Medicines Management Medicines Management for Dietitians. for - PowerPoint PPT Presentation

Medicines Management Medicines Management for Dietitians. for Dietitians. Sue Kellie Sue Kellie Head of Education and Professional Head of Education and Professional Development Development The British Dietetic Association The British Dietetic Association

. Aim of presentation . Aim of presentation  To give an overview of the current legislation To give an overview of the current legislation surrounding medicines management and how surrounding medicines management and how dietitians can effectively use this to improve dietitians can effectively use this to improve patient care. patient care.

Objectives. Objectives. Understanding medicines legislation. Understanding medicines legislation. 1. 1. Define and give examples of common terms Define and give examples of common terms 2. 2. used such as: used such as: Independent prescriber. Independent prescriber.  Supplementary prescriber. Supplementary prescriber.  Exemptions under medicines legislation. Exemptions under medicines legislation.  Patient group direction (PGD.) Patient group direction (PGD.) 

Objectives. Objectives. Provide guidance on producing a PGD and Provide guidance on producing a PGD and 3. 3. protocol. protocol. Give examples of dietitians currently Give examples of dietitians currently 4. 4. managing medicines. managing medicines.

Medicines management. Medicines management.  The Medicines Act (1968) regulates the use of The Medicines Act (1968) regulates the use of medicines in the UK. medicines in the UK.  This requires a medicine to have a marketing This requires a medicine to have a marketing authorisation. authorisation.  When authorisation is granted medicines are When authorisation is granted medicines are placed into one of three classifications. placed into one of three classifications.

Classification of marketing Classification of marketing . authorisation . authorisation Prescription only medicine (POM). Prescription only medicine (POM). 1. 1. Can only be obtained on prescription Can only be obtained on prescription  through a pharmacy eg Insulin, Creon. through a pharmacy eg Insulin, Creon. Pharmacy medicine (P) Pharmacy medicine (P) 1. 1. Sold in pharmacies under the supervision Sold in pharmacies under the supervision  of a pharmacist. Eg Alli of a pharmacist. Eg Alli

Classification of marketing Classification of marketing . authorisation . authorisation General sales list General sales list 3. 3. Sold in general shops as well as in Sold in general shops as well as in  pharmacies eg Fortisip, Ensure pharmacies eg Fortisip, Ensure Nutritional supplements do not require a Nutritional supplements do not require a  prescription & they do not come under prescription & they do not come under medicines management. medicines management.

Dietitians and ACBS Dietitians and ACBS products products  Dietitians can currently solely manage ACBS Dietitians can currently solely manage ACBS products which includes all sip feeds, enteral feeds products which includes all sip feeds, enteral feeds and energy modules. and energy modules.  Dietitians do not require prescribing rights to do this. Dietitians do not require prescribing rights to do this.  You are not required to write PGDs for use of You are not required to write PGDs for use of borderline substances. borderline substances.  The London Procurement Programme Clinical Oral The London Procurement Programme Clinical Oral Nutrition Support Project Nutrition Support Project

Mechanisms for the management of Mechanisms for the management of . prescription only medicines . prescription only medicines Dietitians Dietitians  Patient specific directions Patient specific directions    Patient group directions Patient group directions    Exemptions under medicines legislations ? Exemptions under medicines legislations ?  Supplementary prescribing ? Supplementary prescribing ?  Independent prescribing X Independent prescribing X

Independent prescribing. Independent prescribing.  ‘ ‘Takes responsibility for the clinical Takes responsibility for the clinical assessment of the patient, establishing a assessment of the patient, establishing a diagnosis and clinical management plan, as diagnosis and clinical management plan, as well as a responsibility for the prescribing well as a responsibility for the prescribing where necessary and the appropriateness of where necessary and the appropriateness of any prescription.’ any prescription.’ ‘National Prescribing Centre (2004) ‘Patient National Prescribing Centre (2004) ‘Patient ‘ Group Directions’ www.npc.co.uk www.npc.co.uk’ ’ Group Directions’

Supplementary prescribers. Supplementary prescribers.  ‘ ‘Form a voluntary partnership with an Form a voluntary partnership with an independent prescriber.’ independent prescriber.’  ‘ ‘A clinical management plan is agreed for an A clinical management plan is agreed for an individual patient….’ individual patient….’  ‘ ‘The supplementary prescriber manages the The supplementary prescriber manages the clinical condition, including prescribing, clinical condition, including prescribing, according to the clinical management plan’ according to the clinical management plan’

Exemptions under medicines Exemptions under medicines legislation. legislation.  ‘ ‘ The Prescription Only Medicines Human Use The Prescription Only Medicines Human Use Order (1997) contains some specific Order (1997) contains some specific exemptions which allow for the sale or supply exemptions which allow for the sale or supply and administration of certain POMs directly to and administration of certain POMs directly to patients without the directions of a patients without the directions of a prescriber.’ prescriber.’

Prescribing rights for Prescribing rights for Dietitians Dietitians  Allied health professions, prescribing and Allied health professions, prescribing and medicines supply mechanisms scoping project medicines supply mechanisms scoping project report DH 2009 report DH 2009  Aim – to establish whether there is evidence of Aim – to establish whether there is evidence of service and patient need to support extending service and patient need to support extending prescribing and medicines supply mechanisms prescribing and medicines supply mechanisms available to the AHPs available to the AHPs

Prescribing rights for Prescribing rights for Dietitians Dietitians Recommendation Recommendation On the basis of safety, patient experience and On the basis of safety, patient experience and value there is a strong case for progression to value there is a strong case for progression to supplementary prescribing……..In some supplementary prescribing……..In some cases, independent prescribing and/or cases, independent prescribing and/or exemptions for the supply/administration of exemptions for the supply/administration of specific medicines may best suit the needs of specific medicines may best suit the needs of dietetic patients. dietetic patients.

Prescribing rights for Prescribing rights for Dietitians Dietitians  Any prescribing rights requires a business case Any prescribing rights requires a business case and work with the Non-medical Prescribing and work with the Non-medical Prescribing Board, MHRA and DH Board, MHRA and DH  Prescribing rights will also require a change in Prescribing rights will also require a change in HPC registration status for specifically trained HPC registration status for specifically trained dietitians. dietitians.  Dietitians will need to undergo an approved Dietitians will need to undergo an approved accredited training and education programme accredited training and education programme before being able to practice. before being able to practice.

Patient group direction Patient group direction (PGD). (PGD).  ‘ ‘Allows a range of specified health care Allows a range of specified health care professionals to supply and/or administer a professionals to supply and/or administer a prescription only medicine directly to a patient prescription only medicine directly to a patient with an identified clinical condition without with an identified clinical condition without them necessarily seeing a prescriber.’ them necessarily seeing a prescriber.’

Example – patient group Example – patient group direction. direction.  ‘ ‘ Following a visit to renal out patient clinic, Following a visit to renal out patient clinic, dietitians can use a PGD to give patients a dietitians can use a PGD to give patients a supply of phosphate binder medication for supply of phosphate binder medication for management of phosphate. management of phosphate. ‘National Prescribing Centre (2004) ‘Patient National Prescribing Centre (2004) ‘Patient ‘ Group Directions’ www.npc.co.uk www.npc.co.uk’ ’ Group Directions’