I have studied my bachelors in India where almost all the times only doctors are involved in prescribing medicines. The concept of non-medical prescribing where other health professionals are actively involved in prescribing medicines to patients was completely new to me. With my knowledge of the services provided with in community pharmacies like OTC medication advice, PGD’s, minor ailments scheme, emergency and urgent supply, I realized that community pharmacists actively participate in patient care by writing prescriptions in case of PGD’s in Scotland. However, this is not prescribing. I had to study a lot regarding this topic to get an idea of how non medical prescribing works, its history and advantages. The lectures of the prescribing science module helped me a great deal in understanding supplementary and independent prescribing. I have studied a book on non-medical prescribing which gave me an insight into non-medical prescribing. I have learnt that non -medical prescribing in this country started in 1986 when nurses were recommended to undertake prescribing. In 1994 nurses were allowed to prescribe from a limited formulary. It was in 2003 when supplementary prescribing for nurses and pharmacists began. From May 2006 independent prescribing was introduced and extended prescribing powers were in place for nurses and pharmacists. Nurse independent prescribers can prescribe any licensed drug for any medical condition with in their area of competence which also includes some controlled drugs. Pharmacist independent prescriber can prescribe any drug for any indication with in their area of competence, but, this does not include controlled drugs. I have also learnt that a supplementary prescribing differs from independent prescribing. In supplementary prescribing the supplementary prescriber voluntarily works in conjunction with an independent prescriber to implement a patient specific clinical management plan. There is a significant involvement of the patient in case of supplementary prescribing.
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The benefits of non medical prescribing are 1) It improves patient care without compromising patient’s safety 2) makes it easier for patients to get the medicines they need 3) increases patients choice in accessing medicines 4) makes better use of the skills of health professionals 5) contribute to the introduction of more flexible team working across the NHS. (pdf from 5 boroughs)
Furthermore, I have learned that competencies which are set by National Prescribing Center for non-medical prescribers have to be achieved by the prescribers for safe and effective prescribing. The competency frame work developed can be used as an aid for training and development and also to assist individual CPD of the prescribers. There are three areas of competency 1) The consultation 2) Prescribing effectively 2) Prescribing in context. Each of these areas of has three competencies. Consultation has three different competencies which are clinical and pharmaceutical knowledge, establishing options and communicating with patients. (Competencies)
My understanding of consultation was very much confined to patient consultations between a pharmacist and patient during a medication usage review. I was exposed to such interactions with patient in the pharmaceutical care module. Patient’s case notes and the information gathered from the patient during the interview was used to devise a pharmaceutical care plan for the patient. Initially, I did not know how consultations between prescribers and patients take place. Different models of consultations were introduced in the prescribing science module. I also read chapter on clinical decision making and evidence based prescribing from the book on non-medical prescribing which gave me a thorough understanding of prescriber’s consultations. Out of all the modules I learnt that Calgary-Cambridge observation guides and the SEGUE framework are mostly used to train health care professionals. Subsequently after going through the consultation models, I realized that a patient consultation in context of medical prescribing is totally different. In a general pharmacist-patient interaction the emphasis is more on identifying issues of any alternative therapies which could improve patient compliance and health in general. Prescriber’s consultation such as compliance associated with medications and thinking with medications and any review kind of consultation the emphasis is more on the kind of consultation were introduced to
By studying At first I was not sure of what clinical aspects meant and why are they important in non medical prescriber’s consultations. The book on non -medical prescribing gave me a insight into clinical decision making. I realized that clinical aspects involve diagnosis, medical management and further monitoring of the medical condition. I felt that clinical aspects are really important especially in consultations involving independent prescriber. The reason for it being the actions of independent prescriber is not monitored by anyone else. In case of supplementary prescribing any action regarding prescribing such as starting new medication or change of dose of by the supplementary prescriber has to be agreed upon by the independent prescriber on the clinical management plan. Hence, having a sound clinical and pharmaceutical knowledge is very essential competency required for a prescriber and this is very important in case of independent prescriber. The national prescribing centre also has competency framework for supplementary prescribers which are different than independent prescribers. This made me realize the increased responsibility of a non -medical independent prescriber when compared to a supplementary prescriber who are only confined to the clinical management plan.
A thorough reading of the competency framework put in place by the National prescribing centre for independent pharmacist prescribers gave me a in-depth knowledge of the competencies required for consultation. The competencies involved with the consultation included Clinical and pharmaceutical knowledge. I understood that the prescriber must have up-to-date clinical and pharmaceutical knowledge of their area of competence and also about the relevant products used in the treatment. They must be able to identify any ADR’s, drug interactions associated and also identify any drugs which can be potentially abused. The prescriber must have knowledge about the pharmacological aspects of the drug such as its mechanism of action, pharmacokinetics and how these can be affected in specific patients such as elderly and patients which other complications like liver or renal impairment.
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I also learnt that, the prescriber must be in a position to consider all treatment options such as non pharmacological and pharmacological management of the condition. He or she should be able to take patients previous medical history, medication history and other aspects such as OTC medication when making a clinical decision regarding the drug choice. The prescriber should be able to use equipment to make any clinical diagnosis and suggest or interpret any relevant investigations. The prescriber must be able to monitor the effectiveness of the treatment and make any required adjustments to the medication based on the monitoring.
All the above mentioned points are the clinical aspects which I think are important in consultations of non- medical prescribers. Consideration of all the above points along with other competencies in the areas of prescribing effectively and prescribing in context by non-medical prescribers will lead to safe and effective prescribing. However, I realized from the competency framework document that apart from the clinical aspects there are other aspects of consultation which are also important involved in prescriber consultation and
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