Non-medical Prescribing Edited by Mahesh Sodha BSc(Hons), DipClinPharm, MSc, FRPharmS Community pharmacist, Essex, and Visiting Fellow at the School of Pharmacy, University of Hertfordshire, UK and Soraya Dhillon (VIBE, BPharm, PhD, FRPharmS Foundation Professor and Head of The School of Pharmacy at the University of Hertfordshire, UK (PP) London. Chicago Pharmaceutical Press
Contents Preface About the Editors Contributors IX xi xiii Development of non-medical prescribing - Historical background and competency framework for successful prescribing 1 Maxine Offredy Introduction 1 Competency 3 Competency framework 4 Reasons for measuring competence in healthcare 5 Successful prescribing 8 Summary 10 10 Legal and ethical aspects of prescribing 12 Joy Wingfield Introduction 12 The law relating to prescribing 13 The Medicines Act 1968 and the Misuse of Drugs Act 1971 14 Medicinal products and the licensing system 15 The importance of a medicine being licensed 16 Legislation covering the supply of medicines 17 Controlled drugs (CDs) 18 NHS regulations 21 Who can prescribe what in non-medical prescribing? 22 Legislation on other ways of supplying medicines 23 Legislation on prescription writing 25
vi Contents Accountability and non-medical prescribers 27 Clinical negligence 27 Ethical aspects of non-medical prescribing 28 Conclusion 30 30 31 3 Clinical governance and patient safety in prescribing 32 Richard O'Neill Introduction Clinical governance Principles of clinical governance Clinical governance in community pharmacy Clinical governance in non-medical prescribing Benefits of non-medical prescribing Principles of clinical governance and non-medical prescribing Conclusion Websites 32 33 34 35 35 36 36 54 55 57 58 4 Principles of prescribing and drug handling 61 Soraya Dhillon, Andrzej Kostrzewski and Kiren Gill Introduction 61 A rational approach to safer prescribing 62 Prescribing principles 63 Design of dosage regimens for safe and effective prescribing 65 Adverse drug reactions and interactions 66 Patient safety issues in prescribing 70 Conclusion 72 Case studies: Interpretation of drug levels as an aid to prescribing 73 83 83 5 Clinical decision making and evidence-based prescribing 85 Maxine Offredy Introduction 85 Principles of clinical decision making 86
Contents vii Consultation skills and history taking Consultation with non-medical prescribers Diagnostics and screening The rationale for correct decision making Focus on practice and implementation Errors and pitfalls to avoid Conclusions 88 91 93 95 95 97 97 98 98 6 Prescribing in diabetes 100 Alan Sinclair Introduction and background Description of key issues Brief summary of the knowledge areas and skills required for safe prescribing Prescribing scenarios - diabetes 100 102 102 103 107 107 7 Prescribing in palliative care 108 Jo Noble-Gresty Introduction and background 108 Knowledge and skills required in prescribing in palliative care 110 General principles of prescribing in palliative care 112 Prescribing issues from personal experience 114 Conclusion 114 Case studies 115 122 122 8 Prescribing in cardiology 124 Helen Williams Hypertension 124 Ischaemic heart disease 127 Heart failure 130 Case studies 133 142 143
viii Contents 9 Respiratory disease management 144 Nader Siabi Introduction Is it asthma or COPD? 145 How to perform spirometry 147 Case studies Conclusion 144 148 171 171 10 Prescribing in oncology Nicola Stoner 17 5 Pathophysiology, signs and symptoms, and prevalence 175 Knowledge and skills required for prescribing in oncology 176 General principles of prescribing in oncology 177 Prescribing issues from personal experience 182 Case studies 183 192 11 Prescribing in mental health 193 Fabrizio Schifano Introduction 193 Pathophysiology of mental health disturbances 194 Prevalence of mental health disturbances 195 Common signs and symptoms of mental health disturbances 195 A closer look: schizophrenia Holistic approach in the treatment of mental health disturbances: the role of spirituality issues 198 Knowledge and skills required for prescribing in mental health 199 Non-medical prescribing in mental health: an overview of the recent literature 199 Prescribing issues from personal experience 202 Case studies 203 212 Index 215