1. 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

2. 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

3. 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

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

5. 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

6. 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

7. 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

8. 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

9. 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

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

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

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

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

14. 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

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

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

17. 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

18. 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

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

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