Clinical Prescribing Medicines SOP Document Control Summary Status: Version: Author/Owner/Title: Approved by: Ratified: Related Trust Strategy and/or Strategic Aims Implementation Date: Review Date: Key Words: Associated Policy or Standard Operating Procedures Replacement (Supersedes: Medicines Code: Policies and Procedures to Manage the Clinical Risks associated with the Use of Medicines v6.8) v1.0 Date: December 2015 Cathy Riley - Director of Pharmacy Policy and Procedures Committee Date: 18/02/2016 Policy and Procedures Committee Date: 18/02/2016 Medicines Optimisation Strategy 2013-2018: Making the Most of Medicines February 2016 December 2018 Prescribing, Medicines Medicines Used Outside Terms of Product License or Without a Product License Contents 1. Introduction... 3 2. Purpose... 3 3. Scope... 3 4. Body Text... 3 5. Process For Monitoring Compliance And Effectiveness... 5 6. References... 5 7. Appendix 1....6
Change Control Amendment History Version Dates Amendments V1.0 Dec 15 SOP created from existing Medicines Code V6.10
1. Introduction This SOP guidelines the appropriate procedure to prescribing medicines within the Trust safely and appropriately. 2. Purpose Only suitably authorised independent and supplementary prescribers have the authority to prescribe medicines for patients under the care of the SSSHFT. Practitioners do not administer medicines that have not been authorised by an authorised prescriber. The authorisation is in writing, in the form of a signed prescription, in advance of the administration of the medicine. 3. Scope For use by the medical/non-medical prescriber teams (Medical students are NOT permitted to prescribe medicines in SSSHFT). 4. Body Text 1. Medicines may only be prescribed on official SSSHFT prescribing stationery. The following details must be included on the prescription: Patient s name, including aliases Date of birth Ward, Team, or Clinic name, or agreed Trust code Consultant NHS number Known sensitivities to medicines 2. No more than one current prescription sheet must exist at any one time for any service user. Where more items need to be prescribed more regularly than there are spaces on the sheet, then a second sheet may be used which must be attached to the first. 3. In such circumstances, both prescription sheets must indicate the existence of a second sheet and each must be available when medication is prescribed, administered or required from pharmacy. 4. New prescription sheets are to be introduced into the Trust, which will allow a choice of size, in relation to number of regular medicines prescribed. Prescribers must ensure that the appropriate size is chosen to negate the need to use second sheets. 5. When a patient is re-admitted, a new prescription sheet must be used. Prescriptions for patients transferred from one SSSHFT site to another do not require to be rewritten.
6. When patients are transferred from other Trusts, prescriptions must be rewritten within 24 hours (48 hours at weekends or 72 hours at a bank holiday). 7. In addition to the main prescription sheet there may be a chart incorporating IV fluid regimen, an anticoagulant chart and any other officially agreed special chart. The main prescription sheet must make reference to any therapy indicated on separate specialised charts as well as to any items currently being taken that have been prescribed by a general practitioner, or bought over the counter in a community pharmacy. All prescription cards no longer in use must be filed in a patient s notes. 8. To ensure correct administration another qualified person should always check dose calculations independently. 9. To ensure the accuracy of prescribing, a clinical check of medication cards is made by pharmacists, either through ward visits or prior to individual dispensing from the pharmacy department. Clinical checks are made in compliance with the Pharmacy Standard Operating Procedures, and are recorded in the Pharmacy box on the Medication Card. 10. A training programme is recommended for all healthcare staff (including medical staff) expected to prescribe, prepare and administer insulin. An e-learning programme is available from: http://www.nhsiq.nhs.uk/8473.aspx Medicines Reconciliation The aim of medicines reconciliation on admission to hospital is to ensure that medicines prescribed on admission correspond to those that the patient was taking before admission. Prescribers should refer to the SOP on Medicines Reconciliation. Range of medicines to be prescribed Only those medicines approved for use by the SSSHFT Medicines Optimisation Committee (see Trust formulary). Choice of medicines within the Formulary must be generally guided by the positioning advice within it in order to maximise cost effectiveness. Medicines newly introduced to the market place may only be prescribed in SSSHFT after due consideration and approval by the Medicines Optimisation Committee. Limited exception is given to patients' own medicines, medicines undergoing clinical trial and specialist therapy for individual patients that have been agreed with the Pharmacy Manager. A defined procedure authorised by the Medicines Optimisation Committee must be followed in order to request a new medicine for use within the Trust. Details of the procedure are available from the Chief Pharmacist (see Appendix 1).
5. Process For Monitoring Compliance And Effectiveness Annual audit Error reports 6. References Medicines Code
Appendix 1 South Staffordshire & Shropshire Healthcare NHS Foundation Trust Medicines Optimisation Committee Application to Amend Formulary This form should only be completed by a Consultant Psychiatrist/Associate Specialist. New items that are requested will not be routinely stocked by the Hospital Pharmacy Departments until they have been approved by the Medicines Optimisation Committee. Please complete and return the form to: Diane Thompson, Development Manager, Pharmacy & Medicines Optimisation, St. George s Hospital, Corporation Street, Stafford, ST16 3AG Name of Product: Product to be replaced: (if appropriate) Indications Add to/delete from (please delete as appropriate) Hospital Only Single Use? Yes/No If for single use provide patient Please delete name/unit number below: Name:. NHS No.: Cost: Duration of Treatment: Please tick box Indefinitely Less than 1 year Full course supplied by Trust Strength of recommendation (as described overleaf in absence of examination of key references, this will be D) REASON FOR AMENDMENT TO BE CONSIDERED: For new therapeutic area
More effect than existing drugs New pharmacological properties (e.g. fewer side effects, new licensed indication) Improved delivery system (formulation) than existing product Associated with clinical investigation/research More cost-effective Complements existing drug treatments Other (please give details). All forms should be accompanied by additional information (as appropriate) including: 1. The evidence (key published references) 2. The cost 3. The number of patients anticipated to need the new drug Strength of Recommendation: A. Directly based on category I evidence. B. Directly based on category II evidence or extrapolated recommendation from category I evidence. C. Directly based on category III evidence or extrapolated evidence from category I or II evidence D. Based on clinical opinion Categories of Evidence: I. Based on well-designed randomised control trials, meta-analysis or Systematic Reviews II. Based on well-designed cohort or case control studies/other robust experimental or observational studies III. Based on uncontrolled studies or external consensus or more limited studies but the advice relies upon expert opinion and has the endorsement of respected authorities. Declaration of Interest: Please state any personal or financial link you have with the manufacturer of the product concerned, e.g. company shares, research grant, funded post etc... Signature:.. Date:. Name of Consultant: Directorate:. Base:..