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Aim of presentation Aim of presentation.
.
To give an overview of the current legislation
Medicines Management Medicines Management for Dietitians. for - - PowerPoint PPT Presentation
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
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Objectives. Objectives.
1. 1.
Understanding medicines legislation. Understanding medicines legislation.
2. 2.
Define and give examples of common terms Define and give examples of common terms 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.)
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Objectives. Objectives.
3. 3.
Provide guidance on producing a PGD and Provide guidance on producing a PGD and protocol. protocol.
4. 4.
Give examples of dietitians currently Give examples of dietitians currently managing medicines. managing medicines.
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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.
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Classification of marketing Classification of marketing authorisation authorisation.
.
1. 1.
Prescription only medicine (POM). Prescription only medicine (POM).
- Can only be obtained on prescription
Can only be obtained on prescription through a pharmacy eg Insulin, Creon. through a pharmacy eg Insulin, Creon.
1. 1.
Pharmacy medicine (P) Pharmacy medicine (P)
- Sold in pharmacies under the supervision
Sold in pharmacies under the supervision
- f a pharmacist. Eg Alli
- f a pharmacist. Eg Alli
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Classification of marketing Classification of marketing authorisation authorisation.
.
3. 3.
General sales list General sales list
- 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.
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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
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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
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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’ Group Directions’ www.npc.co.uk www.npc.co.uk’ ’
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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’
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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.’
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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
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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.
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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.
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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.’
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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’ Group Directions’ www.npc.co.uk www.npc.co.uk’ ’
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Patient specific direction Patient specific direction
‘
‘Used once a patient has been assessed by a Used once a patient has been assessed by a prescriber and that prescriber instructs another prescriber and that prescriber instructs another health care professional in writing to supply or health care professional in writing to supply or administer a medicine directly to the patient.’ administer a medicine directly to the patient.’
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Example – patient specific Example – patient specific direction. direction.
‘
‘ Opthamologists can give opthalmic Opthamologists can give opthalmic technicians a written patient specific direction technicians a written patient specific direction to administer eye drops so that the patient has to administer eye drops so that the patient has local anaesthesia prior to seeing the local anaesthesia prior to seeing the
- pthamologist for a scheduled procedure or
- pthamologist for a scheduled procedure or
examination.’ examination.’ ‘ ‘National Prescribing Centre (2004) ‘Patient National Prescribing Centre (2004) ‘Patient Group Directions Group Directions’ www.npc.co.uk ’ www.npc.co.uk’ ’
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Who can use PGDs ? Who can use PGDs ?
Dietitians across the UK are authorised to use
Dietitians across the UK are authorised to use PGDs. PGDs.
Professionals must be registered and act within
Professionals must be registered and act within the professional code of conduct. the professional code of conduct.
Professionals must be fully competent, trained
Professionals must be fully competent, trained and qualified to use PGDs (there must be and qualified to use PGDs (there must be documented evidence of this) documented evidence of this)
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Producing and authorising Producing and authorising PGDs PGDs.
.
Produced by a multi-disciplinary group
Produced by a multi-disciplinary group involving a doctor, a pharmacist and a involving a doctor, a pharmacist and a representative of the professional group representative of the professional group expected to give medicines under the PGD. expected to give medicines under the PGD.
Must follow local trust guidelines in it’s
Must follow local trust guidelines in it’s development. development.
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Producing and authorising Producing and authorising PGDs PGDs.
.
Approved by local drug and therapeutic
Approved by local drug and therapeutic committees. committees.
Authorised by the organisations it is to be used
Authorised by the organisations it is to be used within. within.
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Producing and authorising Producing and authorising a PGD. a PGD.
The PGD should be signed by the doctor and
The PGD should be signed by the doctor and pharmacist involved in developing the PGD pharmacist involved in developing the PGD and authorising authority for the organisation and authorising authority for the organisation in which it is being used. in which it is being used.
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Dose adjustment. Dose adjustment.
This is allowed in a PGD as long as the dosage
This is allowed in a PGD as long as the dosage range is specified. range is specified.
A PGD does not give a legal framework to
A PGD does not give a legal framework to adjust a dose of medicine already in a patients adjust a dose of medicine already in a patients possession. possession.
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Dose adjustment. Dose adjustment.
Written protocols may be used to adjust
Written protocols may be used to adjust medication but are locally ratified documents medication but are locally ratified documents rather than a nationally recognised legal rather than a nationally recognised legal documents documents
The principles of writing a protocol must
The principles of writing a protocol must follow a robust development process similar to follow a robust development process similar to those required for developing a PGD. those required for developing a PGD.
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Who should I be Who should I be talking to ? talking to ?
Multi-disciplinary team – start with the lead
Multi-disciplinary team – start with the lead clinician and pharmacist. clinician and pharmacist.
Drugs & therapeutics committee.
Drugs & therapeutics committee.
Quality teams – clinical governance, clinical
Quality teams – clinical governance, clinical audit and lead for user involvement. audit and lead for user involvement.
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Improving the patient Improving the patient experience. experience.
Audit the use of the PGD and protocol.
Audit the use of the PGD and protocol.
Include patient stories.
Include patient stories.
Consider how to evidence an improvement in
Consider how to evidence an improvement in patient experience. patient experience.
Share with the BDA
Share with the BDA
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Dietitians working with PGDs. Dietitians working with PGDs.
Renal dietitians in Newcastle have been
Renal dietitians in Newcastle have been working under PGDs to streamline the working under PGDs to streamline the processes involved in managing patients’ bone processes involved in managing patients’ bone biochemistry. biochemistry.
More timely changes to patients medications
More timely changes to patients medications are made. are made. ‘ ‘G. Hartley (2006) ‘Prescribing for dietitians.
- G. Hartley (2006) ‘Prescribing for dietitians.
Working under patient group directions.’ Working under patient group directions.’ Dietetics Today. Volume 41, Number 6 Dietetics Today. Volume 41, Number 6 (June)’ (June)’
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Conclusions. Conclusions.
Work under the current legislation in
Work under the current legislation in medicines management. medicines management.
Develop PGDs and protocols within your
Develop PGDs and protocols within your teams. teams.
Audit your work.
Audit your work.
Let the BDA know!