Independent and Supplementary Prescribing
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1 Independent and Supplementary Prescribing An Essential Guide Second edition
2
3 Independent and Supplementary Prescribing An Essential Guide Second edition Edited by Molly Courtenay Matt Griffiths Foreword by June Crown CBE
4 cambridge university press Cambridge, New York, Melbourne, Madrid, Cape Town, Singapore, São Paulo, Delhi, Dubai, Tokyo Cambridge University Press The Edinburgh Building, Cambridge CB2 8RU, UK Published in the United States of America by Cambridge University Press, New York www. cambridge. org Information on this title: www. cambridge. org / Cambridge University Press 2010 First edition published by Greenwich Medical Media 2004 This edition published by Cambridge University Press 2010 This publication is in copyright. Subject to statutory exception and to the provisions of relevant collective licensing agreements, no reproduction of any part may take place without the written permission of Cambridge University Press. First published 2010 Printed in the United Kingdom at the University Press, Cambridge A catalogue record for this publication is available from the British Library Library of Congress Cataloguing in Publication Data Independent and supplementary prescribing : an essential guide / edited by Molly Courtenay, Matt Griffiths; foreword by June Crown. 2nd ed. p. ; cm. Includes bibliographical references and index. ISBN (pbk.) 1. Drugs Prescribing. 2. Nurse practitioners Prescription privileges. I. Courtenay, Molly. II. Griffiths, Matt. III. Title. [DNLM: 1. Drug Prescriptions. 2. Allied Health Personnel. 3. Drug Therapy methods. 4. Nurse s Role. 5. Pharmaceutical Preparations administration & dosage. 6. Pharmacists. QV 748 I ] RM138.I dc ISBN Paperback Cambridge University Press has no responsibility for the persistence or accuracy of URLs for external or third-party internet websites referred to in this publication, and does not guarantee that any content on such websites is, or will remain, accurate or appropriate. Every effort has been made in preparing this book to provide accurate and up-to-date information which is in accord with accepted standards and practice at the time of publication. Although case histories are drawn from actual cases, every effort has been made to disguise the identities of the individuals involved. Nevertheless, the authors, editors and publishers can make no warranties that the information contained herein is totally free from error, not least because clinical standards are constantly changing through research and regulation. The authors, editors and publishers therefore disclaim all liability for direct or consequential damages resulting from the use of material contained in this book. Readers are strongly advised to pay careful attention to information provided by the manufacturer of any drugs or equipment that they plan to use.
5 Contents List of contributors vi Foreword to the second edition ix Preface to the second edition xi 1 Non-medical prescribing: an overview 1 Molly Courtenay and Matt Griffiths 2 Non-medical prescribing in a multidisciplinary team context 7 Barbara Stuttle 3 Consultation skills and decision making 15 Anne Baird 4 Legal aspects of independent and supplementary prescribing 29 Mark Gagan 5 Ethical issues in independent and supplementary prescribing 42 John Adams 6 Psychology and sociology of prescribing 53 Tom Walley and Robin Williams 7 Applied pharmacology 65 Michele Cossey 8 Monitoring skills 86 a. Asthma Trisha Weller b. Coronary heart disease Paul Warburton c. Diabetes Jill Hill 9 Promoting concordance in prescribing interactions 107 Sue Latter 10 Evidence-based prescribing 119 Trudy Granby and Stephen R. Chapman 11 Extended/supplementary prescribing: a public health perspective 130 Sarah J. O Brien 12 Calculation skills 147 Alison G. Eggleton 13 Prescribing in practice: how it works 180 Polly Buchanan 14 Minimising the risk of prescribing error 187 Gillian Cavell Index 199 v
6 Contributors vi John Adams RGN, MA, MPhil Senior Lecturer Faculty of Health and Social Care Peterborough District Hospital Anglia Ruskin University Peterborough, UK Anne Baird RGN, MA Nurse Practitioner and Associate Lecturer Porter Brook Medical Centre, Sheffield and Sheffield University and Sheffield Hallam University Sheffield, UK Polly Buchanan RGN, RM, ONC, DipN, BSc (Hons) Department of Chemistry King s College London London, UK Gillian Cavell King s College Hospital Denmark Hill London, UK Stephen R. Chapman BSc (Hons), PhD, Cert H Econ, FRSM, MRPharmS Professor of Prescribing Studies Technical Development School of Pharmacy Keele University Staffordshire, UK Michele Cossey MSc, BPharm (Hons), MRPharmS Prescribing and Pharmacy Lead NHS Yorkshire and the Humber York, UK Molly Courtenay PhD, MSc, BSc, CertEd, RGN, RNT Professor, Division of Health and Social Care University of Surrey Marlow Surrey, UK Alison G. Eggleton MEd, MSc, BSc, SP Principal Pharmacist, Education and Training Addenbrooke s Hospital Cambridge, UK Mark Gagan RN, RNT, LLM, PGDip Social Research, CertEd Senior Lecturer Bournemouth University School of Health and Social Care Bournemouth, UK Trudy Granby RN, DN, MSc Clinical Nursing Assistant Director, Prescribing and Development Support NPC Plus Keele University Staffordshire, UK Matt Griffiths RGN, A&E Cert, FAETC Senior Nurse, Medicines Management University Hospitals of Leicester NHS Trust and Visiting Professor of Prescribing and Medicines Management University of the West of England Bristol, UK Jill Hill Birmingham East and North PCT Community Diabetes Team Office Washwood Heath Birmingham, UK Sue Latter PhD, BSc (Hons), RN, PGDipHV Professor of Nursing
7 Contributors School of Health Sciences University of Southampton Southampton, UK Sarah J. O Brien MB BS, FFPH, DTM&H School of Transitional Medicine Clinical Sciences Building Salford Royal NHS Foundation Stott Lane Salford, UK Barbara Stuttle CBE, MHA, RN, DN, FQNI Director of Quality and Nursing Chair, Association for Nurse Prescribing South West Essex Basildon Essex, UK Tom Walley MD, FRCP, FRCPI Professor of Clinical Pharmacology University of Liverpool Department of Pharmacology and Therapeutics Liverpool, UK Paul Warburton RN, MSc, CertEd, ENB 125 Senior Lecturer and Non-Medical Prescribing Programme Co-ordinator Edge Hill University Faculty of Health Ormskirk Lancashire, UK Trisha Weller MHS, RGN, NDN Cert, CPT, DPSCHN(PN) Formerly Asthma Lead Education for Health Warwick, UK Robin Williams MSc, RMN, RGN, CPN Cert, Dip Nursing (London), IHSM Nurse Clinician and Honorary Lecturer Department of Pharmacology and Therapeutics University of Liverpool Liverpool, UK vii
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9 Foreword to the second edition The extension of the authority to prescribe has moved on apace since the publication of the Review of the Prescribing, Supply and Administration of Medicines in Now nurses, pharmacists, allied health professionals and optometrists, as well as doctors and dentists, can prescribe. These rapid developments have set challenges for professional and regulatory bodies and for individual practitioners. However, all concerned have risen to these challenges with energy and enthusiasm. Training programmes are well developed, many nurses, pharmacists and allied health professionals have completed training, and the benefits to patients are already being felt. Th is book is timely and I would like to congratulate Molly Courtenay and Matt Griffiths on bringing together a group of distinguished contributors who have produced an authoritative and comprehensive account of all aspects of prescribing. I am sure that it will prove invaluable both as a practical guide to new prescribers and as a continuing reference source. I hope that this book will not be seen only as a book for the new prescribing professions. Its thorough examination of all aspects of the prescribing process and the implications of extended prescribing for multidisciplinary teams should also commend it to existing prescribers. It is a valuable text for every professional who is learning to prescribe or who wishes to improve their practice. I have no doubt that Independent and Supplementary Prescribing will inform and support prescribers and that it will make an important contribution to improvements in both the quality and accessibility of patient care. Dr June Crown CBE ix
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11 Preface to the second edition The introduction of non-medical prescribing has meant that nurses, pharmacists, allied health professionals and optometrists have had to expand their practice and so acquire new knowledge and skills in a number of fields. This new knowledge has had to be applied to the many issues surrounding prescribing in the practice setting. There are currently few books available that provide these prescribers with information to help them in this role. As the number of non-medical prescribers grows and as other healthcare professionals take on this role, the need for such information will increase. This book is aimed at those non-medical professions involved in prescribing medicines. Chapter 1 provides a general overview of non-medical prescribing and describes the current education and training available for extended independent and supplementary prescribers. Chapters 2 to 5 examine non-medical prescribing within a multiprofessional team context, the different models of consultation that might be used by prescribers and the legal and ethical aspects surrounding prescribing. The psychology and sociology of prescribing, applied pharmacology and monitoring skills are explored in chapters 6 to 8. Chapters 9 to 12 deal with promoting concordance, evidence-based prescribing, prescribing within a public health context and the calculation skills required by prescribers. Chapter 13 describes how prescribing can be implemented for practitioners working in the area of dermatology. It is hoped that insights gained from this chapter can be applied to other practice settings. The concluding chapter, chapter 14, examines prescribing errors, their causes and actions to be taken to minimise the risk of prescribing error. Each chapter is fully referenced and, where appropriate, readers are offered suggestions for further reading and other information sources. We hope that this book will make a positive contribution in a very important aspect of patient care. xi
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