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Independent Prescribing in MAU

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Alex Sweeney

on 9 February 2014

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Transcript of Independent Prescribing in MAU

Independent Prescribing in MAU
Alex Sweeney MAU Pharmacist Bristol Royal Infirmary
Background
Became an IP 2011 - anticoagulation in VTE disease
Tortuous but worthwhile process
Felt it was going to be the answer to all prescribing issues on MAU and would work alongside our pharmacy enabling policy
Also, help with SHA safety work and CQUINs targets
However, quickly came to the realisation that GPHC model did not quite fit my area of practice and what I envisaged
Journey
Started with VTE prophylaxis - not very challenging
Developed to treatment of PE and DVT - very very challenging!
ECGs
VQ scans
Ultrasound
CTPA
D-dimer
Pregnancy...Gulp!
Differential diagnosis
The course was excellent in:
Revealing my deficiencies.
Equipping me with a skill set I new little about
E.g. consultation skills, examination skills
Providing a holistic view of patient care
Providing caution in how we use the prescribing privilege
Prescribing in MAU
Importantly, day to day practice does not involve me stumbling over undiagnosed PEs and saving the day!

BUT, I do correct VTE prescriptions e.g. clexane doses, VTE risk assessments, warfarin titration, advice on NOACs

However, 80% of my day is spent correcting drug histories and MAU also includes:
Endocrine, Cardiac, Gastro, Hep and Resp patients

So, I also correct drug histories and make decisions on what drug to continue or stop using my IP skills...hang on is that allowed?

Legally - Yes...(as long as it is within your competence).

DoH guidance
7. The Department of Health’s working definition of independent prescribing is prescribing by a practitioner (e.g. doctor, dentist, nurse, pharmacist)
responsible and accountable for the assessment of patients with undiagnosed or diagnosed conditions and for decisions about the clinical management required, including prescribing.
Within medicines legislation the term used is ‘appropriate practitioner’.
8. In partnership with the patient,
independent prescribing is one element of the clinical management of a patient.
It requires an initial patient assessment, interpretation of that assessment, a decision on safe and appropriate therapy, and a process for ongoing monitoring. The independent prescriber is responsible and accountable for at least this element of a patient’s care. Normally prescribing would be carried out in the context of practice within a multidisciplinary healthcare team, either in a hospital or in a community setting, and within a single, accessible healthcare record.
Framework for prescribing on MAU
1. What is the clinical situation?
You need to know the whole patient story!
What drug is missing?
Laxatives or Chemo?
2. Am I competent?
(see GPHC code of ethics section 5.1 and DofH guidance on IP 2006 page 15 pg 53)
3. Is it in the best interest of the patient?
(see GPHC code of ethic section 1 - make patients your first concern!)
4. Can you do it in the context of the MDT?
5. Are you more competent than the F1?

If all of the above = yes...then prescribe the drug
Clinical situation 1
73 year old male with CAP has GTN spray omitted from chart due to poor drug history but patient now complaining of chest pain
Medics have gone to lunch
Do you:
a) Wait until they get back
b) Call the on-call F1
c) Prescribe the drug after a detailed check of current clinical situation, allergies and observations
d) Pretend your not competent with the drug

Clinical situation 2
Furosemide omitted from drug history in a patient with heart failure but admitted with confusion associated with UTI, dehydration and AKI

Do you:
a) Prescribe the drug after a detailed check of the clinical situation
b) Interrupt the ward round to reveal your discovery!
c) Leave a note somewhere on the drug chart
d) Write up the drug, cross it out (stating reasons) and make an entry in the medical notes (+ share info with team at board round).
How to start on MAU?
Start small then build
Think about pain control, constipation, N&V, inhalers, eyedrops, creams
Use treatment plans for complex areas where you feel your competence is lacking (e.g. anticoagulation)
Try and get a second check
Definition of prescribing. Pg2 Pg7
Conclusion
Stay the course - its worth it!
Learn the basics - they do help!
When your done use your qualification - patients will benefit!
If your nervous that's a good sign!
Use a framework for how you decide to prescribe
Get your employers support
Questions?
Second check?
Proving competence?
#itsnowornever
@rpharms
@SweensterAlex
Full transcript