Medicines Management for Dietitians. Sue Kellie Head of Education and Professional Development The British Dietetic Association
Aim of presentation. To give an overview of the current legislation surrounding medicines management and how dietitians can effectively use this to improve patient care.
Objectives. 1. Understanding medicines legislation. 2. Define and give examples of common terms used such as: Independent prescriber. Supplementary prescriber. Exemptions under medicines legislation. Patient group direction (PGD.)
Objectives. 3. Provide guidance on producing a PGD and protocol. 4. Give examples of dietitians currently managing medicines.
Medicines management. The Medicines Act (1968) regulates the use of medicines in the UK. This requires a medicine to have a marketing authorisation. When authorisation is granted medicines are placed into one of three classifications.
Classification of marketing authorisation. 1. Prescription only medicine (POM). Can only be obtained on prescription through a pharmacy eg Insulin, Creon. 1. Pharmacy medicine (P) Sold in pharmacies under the supervision of a pharmacist. Eg Alli
Classification of marketing authorisation. 3. General sales list Sold in general shops as well as in pharmacies eg Fortisip, Ensure Nutritional supplements do not require a prescription & they do not come under medicines management.
Dietitians and ACBS products Dietitians can currently solely manage ACBS products which includes all sip feeds, enteral feeds and energy modules. Dietitians do not require prescribing rights to do this. You are not required to write PGDs for use of borderline substances. The London Procurement Programme Clinical Oral Nutrition Support Project
Mechanisms for the management of prescription only medicines. Patient specific directions Patient group directions Dietitians Exemptions under medicines legislations? Supplementary prescribing? Independent prescribing X
Independent prescribing. Takes responsibility for the clinical assessment of the patient, establishing a diagnosis and clinical management plan, as well as a responsibility for the prescribing where necessary and the appropriateness of any prescription. National Prescribing Centre (2004) Patient Group Directions www.npc.co.uk
Supplementary prescribers. Form a voluntary partnership with an independent prescriber. A A clinical management plan is agreed for an individual patient. The supplementary prescriber manages the clinical condition, including prescribing, according to the clinical management plan
Exemptions under medicines legislation. The Prescription Only Medicines Human Use Order (1997) contains some specific exemptions which allow for the sale or supply and administration of certain POMs directly to patients without the directions of a prescriber.
Prescribing rights for Dietitians Allied health professions, prescribing and medicines supply mechanisms scoping project report DH 2009 Aim to establish whether there is evidence of service and patient need to support extending prescribing and medicines supply mechanisms available to the AHPs
Prescribing rights for Recommendation Dietitians On the basis of safety, patient experience and value there is a strong case for progression to supplementary prescribing..in some cases, independent prescribing and/or exemptions for the supply/administration of specific medicines may best suit the needs of dietetic patients.
Prescribing rights for Dietitians Any prescribing rights requires a business case and work with the Non-medical Prescribing Board, MHRA and DH Prescribing rights will also require a change in HPC registration status for specifically trained dietitians. Dietitians will need to undergo an approved accredited training and education programme before being able to practice.
Patient group direction (PGD). Allows a range of specified health care professionals to supply and/or administer a prescription only medicine directly to a patient with an identified clinical condition without them necessarily seeing a prescriber.
Example patient group direction. Following a visit to renal out patient clinic, dietitians can use a PGD to give patients a supply of phosphate binder medication for management of phosphate. National Prescribing Centre (2004) Patient Group Directions www.npc.co.uk
Patient specific direction Used once a patient has been assessed by a prescriber and that prescriber instructs another health care professional in writing to supply or administer a medicine directly to the patient.
Example patient specific direction. Opthamologists can give opthalmic technicians a written patient specific direction to administer eye drops so that the patient has local anaesthesia prior to seeing the opthamologist for a scheduled procedure or examination. National Prescribing Centre (2004) Patient Group Directions www.npc.co.uk
Who can use PGDs? Dietitians across the UK are authorised to use PGDs. Professionals must be registered and act within the professional code of conduct. Professionals must be fully competent, trained and qualified to use PGDs (there must be documented evidence of this)
Producing and authorising PGDs. Produced by a multi-disciplinary group involving a doctor, a pharmacist and a representative of the professional group expected to give medicines under the PGD. Must follow local trust guidelines in it s development.
Producing and authorising PGDs. Approved by local drug and therapeutic committees. Authorised by the organisations it is to be used within.
Producing and authorising a PGD. The PGD should be signed by the doctor and pharmacist involved in developing the PGD and authorising authority for the organisation in which it is being used.
Dose adjustment. This is allowed in a PGD as long as the dosage range is specified. A PGD does not give a legal framework to adjust a dose of medicine already in a patients possession.
Dose adjustment. Written protocols may be used to adjust medication but are locally ratified documents rather than a nationally recognised legal documents The principles of writing a protocol must follow a robust development process similar to those required for developing a PGD.
Who should I be talking to? Multi-disciplinary team start with the lead clinician and pharmacist. Drugs & therapeutics committee. Quality teams clinical governance, clinical audit and lead for user involvement.
Improving the patient experience. Audit the use of the PGD and protocol. Include patient stories. Consider how to evidence an improvement in patient experience. Share with the BDA
Dietitians working with PGDs. Renal dietitians in Newcastle have been working under PGDs to streamline the processes involved in managing patients bone biochemistry. More timely changes to patients medications are made. G. Hartley (2006) Prescribing for dietitians. Working under patient group directions. Dietetics Today. Volume 41, Number 6 (June)
Let the BDA know! Conclusions. Work under the current legislation in medicines management. Develop PGDs and protocols within your teams. Audit your work.