Pharmacist independent prescribers

Part XVIIB(ii) - Nurse and pharmacist independent prescribing... 

This part provides information on nurse and pharmacist independent prescribing. Further details on independent non-medical prescribing can be found in Section 3.2.5. 

Nurse independent prescribers are able to prescribe any licensed medicinal product including some controlled drugs. Pharmacist independent prescribers have similar prescribing rights however, currently they may not prescribe any controlled drugs (although this may change in the future). 

Further information on independent nurse and pharmacist prescribing can be found in Part XVIIB(ii) of the Drug Tariff for England and Wales (see Section 2.4.1). This states that nurse independent prescribers and pharmacist independent prescribers ... 

The pharmacist must be satisfied that the supply is being requested by a doctor, community practitioner nurse prescribes supplementary prescribes nurse independent prescriber or pharmacist independent prescriber. 

They may only be sold or supplied from a registered pharmacy, by or under supervision of a pharmacist in accordance with the prescription of a doctor, dentist or veterinary practitioner or other qualified prescriber. Nurse independent prescribers, pharmacist independent prescribers and supplementary prescribers can write prescriptions for POM. Given below are examples of the types of drug that are POM ... 

Extended formulary nurse prescribing was discontinued in 2006 and replaced by qualified nurse independent prescribing. Nurses can now prescribe any licensed medicine, including some controlled drugs, if they are qualified to do so. At the same time, pharmacists became eligible to train as pharmacist independent prescribers, being able to prescribe all licensed medicines but, as yet, no controlled drugs. 

Training for supplementary prescribing is now incorporated into nurse and pharmacist independent prescribing as multidisciplinary training. 

Traditionally, the prescriber would have been a doctor or a dentist, but recent changes to healthcare legislation and the introduction of supplementary and independent prescribers mean that many other healthcare professionals, such as nurses and pharmacists, are now also permitted to prescribe (see Section 3.2). 

In addition to supplementary prescribing by non-medical practitioners (see Section 3.2.4), independent non-medical prescribing has also recently been introduced. Currently this is limited to suitably qualified nurses and pharmacists, although as with supplementary prescribing, independent prescribing may be extended to other health professional groups in due time. 

Some individuals have advocated that pharmacists be granted independent prescriptive authority—that is, authority to prescribe medications independent of a defined collaborative relationship with an individual physician or medical group. Indeed, the system operative in Florida represents a form of independent prescriptive authority for pharmacists, albeit limited to a select formulary of drugs. Others have argued that pharmacists should function in a dependent role where prescriptive authority is delegated by a physician or other independent prescriber to another health care professional whom that prescriber believes possesses the professional skills and judgment necessary to perform these delegated duties. 

A similar process occurred with podiatry, physiotherapy and radiography and led to extension of supplementary prescribing to these professions in April 2005. In a further development in 2006, nurses and pharmacists became eligible to train as independent prescribers. 

Nurses, midwives and pharmacists can now train to prescribe any licensed medicine as independent prescribers to patients. 

Supplementary prescribing is likely to be most suitable with patients who have chronic conditions and can be managed by a supplementary prescriber between reviews by the doctor. Legislation may change again in the future to allow other health care professionals, in addition to nurses and pharmacists, to train to become independent prescribers. 

There are a number of criteria that must be met for supplementary prescribing to occur (www.dh.gov.uk/en/Publicationandstatistics/). For instance, the independent prescriber must be a doctor or dentist the supplementary prescriber must be from a professional group that is legally allowed to be a supplementary prescriber (such as radiographer, nurse, pharmacist, chiropodist, physiotherapist, optometrist) and there must a written CMP relating to a named patient and their specific condifion(s). 

The physiotherapy profession could aim to follow the path taken by the nursing profession, from first being able to prescribe a few drugs, to widening access to where they are today with independent prescribing. In 2006, nurses and pharmacists became able to train as independent prescribers. 

Although dentistry is an independent health care field, it is not entirely detached from other health care services and collaboration between dentistry and other health care providers ensures positive outcomes for patients. Dentists often see patients more often than physicians and may be the first to diagnose systemic diseases, including inflammatory conditions, autoimmune diseases, and cardiovascular risk factors. Dentists also work with pharmacists to prescribe the best antibiotics or anesthetics for dental patients, as well as to understand how certain medications affect dental care and oral health. 

Independent calculation of pediatric doses by more than one person (e.g., prescriber and pharmacist)... 

The federal government has experimented with various models of pharmacist prescribing.The VA and the IHS appear to have the most liberal policies toward pharmacist prescribing.In the VA, clinical pharmacy specialists are required to have an advanced degree or have completed an accredited residency (e.g., an American Society of Health Systems Pharmacy, ASHP, accredited residency) or specialty board certification (e.g., a Board of Pharmaceutical Specialties, BPS, certification) before they may prescribe medications within their scope of practice. The scope of practice is established within the local VA facility. Once this criterion is satisfied, the clinical pharmacy specialist may function as an independent health care provider. In the IHS, pharmacists can be credentialed to provide primary care and use their prescriptive authority to evaluate and manage the care of certain patients. 

Most drugs are dispensed to patients directly by the physicians who prescribe them. In fact, only 10 percent (by value) of drugs in Japan were sold by independent pharmacists in 1985 the rest were purchased from independent doctors or hospital pharmacies. 2 Most drugs are sold by manufacturers to hospitals and clinics (139,163,344), usually through wholesalers, at a discount off the rate set by the HIB wholesalers receive similar discounts from the manufacturers. 43 Therefore, when the doctor or hospital pharmacy is reimbursed for dispensing a drug at the HIB rate, he or she (or the hospital) makes a profit. Discounts vary widely but typically run from 10 to 30... 

Ideally, the physician s full DEA number should not be preprinted on the prescription pad most prescriptions will not be for controlled substances and will not require the registration number, and anyone in possession of a valid DEA number may find it easier to commit prescription fraud. Some physicians may intentionally omit part or aU of their DEA number on a prescription and instead write pharmacist call to verify or call for registration number. This practice works only when the pharmacist may independently verify the authenticity of the prescription, and patients must be advised to fill the prescription during the prescriber s office hours. Pharmacists can ascertain the Kkely authenticity of a physician s DEA number using an algorithm. 

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