Non -Medical Prescribing in the Northern Health and Social Care Trust Professor Mike Scott Head of Pharmacy and Medicines Management Clotworthy House 27th June 2013

NHSCT non –medical prescribing committee (ToR 1) Management of non-medical prescribing matters within the NHSCT To ensure that the appropriate governance arrangements are in place in respect of non –medical prescribing To update the Northern Prescribing Forum on non-medical prescribing matters as required

NHSCT non –medical prescribing committee (ToR 2) To act as the focal point of contact or liaise with HSC Board,DHSSPS ,PHA and BSO as required To act as the link to the respective professional group in respect of non medical prescribing issues. To ensure that all statutory obligations in respect of non medical prescribing are met

Agenda Items Controlled drugs Unlicensed medicines policy Mixing of medicines AHP prescribing update Electronic database Patient group directions Training

Non- Medical Prescribing Policy(1) Provides the framework for the prescribing of medicines by nurses,midwives pharmacists and AHPs as legislation permits The purpose of the policy is to enable registered non –medical prescribers to prescribe medicines for patients within the NHSCT The overall aim of this policy is to significantly improve the accessibility of medicines to patients and to support modernisation and reform of the service

Non- Medical Prescribing Policy(2) Who May Prescribe Qualifications Selection process for Training Process for approval to practice for qualified non –medical prescribers Process for those who change speciality

Non- Medical Prescribing Policy(3) Prescribing and Dispensing Process Inclusions and exclusions for prescribing Prescribing process within the Trust (a) Patient consent (b) Prescription writing (c) Prescription security Separation for prescribing ,dispensing and administration where appropriate Verification for prescribing status

Non- Medical Prescribing Policy(4) Record keeping Requests for new products/technologies Ordering and receiving laboratory tests Maintaining competency and service developments Area of practice and clinical responsibility Continuing professional development accountability

Non- Medical Prescribing Policy(5) Clinical and social care governance and audit Supporting designated medical practitioner Who can become one Roles and responsibilities working with non medical prescribers Roles and responsibilities of the non medical prescriber Assessment in practice Mentoring Monitoring prescribing

Non- Medical Prescribing Policy(6) Incident reporting Adverse drug reactions Legal and clinical liability Trust liability Individual practitioner liability Patients and public involvement

Non- Medical Prescribing Policy(7) Prescribing for self family and friends Relationships with pharmaceutical companies Equality statement

Pharmacist Prescribers Independent 141 Supplementary 18 Independent 22 community 2 locum/community 12 practice pharmacist 7 prescribing advisor 95 Hospital

Primary care Nurse prescribers Eastern Area 134 Northern Area 52 Southern Area 54 Western Area 82

Seven Principles of Good Prescribing (National Prescribing Centre) Consider the patient Which Strategy Consider the choice of product Negotiate a ‘contract’ Review Record keeping reflect

Areas of work of Non –Medical Prescribers Palliative care Respiratory Diabetes Urology Family planning Rheumatology Endoscopy Heart failure Anti coagulants

General Treatment plan for pharmacist independent prescribers Admission medicines Amendments to kardexes Minor ailments Product standardisation Discharge prescriptions Medicine titration dosage adjustments

Validation of independent pharmacist prescribing The study was conducted over a 6-week period on a 27-bedded cardiovascular ward. Data was collected at admission during the medicines reconciliation process, by pharmacist independent prescribers who prescribed at warfarin clinics but who did not prescribe routinely at ward level. Details of occasions when the input of medical staff was required to change a patient’s admission medication that the independent prescribers could have changed themselves were recorded. The time taken to obtain medical input and if the medical staff agreed with the proposed changes were also recorded. Details were not recorded on changes required to: controlled drug prescriptions unlicensed drugs proposed changes to medicines related to the management of the patients’ acute conditions

Results Table 1: Types of interventions proposed by the pharmacist independent prescribers during the data collection period Intervention Number of times proposed by pharmacist Number of times intervention accepted by medical staff Medication inadvertently omitted 83 83 (100%) Medication prescribed incorrectly 45 45 (100%) Medication recommended by other HC professionals 4 4 (100%) Medications prescribed twice 3 3 (100%) Other

Benefits Increased job satisfaction Self –confidence Increased time with patients Greater recognition of role Time saving More medicines information provided

Barriers Organisational structure Financial problems Lack of awareness of the prescribing role Restrictions imposed by the CMP