Features

Taking on new areas of practice by becoming an independent prescriber

My job as “eldercare directorate pharmacist” in Cornwall and Isles of Scilly Health Authority is split into two parts. At Treliske Hospital, Truro, I look after two wards and the acute care of the elderly directorate and as a community eldercare pharmacist I visit two community hospitals and look after the community care of the elderly division.

When I qualified as an independent prescriber nine months ago, I had planned to continue with the work I was doing while I was training to become a prescriber. The doctor who was mentoring me worked at one of the community hospitals in the south of Cornwall where I had already established a service reviewing medicines in the falls clinic and writing to patients’ GPs in order to get changes made to medication regimens that I recognised as unsafe.

I was hoping that the prescribing couse would give me the skills to continue and expand this service to involve prescribing medicines such as bisphosphonates and calcium and vitamin D when necessary and to provide schedules for reducing the use of benzodiazepines and other sedating drugs.

However, the course also taught me how to take a holistic approach to patient care, from taking histories and undertaking examination techniques to formulating treatment plans. To do this I worked both in the outpatient department and on wards, alongside the medical staff and other health professionals, and this gave me a way of integrating my pharmacy knowledge and new skills to the benefit of the patients and the team.

We were the first cohort to become independent prescribers at the University of Bath so I feel like a bit of a pioneer of independent prescribing. Perhaps this is partly why I believe that prescribing pharmacists need also to find new ways of working and to communicate these to those hoping to build on our work.

I have now extended the medicines management work on the wards of the acute hospital to include reviewing patients with swallowing difficulties and changing products to suitable and safe formulations, especially for patients who are fed by nasogastric or PEG tubes. I also do some minor ailment prescribing. In the care of the elderly, this is usually prescribing for constipation, indigestion or eye infections.

I have, in conjunction with the hospital’s medicines management chief technician written a policy for patients who, on admission, have been using monitored dosage systems. These patients need to be discharged with medicines that do not confuse them and the best way to ensure this is to liaise with the community pharmacist who usually blister packs their medicines.

If a prescription has changed, on discharge I will write an FP10 and fax it to the community pharmacist to ensure that, on getting home, the patient will have his or her usual monitored dose system, that he or she is used to, delivered to them by the pharmacy.

I have my own stamp for the yellow FP10s I write. This saves the time and trouble of explaining to the doctor who writes the discharge summary (which is incorporated into the hospital discharge form) and asking him or her to rewrite the discharge prescriptions on FP10s.

In July 2007, I attended a Parkinson’s disease master class intended for specialist registrars who work in Parkinson’s disease clinics and have used this to offer pharmacy services in a new area, becoming part of a team alongside a consultant and a specialist nurse in a Parkinson’s disease clinic.

I thus work as an independent prescriber on my wards and in two outpatient clinics (the falls clinic and the Parkinson’s disease clinic). However, I believe I need to build on this work.

As an independent prescriber I have to do more continuing professional development than I used to because, in these formative years, there is still so much to learn. Alongside other independent and supplementary prescribers the three pharmacist independent prescribers at the hospital have now formed a group that meets regularly to discuss our practice and training issues, and to support one another.

Prescribing has changed my job and my outlook on pharmacy services. It is rewarding to get feedback on patients whose conditions have improved. The prescribing course at Bath was a lot of hard work but the experience has changed my perception of patient care and made me more aware of therapy for the elderly, caring for the patient as a whole, and not just looking at what medicines they are taking.

I think the future is bright for pharmacist independent prescribers.