Introduction
To qualify as a pharmacist independent prescriber (also know as independent prescribing), you need to meet the following criteria:
- Satisfy the General Pharmamecutical council (GPHC) independent prescribing criteria, i.e., (1) be a qualified pharmacist with suitable experience ; (2) have access to a designated prescribing practitioner (DPP).
- Enroll on a pharmacist independent prescriber GPHC accredited course
- Complete the pharmacist independent prescribers nonmedical prescribing portfolio and essays
- Verification from the designated prescribing practitioner that the student is safely able to prescribe
Trainee pharmacist independent prescribers portfolio requirement
A portfolio is a compilation of work that demonstrates your skills and experience in a particular area. When it comes to nonmedical prescribing and independent prescribing, it is important to have a portfolio that illustrates your knowledge and expertise in this area. In order to help you get started, here is an example of a nonmedical prescribing portfolio.
What should be included in your nonmedical prescribing portfolio
A nonmedical prescribing portfolio should include:
An introduction – (a template is usually provided by the university).
Your skills and experience in supervised independent prescribing
Your scope of practice
Your ability to engage with patients
Your ability to work within a team
References from colleagues or patients
Any relevant research you have undertaken
Any articles you have published on the topic of nonmedical prescribing
Your future goals for prescribing practice.
A portfolio is a way of collecting and presenting your work in a way that is easily accessible to others. It can be used as a tool for reflection, to evidence your skills and experience, or as a means of marketing your services. Creating a nonmedical prescribing portfolio can be an excellent way to showcase your abilities and expertise in this area and can help you to secure new prescribing opportunities.
If you are interested in creating a nonmedical prescribing portfolio, here are some tips on what should be included:
An introduction:
Your portfolio should include an introduction that provides an overview of your skills and experience in nonmedical prescribing. This can help to give context to the rest of the portfolio and provide readers with a clear understanding of your abilities.
Your skills and experience:
Your portfolio should highlight your skills and experience in nonmedical prescribing. This could include details of any training you have undertaken, as well as your clinical experience. You may also want to include information on any research you have undertaken in this area.
Your knowledge in this area:
It is important to demonstrate your knowledge and understanding of nonmedical prescribing in your portfolio. This could include evidence of your reading and research in this area, as well as any articles you have published on the topic.
Your ability to engage with patients:
Your portfolio should also show that you are able to engage effectively with patients. This could include examples of how you have helped patients to manage their conditions, as well as feedback from patients on your prescribing practice.
Your ability to work within a team:
It is important to demonstrate that you are able to work effectively within a team when carrying out nonmedical prescribing. This could include examples of how you have collaborated with other healthcare professionals, as well as details of any team-based projects you have undertaken.
References from colleagues or patients:
Your portfolio should also include references from colleagues or patients who can attest to your abilities as a nonmedical prescriber. These could be written testimonials or contact details for individuals who are willing to provide a reference.
Any relevant research you have undertaken:
If you have undertaken any relevant research in the area of nonmedical prescribing, this should also be included in your portfolio. This could be details of a research project you have conducted or a summary of your findings.
Any articles you have published on the topic of nonmedical prescribing:
If you have published any articles on the topic of nonmedical prescribing, these should also be included in your portfolio. This will help to show that you are an expert in this area and can provide valuable insights into prescribing practice.
Your future goals for prescribing practice:
Finally, your portfolio should include your future goals for prescribing practice. This could include plans for further training or research, as well as your aspirations for your career in this field.
Creating a nonmedical prescribing portfolio can be an excellent way to showcase your abilities and expertise in this area. Including the information listed above will help you to create a comprehensive and impressive portfolio that will be of value to potential employers or customers.
Why is it important to have a portfolio
A portfolio is an important tool for any healthcare professional, and it is especially important for those who practise nonmedical prescribing. A well-crafted portfolio can demonstrate your skills and experience in this area and can help you to secure new prescribing opportunities. It can also be a valuable resource for continuing professional development (CPD) and can help to keep you up-to-date with the latest developments in prescribing practice.
Creating a portfolio can therefore be an excellent way to further your career in nonmedical prescribing.
How can you create a portfolio that showcases your skills and experience?
When creating a portfolio to showcase your skills and experience in nonmedical prescribing, it is important to include a variety of different types of information. This could include examples of your clinical work, your research and reading in this area, as well as any articles you have published on the topic. It is also important to include references from colleagues or patients who can attest to your abilities as a prescriber.
Your portfolio should be well-organized and easy to navigate so that potential employers or customers can quickly find the information they are looking for. It is also important to make sure that the content is up-to-date and reflects your current level of expertise in this field.
If you are not sure where to start, contact one of our team of experts on 01869 689149.
What are some tips for submitting your portfolio?
When it comes to submitting your portfolio, there are a few things to keep in mind. First, make sure that your portfolio is well-organized and easy to navigate. Secondly, be sure to include a variety of materials that demonstrate your skills and expertise in nonmedical prescribing. Finally, be sure to tailor your portfolio to the specific audience or organization you are targeting. By following these tips, you can create a portfolio that will impress potential employers or clients.
What are the benefits of having a portfolio?
A portfolio is an important tool for any healthcare professional, and it is especially important for those who practise non medical prescribing. A well-crafted portfolio can demonstrate your skills and experience in this area and can help you to secure new prescribing opportunities. It can also be a valuable resource for continuing professional development (CPD) and can help to keep you up-to-date with the latest developments in prescribing practice.
Creating a portfolio can therefore be an excellent way to further your career in non medical prescribing.
Nonmedical prescribing learning outcomes example
Identify your learning outcomes.
To be able to assess and consult with patients effectively by:
- Developing effective communication skills
- Conducting a relevant physical assessment/ examination of those conditions for which I am competent to prescribe, e.g. Hypertension
- Developing effective decision-making skills
- Developing knowledge and skills in order to make a prescribing decision, e.g. prescribe, not to prescribe, non-drug treatment or a referral for treatment
- Gaining knowledge on how to assess patient’s medication needs while taking into account their wishes, ethnicity, values etc
- Undertake a thorough medical history which would include a full medication history, current medications including over-the-counter medicines, alternative and complementary health therapies
- Understand and apply relevant legislation to the practice of pharmacist prescribing
- Critically appraise, and use sources of information and/or advice to support my prescribing practice.
- Understand the influences that can affect my prescribing practice
- Understand and apply existing and new knowledge of pharmacology in my prescribing practice area of expertise
- Prescribe safely, appropriately and cost-effectively
- Practice within the Royal Pharmaceutical Society competency framework of prescribers
- Develop a clinical management plan within legislative requirements
How are you going to achieve this?
- Attend university study sessions
- Undertake self-study using the internet, reference books and journals etc
- Shadow a designated prescribing practitioner (DPP)
- Allow DPP to observe my practice
- Observe other general practitioners and other appropriate health care professionals, e.g. nurses, pharmacists etc
- Observation ofObjective Structured Clinical Examinations (OSCEs)
How will you demonstrate your learning in your portfolio?
Complete all parts of the Non medical prescribing practice document
Nonmedical prescribing clinical observation hours example
Date
4/10/17
3 hours
Observing a range of consultations of the patient by DMP, e.g. to discuss treatment of Hypertension, treat conjunctivitis, treat lower urinary tract symptoms in child-With DMP
LO1,LO2,LO3a,LO3bLO4,LO5,LO6
6/10/17
3 hours
Observing a range of consultations of patients by DMP, e.g. to undertake annual asthma reviews, to review adverse effects of drugs such as ankle swelling caused by Amlodipine- With DMP
LO1,LO2,LO3a,LO4,LO5,LO6
11/10/17
3 hours
Observing a range of consultations of patients by DMP, e.g. to review fitting of a contraceptive coil, to relieve symptoms of ear pain, to review mental health symptoms etc. – With DMP
LO1,LO2,LO3a,LO4,LO5,LO6
13/10/17
3 hours
Observing a range of consultations of patients by DMP, e.g. to discuss treatment of depression, to review chronic kidney disease medication, manage lower back pain etc.-With DMP
LO1,LO2,LO3a,LO4,LO5,LO6
18/10/17
3 hours
Observing a range of consultations of patients by DMP, e.g. to discuss treatment of heart failure, relieve symptoms of upper respiratory tract infection, discuss laboratory results etc. –With DMP
LO1,LO2,LO3a,LO4,LO5,LO6
20/10/17
1 hour
Observing a range of consultations of patients by DMP, e.g. to manage otitis media, discuss pain management of a patient, treat sore throat etc. –With DMP
LO1,LO2,LO3a,LO4,LO5,LO6
25/10/17
3 hours
Discussion with DMP in setting up a pharmacist-led hypertension clinic, which included a review of pharmacology, clinical assessment skills etc. in addition, I observed a range of consultations with DMP, e.g. reviewing heart failure patients to discuss a treatment plan, to undertake clinical level 3 medication reviews
LO1,LO2,LO3a,LO4,LO5,LO6
27/10/17
2 hours
Observing a range of consultations of patients with DMP, e.g. to discuss discharge medication changes with the patient, treat symptoms of chest pain and breathlessness, manage symptoms of lower urinary tract infection etc. – With DMP
LO1,LO2,LO3a,LO4,LO5,LO6
01/11/17
2 hours
Observing a range of consultations of patients with DMP, e.g. to undertake routine mid-pregnancy reviews, manage symptoms of Parkinson’s disease etc.- with DMP
LO1,LO2,LO3a,LO4,LO5,LO6
03/11/17
4 hours
Observing a range of consultations of patients with DMP, e.g. management of epilepsy, treatment of otitis media etc.
Also, in the afternoon, a review of PACT data, QOF targets, and staff training with DMP.
LO1,LO2,LO3a,LO4,LO5,LO6
8/11/17
2 hours
Observing a range of consultations of patients with DMP, e.g. undertaking hypertension medication reviews, undertaking annual patient reviews and treatment of tension headache etc. – with DMP
LO1,LO2,LO3a,LO4,LO5,LO6
10/11/17
2 hours
Discussion with DMP to formulate a plan to implement repeat dispensing and observing a range of consultations- with DMP, e.g. discussing the treatment of Hypertension, discussing the non-pharmacological treatment of diabetes, undertaking type 2 clinical reviews of medication
LO1,LO2,LO3a,LO4,LO5,LO6
15/11/17
5 hours
Undertaking consultations of patients with DMP supervision, e.g. hypertension reviews- with DMP
LO1,LO2,LO3a,LO4,LO5,LO6
17/11/17
5 hours
Observing a range of consultations with DMP, e.g. undertaking diabetes medication review, offering treatment for conjunctivitis in newborn babies and young children, reviewing the management of Hypertension, updating medical notes with discharge summaries, undertaking routine pregnancy mid reviews- with DMP
LO1,LO2,LO3a,LO3b,LO4,LO5,LO6
22/11/17
2 hours
Observing a range of consultations of patients with DMP, e.g. to discuss myocardial infarction treatment plan, relieve symptoms of a skin rash, treat lower back pain- With DMP
LO1,LO2,LO3a,LO4,LO5,LO6
24/11/17
5 hours
Undertaking a range of consultations of patients with DMP supervision e.g.to undertake annual hypertension reviews- with DMP
LO1,LO2,LO3a,LO4,LO5,LO6
29/11/17
2 hours
Observing a range of consultations of patients with DMP, e.g. to discuss contraception options, treatment of Hypertension, to discuss patients’ lab results etc. – with DMP
LO1,LO2,LO3a,LO4,LO5,LO6
1/12/17
5 hours
Observing a range of consultations of patients with DMP, e.g. to undertake diabetes annual reviews, manage and review Hypertension of those individuals whose target blood pressure is not being met, update MHRA recommendations- with DMP
LO1,LO2,LO3a,LO4,LO5,LO6
6/12/17
5 hours
Observing a range of consultations of patients with DMP, e.g. to undertake asthma reviews, treat minor acute infections, undertake newborn baby regular checks, undertake flu vaccinations- with DMP
LO1,LO2,LO3a,LO3b,LO4,LO5,LO6
8/12/17
3 hours
Observing a range of consultations of patients with DMP, e.g. to treat symptoms of depression, administer corticosteroid injection to manage shoulder pain, manage eczema in newborn baby etc.- with DMP
LO1,LO2,LO3a,LO3b,LO4,LO5,LO6
13/12/17
3 hours
Observing a range of consultations of patients with DMP, e.g. to undertake medication review of heart failure, treat symptoms of eczema, offer contraceptive advice- with DMP
LO1,LO2,LO3a,LO4,LO5,LO6
15/12/17
3 hours
Observing a range of consultations of patients with DMP, e.g. to review oral contraception and discuss other forms of contraception such as the coil. Also, we undertook asthma medication reviews- with DMP
LO1,LO2,LO3a,LO4,LO5,LO6
20/12/17
3 hours
Observing a range of consultations of patients with DMP e.g.to review hypertension medication due to uncontrolled Hypertension, manage severe depression and offer non-pharmacological treatment, manage symptoms of eczema etc.- WithDMP
LO1,LO2,LO3a,LO4,LO5,LO6
22/12/17
3 hours
Observing a range of consultations of patients with DMP, e.g. to review skin allergy, offer advice on weight loss, manage diabetes and review treatment- WithDMP
LO1,LO2,LO3a,LO4,LO5,LO6
27/12/17
3 hours
Observing a range of consultations of patients with DMP, e.g. medication reviews for a range of patients with varying clinical conditions such as Asthma, Diabetes, Hypertension etc.- WithDMP
LO1,LO2,LO3a,LO4,LO5,LO6
29/12/17
3 hours
Observing a range of consultations of patients with DMP, e.g. to manage symptoms of migraine, manage symptoms of sore throat, treat a rash and review hypertension treatment- WithDMP
LO1,LO2,LO3a,LO4,LO5,LO6
3/1/18
3 hours
Observing a range of consultations of patients with DMP, e.g. to update discharge summaries on patient records, action MHRA guidelines, treat and manage atrial fibrillation etc.- With DMP
LO1,LO2,LO3a,LO4,LO5,LO6
5/1/18
3 hours
Observing a range of consultations of patients with DMP, e.g. undertaking routine pregnancy checks and undertaking newborn baby routine checkups and managing symptoms of lower respiratory infection etc.- WithDMP
LO1,LO2,LO3a, LO3b,LO4,LO5,LO6
10/1/18
3 hours
Observing a range of consultations of patients with DMP, e.g. to manage symptoms of rash, treat oral thrush, offer advice on eczema etc. WithDMP
LO1,LO2,LO3a,LO4,LO5,LO6
17/1/18
2 hours
Observing diabetes review consultations with specialist diabetic Nurse independent prescriber, e.g. to review the management of diabetes, to offer lifestyle advice etc.- With NurseIndependent Prescriber
LO1,LO2,LO3a,LO4,LO5,LO6
19/1/18
2 hours
Observing diabetes review consultations withspecialist diabetic Nurse independent prescriber, e.g. to discuss the clinical management of diabetes in newly diagnosed patients, to manage Hypertension in diabetes etc.- WithNurse independent prescriber
LO1,LO2,LO3a,LO4,LO5,LO6
24/1/18
1 hour
Observing reviews of chronic Asthma with a Specialist asthma nurse, e.g. to discuss the clinical management of Asthma and undertake asthma reviews etc.- with a Specialist asthma nurse
LO1,LO2,LO3a,LO4,LO5,LO6
31/1/18
2 hours
Undertaking training with EMIS software practice manager, e.g. to learn how to use EMIS, to undertake searches to identify QOF targets, to review PACT data
LO5, LO6
Nonmedical prescribing competency framework example
Prescribing Competency Framework
The Consultation (Competencies 1-6)
Competency 1: Assess the Patient
1.1 Takes an appropriate medical, social and medication history, including allergies and intolerances.
Please refer to the Cambridge and Calgary template I have developed for undertaking hypertension reviews. The template is comprehensive and covers all aspects of history taking
1.2 Undertakes an appropriate clinical assessment.
Please refer to observed OSCEs.
As a qualified Pharmacist, I am aware of the importance of undertaking an appropriate clinical assessment. For example, when assessing an individual who presents with high blood pressure, it is important to undertake a full history in order to reach a diagnosis and develop a clinical management plan.
1.3 Accesses and interprets all available and relevant patient records to ensure knowledge of the patient’s management to date.
When undertaking consultations for Hypertension, I regularly reviewed patient records, which include their past and current medical history. In addition, I reviewed recent consultation entries and, where appropriate, any hospital discharge letters and blood results that may be relevant to the patient, thus ensuring knowledge of the patient’s management is current.
1.4 Requests and interprets relevant investigations necessary to inform treatment options.
When formulating a clinical management plan which may involve prescribing a medication, it is important to review the current relevant information. For example, when prescribing an ACE-inhibitor patient’s kidney function and potassium levels should be reviewed.
1.5 Makes, confirms or understands the working or final diagnosis by systematically considering the various possibilities
Please refer to supervised OSCEs. In order to ensure an appropriate clinical assessment of the patient is undertaken, I have adopted the Cambridge and Calgary model of undertaking consultations.
During my hypertension consultations, when formulating a diagnosis such as Essential Hypertension, it is important to rule out any secondary causes for raised blood pressure, such as thyroid dysfunction, medicines etc.
1.6 Understands the condition(s) being treated, their natural progression and how to assess their severity, deterioration and anticipated response to treatment.
Please refer to my prescribing Episode.
1.7 Reviews adherence to and effectiveness of current medicines.
During consultations with patients, I give an in-depth clinical medication review. In addition, treatment effectiveness in the case of Hypertension can be seen through lowering of blood pressure.
1.8 Refers to or seeks guidance from another member of the team, a specialist or a prescribing information source when necessary.
Please refer to discussions during consultations, and I refer you to our discussion about a child suffering from severe chicken pox that had progressed to the eyelid.
Competency 2: Consider the Options
2.1 Considers both non-pharmacological (including no treatment) and pharmacological approaches to modifying disease and promoting health.
Please refer to observed OSCEs for Hypertension and the prescribing episodes.
In addition, when undertaking hypertension consultations, I offer patients non-pharmacological advice give, such as the need to exercise, reduce salt and increase intake of vegetables etc
2.2 Considers all pharmacological treatment options, including optimizing doses as well as stopping treatment (appropriate polypharmacy, de-prescribing).
Please refer to the discharge summary tasks and Medication review guidelines I had produced for the practice.
In addition, an example used in my practice is to consider increasing anti-hypertensive drugs to the maximum tolerated doses, e.g. Ramipril 10mgs, before adding further medication to control blood pressure. Also, where necessary, stop the medication, such as In the event of hyperkalemia caused by potassium-sparing diuretics.
2.3 Assesses the risks and benefits to the patient of taking or not taking medicine or treatment.
Please refer to discussions during OSCEs and the medication review guidelines I have produced for the practice.
In addition, an example in my practice would be an increased risk of stroke caused by non-adherence to medication.
2.4 Applies to the understanding of the mode of action and pharmacokinetics of medicines and how these may be altered (e.g. by genetics, age, renal impairment, pregnancy).
As a pharmacist, I have studied pharmacology in-depth and am aware of the changes that occur with age in those organs primarily involved in drug metabolisms, such as the kidneys and the liver.
2.5 Assesses how co-morbidities, existing medication, allergies, contraindications and quality of life impact management options.
During consultations, an in-depth history is taken to ensure an appropriate clinical assessment is made. For example, the decision to prescribe beta-blockers for heart failure in those who are asthmatic must be made with caution; also, in men, it would be prudent to consider the effects of beta-blockers on sexual function and their impact on the patient.
2.6 Takes into account any relevant patient factors (e.g. ability to swallow, religion) and the potential impact on the route of administration and formulation of medicines.
Please refer to the medication review guidelines I produced for the practice.
As a pharmacist, in my practice, I routinely consider patient factors that may impact the route or formulation of medicines. An example would be the need to prescribe tablets without gelatin for those individuals that do not take gelatin which is often found in capsules etc.
2.7 Identifies, accesses, and uses reliable and validated sources of information and critically evaluates other information.
All sources of information are critically evaluated by ensuring they are appropriately referenced using reliable sources such as NICE.
2.8 Stays up-to-date in own area of practice and applies the principles of evidence-based practice, including clinical and cost-effectiveness.
I regularly undertake CPD learning by attending courses and undertaking self-study. Recently, I have undertaken a short course on Hypertension.
2.9 Takes into account the wider perspective, including the public health issues related to medicines and their use and promoting health.
I have undertaken pharmacovigilance training as a qualified pharmacist. In addition, I refer you to my duties within the practice to undertake the implementation of MHRA alerts.
2.10 Understands antimicrobial resistance and the roles of infection prevention, control and antimicrobial stewardship measures.
I have undertaken the CPPE learning in antimicrobial resistance and have read guidelines available on the government website. I am aware of the Start SMART and TARGET tool kits.
Competency 3: Reach a Shared Decision
3.1 Works with the patient/carer in partnership to make informed choices, agreeing on a plan that respects patient preferences, including their right to refuse or limit treatment.
Please refer to consultation notes for patients I have reviewed with Hypertension.
In addition, patient preferences are respected when agreeing on a plan. For example, during a hypertension review, a patient with borderline Hypertension preferred not to be prescribed an anti-hypertensive but instead wanted to try and reduce weight.
3.2 Identifies and respect the patient in relation to diversity, values, beliefs and expectations about their health and treatment with medicines.
Please refer to the consultation notes for patients I have reviewed with Hypertension. In addition, I refer to the observed OSCE where the patient did not want to undertake regular blood pressure testing and reduce his salt intake further.
3.3 Explains the rationale behind and the potential risks and benefits of management options in a way the patient/carer understands.
Please refer to the consultation notes for patients I have reviewed with Hypertension. In addition, all patients are given a clear explanation of the rationale behind the clinical management of their condition, which involves an explanation of the risks and benefits of management options e,g. pharmacological vs non-pharmacological treatment of Hypertension.
3.4 Routinely assesses adherence in a non-judgemental way and understands the different reasons non-adherence can occur (intentional or non-intentional) and how best to support patients/carers.
During consultations, I routinely ask patients about the use of their medication and appreciate that some patients may be termed “non-adherent to treatment”. Reasons for non-adherence are complex and mufti-factorial. However, where possible, support is provided, e.g. the use of a dossette box.
3.5 Builds a relationship which encourages appropriate prescribing and not the expectation that a prescription will be supplied.
I routinely inform patients that medication is only one of many options to treat a particular problem, e.g. initially, patients who are diagnosed with borderline Hypertension are encouraged to make lifestyle changes.
3.6 Explores the patient/carers’ understanding of consultation and aims for a satisfactory outcome for the patient/carer and prescriber.
Please refer to observed OSCEs
In addition, when undertaking consultations, patients are informed, and the aims of the consultation are explained from the outset and asked at the end of the consultation if their outcomes have been met.
Competency 4: Prescribe
4.1 Prescribes a medicine only with adequate, up-to-date awareness of its actions, indications, dose, contraindications, interactions, cautions, and side effects.
I ensure medication is prescribed within the license of the product and in line with guidelines. If ever in doubt, I refer to the BNF and clinical guidelines.
4.2 Understands the potential for adverse effects and takes steps to avoid/minimize, recognize and manage them.
When prescribing medication, I am aware of the potential for adverse effects.
As such, I always inform the patients of possible adverse effects when treatment is prescribed, i.e. coughing and ACE inhibitors. In addition, I start medication at a low dose and titrate after a review; e.g. when titrating ramipril, I would wait 2-4 weeks and review the patient.
4.3 Prescribes within relevant frameworks for medicine use as appropriate (e.g. local formularies, care pathways, protocols and guidelines).
Please refer to the prescribing Episode.
4.4 Prescribes generic medicines where practical and safe for the patient and knows when medicines should be prescribed by branded products.
As a pharmacist, I am aware of the need to prescribe generically where appropriate. However, certain medications, e.g. beclometasone 100mcg inhaler, should be prescribed as a brand, i.e. Qvar or Clenil.
4.5 Understands and applies relevant national frameworks for medicine use (e.g. NICE, SMC, AWMSG and medicines management/optimization) to own prescribing practice.
Refer to discussions during consultations and observed OSCEs. In addition, as a pharmacist, I am regularly updating my knowledge to ensure prescribing within my practice is evidence-based, e.g. the use of beta-blockers in Hypertension is no longer the first line according to NICE (2016).
4.6 Accurately completes and routinely checks calculations relevant to prescribing and practical dosing.
As a pharmacist, I have experience in calculating doses and undertaking relevant checks
In addition, when prescribing, doses are checked against the formulary, e.g. antibiotics for children.
4.7 Considers the potential for misuse of medicines.
As a pharmacist, I am aware of the potential misuse of medicines, e.g. codeine, tramadol etc
4.8 Uses up-to-date information about prescribed medicines (e.g. availability, pack sizes, storage conditions, excipients, costs).
Please refer to the “out of stock” medicines handouts which I have prepared for the practice. In addition, the EMC provides an updated summary of products which is useful for further drug information
4.9 Electronically generates or writes legible, unambiguous and complete prescriptions which meet legal requirements.
Please refer to the prescribing episodes. In addition, as a pharmacist, I am aware of the law with regards to prescription writing, e.g. with controlled drugs, it is a legal requirement to have a dose specified.
4.10 Effectively uses the systems necessary to prescribe medicines (e.g. medicine charts, electronic prescribing, decision support).
I am aware of the systems necessary to prescribe, such as electronic prescribing.
4.11 Only prescribes medicines that are unlicensed, ‘off-label’, or outside standard practice if satisfied that alternative licensed medicine would not meet the patient’s clinical needs.
I am aware of the importance of prescribing within the product license; however, it may be required to prescribe medication against the product license when clinically needed, e.g. colchicine for pericarditis
4.12 Makes accurate, legible and contemporaneous records and clinical notes of prescribing decisions.
Please refer to the OSCE consultation notes. In addition, I am aware of the importance of making accurate records of prescribing decisions.
4.13 Communicates information about medicines and what they are being used for when sharing or transferring prescribing responsibilities/ information.
I routinely link medication with the intended conditions that they are being used to treat on EMIS.
In addition, when prescribing, I document the conditions the medication is being used to treat within the dose instruction, e.g. ONE daily- for HYPERTENSION. This allows for an easier transition of prescribing responsibilities.
Competency 5: Provide Information
5.1 Checks the patient/carer’s understanding of and commitment to the patient’s management, monitoring and follow-up.
I routinely check the patient’s understanding of and commitment to the management during consultations.
5.2 Gives the patient/carer clear, understandable and accessible information about their medicines (e.g. what it is for, how to use them, possible unwanted effects and how to report them, and expected duration of treatment).
Please refer to observed hypertension OSCEs. In addition, I regularly signpost patients to ‘patient-friendly’ websites such as a patient. U.K. and print off information leaflets on health advice/medication.
5.3 Guides patients/carers on how to identify reliable sources of information about their medicines and treatments.
I inform patients about the need to critically evaluate sources of information and the importance of checking references when health claims are made. In addition, I inform patients to refer to NHS websites such as NHS Choices.
5.4 Ensures that the patient/carer knows what to do if there are any concerns about the management of their condition, if the condition deteriorates or if there is no improvement in a specific time frame.
I ensure when giving any health advice, patients are ‘safety-netted’. For example, when advising on treatment for Hypertension, if improvements in blood pressure are not observed after the use of the prescribed medication (depending on drug half-life and expected onset of action), patients are encouraged to contact their doctor or me. In addition, I inform patients about the 111 NHS service and late-night community pharmacies that can provide advice when G.P. practices are closed.
5.5 When possible, encourage and supports patients/carers to take responsibility for their medicines and self-manage their conditions.
Patients are regularly encouraged to seek information and are given information to empower them to manage their conditions. For example, patients are informed about the importance of lifestyle modifications to reduce their blood pressure, such as weight loss and reduced salt intake. In addition, patients are given practical tips to implement the advice given, such as referring to food labelling to help make healthier choices.
Competency 6: Monitor and Review
6.1 Establishes and maintains a plan for reviewing the patient’s treatment.
Refer to documents produced for the practice with regards to medication reviews, in particular Level 3 clinical reviews. In addition, in line with the practice, patients are booked to have annual reviews during their birthday month.
6.2 Ensures that the effectiveness of treatment and potential unwanted effects are monitored.
All patients are given explanations about the treatment they are prescribed and are counselled on how to take the medication. In addition, patients are regularly invited for a review of their medication.
6.3 Detects and reports suspected adverse drug reactions using appropriate reporting systems.
I have undertaken the CPPE training on Drugs and ADRs and am aware of the need to report ADRs, i.e. via the yellow card system.
6.4 Adapts the management plan in response to ongoing monitoring and review of the patient’s condition and preferences.
I am aware of the importance of adapting the management plan, e.g. the switching of simvastatin to atorvastatin, so the patient is able to take the medication in the morning instead of the evening or changing an anti-hypertensive due to adverse effects.
Prescribing Governance
Competency 7: Prescribe Safely
7.1 Prescribes within own scope of practice and recognizes the limits of own knowledge and skill.
I am aware of my limitations and will initially prescribe for Hypertension. However, I will learn and gain skills in other clinical areas such as diabetes, Asthma etc
7.2 Knows about common types and causes of medication errors and how to prevent, avoid and detect them.
As a pharmacist, I am aware of the common types and causes of medication errors, e.g. incorrect dosing of antibiotics in children etc. and am aware of ways to prevent these errors, such as always taking a thorough history which includes a medication history etc
7.3 Identifies the potential risks associated with prescribing via remote media (telephone, email or through a third party) and takes steps to minimize them.
I am aware of the risk associated with remote media and have read the standards set out in good medical practice. In addition, I have read the ‘Telephone triage and consultation….’ document produced by The Royal College of General practitioners.
7.4 Minimizes risks to patients by using or developing processes that support safe prescribing, particularly in areas of high risk (e.g. transfer of information about medicines, prescribing of repeat medicines).
I have read the guidelines at the G.P. practice, which deal with ‘repeat prescribing’.
In addition, I have read the Kings fund document ‘Polypharmacy and medicines optimization making it safe and sound’.
7.5 Keeps up to date with emerging safety concerns related to prescribing.
I regularly undertake CPD and keep up-to-date with emerging safety concerns such as MHRA alerts.
7.6 Reports prescribing errors, near misses and critical incidents, and reviews practice preventing recurrence.
I have recently attended a meeting at the G.P. practice and am aware of the importance of recording near misses and learning from incidents.
In addition, as a pharmacist, I am aware of the importance of maintaining an audit trail of prescribing errors and the importance of reflection on my practice.
Competency 8: Prescribe Professionally
8.1 Ensures confidence and competence to prescribe are maintained.
I regularly undertake CPD by attending training courses and continue to develop existing knowledge and gain new knowledge
8.2 Accepts personal responsibility for prescribing and understands the legal and ethical implications.
As a pharmacist, I am familiar with the legal and ethical implications of prescribing.
In addition, I have undertaken the nonmedical prescribing course and am aware of the need to take personal responsibility for prescribing.
8.3 Knows and works within legal and regulatory frameworks affecting prescribing practice (e.g. controlled drugs, prescribing of unlicensed/off-label medicines, regulators’ guidance, supplementary prescribing).
I have recently reviewed the medicines and ethics practice document.
8.4 Makes prescribing decisions based on the needs of patients and not the prescriber’s personal considerations.
I ensure my decisions to prescribe are based on the needs of patients by ensuring a patient-centred approach to prescribing. I have recently undertaken the CPPE training for patient-centred prescribing.
8.5 Recognizes and deals with factors that might unduly influence prescribing (e.g. pharmaceutical industry, media, patient, colleagues).
I am aware of the importance of critically evaluating information and making evidence-based decisions.
8.6 Works within the NHS/organizational/regulatory and other codes of conduct when interacting with the pharmaceutical industry.
I have recently read an example of a policy implemented by the Surrey CCG and read the Department of Health best practice guidelines for joint working between NHS and the pharmaceutical industry.
Competency 9: Improve Prescribing Practice
9.1 Reflects on own and others are prescribing practice and acts upon feedback and discussion.
I regularly undertake CPD and ask for feedback where necessary from my peers.
9.2 Acts upon colleagues’ inappropriate or unsafe prescribing practice using appropriate mechanisms.
As a pharmacist, I am aware of the importance of whistle-blowing in line with the policy of the particular institution.
9.3 Understands and uses available tools to improve prescribing (e.g. patient and peer review feedback, prescribing data analysis and audit).
I am aware of the importance of feedback from peers and the importance of reviewing performance and outcomes using tools such as PACT data or results from audits etc.
Competency 10: Prescribe as Part of a Team
10.1 Acts as part of a multidisciplinary team to ensure that continuity of care across care settings is developed and not compromised.
Please refer to the learning undertaken during my time with the practice and meetings attended. In addition, I am aware of the importance of team working.
10.2 Establishes relationships with other professionals based on understanding, trust and respect for each other’s roles in relation to prescribing.
Please refer to the training I have undertaken while completing my prescribing course.
10.3 Negotiates the appropriate level of support and supervision for a role as a prescriber.
Please refer to the training I have undertaken while completing my prescribing course.
10.4 Understands and uses available tools to improve prescribing (e.g. patient and peer review feedback, prescribing data analysis and audit).
Please refer to the learning undertaken during my time with the practice and meetings attended. In addition, I am aware of the importance of analyzing data from audits to improve prescribing.
