Prescribers pharmacist communication

All prescription orders should be legible, unambiguous, dated (and timed in the case of a chart order), and signed clearly for optimal communication between prescriber, pharmacist, and nurse. Furthermore, a good prescription or chart order should contain sufficient information to permit the pharmacist or nurse to discover possible errors before the drug is dispensed or administered. 

A patient may need medicines. In most countries they need a prescription from a medical doctor who thereby shares responsibility with the patient. The pharmacist (community, hospital, industrial pharmacist, scientist, teacher or competent authority) is responsible for the supply of the prescribed medicines, being professionally... 

In some mainly rural areas the doctor may also dispense the medicines prescribed, but more usually the patient takes the prescription to a community pharmacist, also under contract with the NHS, who dispenses the medicines and claims reimbursement at predetermined rates. Unless they are exempt, patients pay a prescription charge at the time of dispensing. 

Rupp MT, De Young M, Schondehneyer SW. Prescribing problems and pharmacist interventions in community... 

Rupp MT. 1988. Evaluation of prescribing errors and pharmacist interventions in community practice An estimate of value added. Am Pharm NS28 766. 

Rupp MT. 1992. Value of community pharmacists interventions to correct prescribing errors. Ann Pharmacother 26 1580. 

Errors can result when ambiguous orders are interpreted in a manner other than what the prescriber intended. Proper expression of doses is vital in a drug order. Pharmacists should be able to recognize improper expressions of doses, and the potential for error, when they see them. When the order is not clear, the pharmacist must contact the prescriber for clarification. Pharmacists and technicians should avoid using dangerous expressions of doses as they process orders, type labels, and communicate with others. The following examples include several improperly expressed orders that were reported to the Institute for Safe Medication Practices (ISMP) ... 

To sell the opportunity effectively, the entrepreneur must be able to quickly communicate the value proposition associated with the product, service, or business. In entrepreneurship circles, this is referred to as the elevator pitch. The elevator pitch refers to the ability to pitch the concept to a potential investor in the amount of time it takes to get on an elevator and then get off. The idea behind this is for the entrepreneur to be ready to pitch the concept clearly and concisely at any time. This skill actually fits in well for pharmacists because it is similar to how pharmacists often must counsel patients and make drug therapy recommendations to prescribers. One method of getting additional training in doing this effectively is the book, How to Get Your Point Across in 30 Seconds or Less (Frank, 1986). Three key questions that may be helpful to address are... 

Recommend that he discusses his progress with the practice nurse or community pharmacist a few days after discharge from hospital. His GP should monitor effectiveness of inhaled steroids after discharge. Monitor for oral candidiasis if inhaled steroids prescribed. 

Pharmacists are uniquely positioned to become involved in DM activities for several reasons. First, within the community, pharmacists practice at the interface of care and therefore have the ability to interact directly with patients. In addition, public opinion polls reveal that pharmacists are consistently ranked among the most trusted professionals. Figure 17.1 illustrates how the drug prescribing process places pharmacists at the interface of patient care. Because pharmacists, like physicians, have the ability to directly deliver DM services, they can serve as conduits for implementing DM programs developed by health insurance providers, PBMs, pharmaceutical companies, wholesalers and distributors, and employers. 

The process of pharmacists dispensing prescriptions is designed to ensure that patients receive the proper drug in the correct dosage and with correct directions for use. This pharmaceutical care requires the pharmacist to perform an assessment of the patient s medications, to monitor their use and effects, and to communicate with the prescriber and patient to correct or prevent drug-related problems. This drug therapy review service is codified in the term medication therapy management. 

The date on which the prescription was written is critical. A delay in presenting the prescription to a pharmacy may warrant communication between the pharmacist and the clinician to determine whether the intent of the prescriber and needs of the patient can still be met.This matter is more crucial in the management of acute rather than chronic illnesses and in the dispensing of controlled substances. 

Errors can occur in all steps of prescription communications, from written to oral to fax transmissions. Patients ultimately suffer the consequences of inappropriate prescription communications, and care must be taken by both the prescribing practitioner and the pharmacist to minimize these concerns. 

A compilation of manufacturers PILs for many prescribed medicines. Such texts require the prior approval of the MCA. The Compendium is distributed to all general practitioners and to hospital and community pharmacists. 

GP10P Blue Pharmacists supplementary prescribing (community)... 

In a similar way to dental prescribing in the NHS (see Section 3.2.2) it is important that pharmacists are aware of the contents of the respective parts of the Drug Tariff(s) dealing with nurse prescribing on the NHS. The British National Formulary also indicates whether an item would be able to be prescribed on an NHS prescription by a nurse by listing the Nurse Presenters Formulary for Community Practitioners. However, the British National Formulary is not usually as up to date as the Drug Tariff as indicated above. 

Once the label(s) has/have been generated, the item(s) may be dispensed. There are many items which may be prescribed via an NHS prescription form and it is important that pharmacists and pharmacy technicians ensure that the correct item(s) are being supplied. Remember, within community pharmacy, if a drug is prescribed using a proprietary name, the proprietary product must be supplied. However, if a drug is prescribed by its generic name, in most cases, any generic or proprietary equivalent may be supplied. (The exception to this is for some sustained-release preparations where the release properties of different brands may vary.)... 

If the receiving organisation receive any forms that require further annotation, either by the prescriber (e.g. the omission of SLS - see Section 2.6.3) or the pharmacist (e.g. missing endorsements - see Section 2.4.1, Part IIIA), they will return them to the community pharmacy for the missing information to be added. Analysis of these returns can be used to audit the dispensing process (see Section 1.4.3 and Figure Al). 

If the drug name is unclear or written on the drug chart as a proprietary product, the ward pharmacist will annotate the entry with the correct generic name (hospital prescribing is not constrained by the same rules regarding the supply of proprietary items as those NHS prescription forms originating in the community (see Section 2.4.1, Part VIII)). If the... 

For out-patient prescriptions, it is the responsibility of the pharmacist to perform a clinical check on the prescription. This will follow the same stages that are followed when performing a clinical check on an NHS prescription (see Section 3.3.4). The main key difference is that the hospital pharmacy staff will not have access to the patient s patient medical record (PMR) as this is usually held on the computer of the patient s usual community pharmacy. Therefore, it will not usually be possible to check for interactions with previously prescribed medication. In summary, the following points need to be considered ... 

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. 

Explaining is one of a pharmacist s most frequently used skills and lies at the heart of pharmacy practice. It is basically an informative function but also has an educational role with regard to public health. The area will continue to expand as pharmacists engage in new roles, such as medicines use reviews (MURs), pharma-cist-led clinics, pharmacist prescribing, etc. If pharmacists and pharmacy technicians are to maximise their potential roles it is essential that their communication skills are maintained to provide positive health benefits to patients. 

While most of the day-to-day communication will be with patients, there will also be times when pharmacists and pharmacy technicians communicate with prescribers and other healthcare professionals. 

Communication with other healthcare professions will include both verbal and written communication. For example, patient referral forms would be a form of written communication from the pharmacist to the prescribes These forms concern information that the pharmacist may have obtained ... 

In community pharmacy the most common form of contact with a GP is by telephone concerning a prescription that has been received in the pharmacy. As pharmacists we are problem solving all the time, so if there is a problem with a prescription we will normally try to resolve it without resorting to contacting the prescriber. However in certain cases contact with the prescriber will be required. 

It is up to the individual pharmacist as to what evidence that he or she would like to see to verify that the patient has previously been prescribed the item(s) being requested. Suitable evidence would include old medication packaging, including the dispensing label (usual if the patient has run out of medication), or a repeat medication slip (used to request a prescription form for a further supply from the patient s GP). Alternatively, you could obtain details of the patient s usual community pharmacy and contact them by telephone to verify any previous supply via the patient medication record system. In addition, it would be usual to request to see some form of identification so you can verify the identity of the patient. 

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