system which practice nurses
have with GPs in primary care.” But the system created professional
frustration as Mr Booth would find himself “prescribing” for
patients whom he never saw. He said: “I would know the name of
the patient but I if I met them in the corridor I wouldn’t know
who they were.”
At the same time there was some disquiet at the hospital about the
system of obtaining patient consent for chemotherapy. Under the old
system,
after being given the diagnosis the oncologist would explain the need
for chemotherapy and expect the patient to give verbal consent to the
treatment almost straight away. Mr Booth said: “Although there
really wasn’t enough time for the consultant to go through all
the details about chemotherapy, they were seeking verbal consent for
the treatment from the patient. Patients often went away for a cup of
tea before coming back to give their consent. We all felt that patients
really weren’t being given enough time to make a proper decision.”
When the opportunity to become supplementary prescriber became possible
last year Mr Booth could see the benefits the additional clinical responsibility
could bring to patients as well as the increased professional satisfaction
it would create. He said: “I was already working to what we called
an authorisation sheet, which was basically a management plan of treatment
for the patient including the diagnosis and the chemotherapy doses.”
The sheet was similar to the clinical management plan required for supplementary
prescribing, so the obvious next step was for Mr Booth to train as a
supplementary
prescriber. After becoming one of the first hospital pharmacists to qualify
as a supplementary prescriber in the spring the idea of the chemotherapy
consent clinic was developed further and finally got off the ground this
summer (see Panel for details).
He said: “I could see the potential of the clinic for me as a supplementary
prescriber and at the same time the senior nurse could see the benefit
for patients as far as gaining patient consent was concerned. The clinic
just came together out of that.”
So far around 20 patients, including those newly diagnosed with cancer
and some who are returning for chemotherapy because their cancer has
returned, have attended the clinic. Once the clinic is established the
team expects to see five new patients every week.
Even though the clinic is in its infancy the initial feedback from staff
and patients has been positive. According to Mr Booth, the consultants
are happy with the new system because it means they spend more time with
patients discussing diagnoses rather than having to devote time to discussing
the treatment.
The problems of rushed patient consent have been overcome and patients
report they feel more informed about their treatment. Mr Booth added: “The
feedback has been positive even though it’s early days. Patients,
particularly those who have had cancer before, think it’s excellent
and comment that they never had as much information before.”
He acknowledges that he may not actually be making the decision about
the choice of chemotherapy; that decision is still taken by the oncologist.
Nevertheless, he is getting professional satisfaction from making sure
that the right patient is taking the right drug at the right time, and
that patients are being monitored and reviewed regularly. He added: “I
don’t see why, in future, the oncologist shouldn’t make the
diagnosis about the type of cancer and then refer the patient on to me
at the clinic. I think that may be a long time off, particularly if patients
need second- or third-line treatment. I am also not confident about doing
that at the moment, but don’t see why I shouldn’t be able
to do that in the
future.” Confidence boosted
Mr Booth admitted that his role in the chemotherapy consent
clinic boosts his professional confidence. He said: “I get a great deal of
professional satisfaction. I think supplementary prescribing has been
the biggest development in the past few years from my own personal
point of view. I had got to a certain stage in my career where I had
started to think about what I was going to do next. I can see supplementary
prescribing being my focus now for a long time in the future.”
By the end of this August there were 201 supplementary prescribers
with the majority, 82, working in hospital pharmacy.
Sue Kilby, head of practice at the Royal Pharmaceutical Society, said
that pharmacists were aware of the different opportunities that supplementary
prescribing offered. She said: “There is a wide variety in what
supplementary prescribers are doing at the moment. The variety of initiatives
doesn’t surprise me because I always thought there were all sorts
of ways for pharmacists to get involved in supplementary prescribing.” |
