Becoming a prescriber gives you incredible powers, but you need to know your limits.Faheem Ahmed, award-winning pharmacist prescriber
Scope of practice. The term that confuses so many, and you will encounter this when you begin filling out any independent prescribing course application form. Basically, you need to identify an area in which you would like to develop your prescribing skills.
But, a common trap you may fall for is selecting a scope of practice that is too broad such as minor illnesses- there are so many conditions which one?- or you may choose a chronic disease like hypertension – but which stages of hypertension?
So let me explain how to select and then define your scope of practice.
Selecting your scope of practice
Choose an area that you are passionate about and develop your skills in this area before you attempt to gain your prescribing qualification.
For example, you may want to develop your skills in diagnosing and treating a single minor illness such as tonsillitis or acne if you are in a community pharmacy. Similarly, in a GP practice, you may decide on developing your skills in the diagnosis and management of a single chronic disease such as hypertension or asthma.
However, there is a caveat: you need to have sufficient experience – I’ll discuss in more depth below – within your scope of practice before undertaking your prescribing qualification.
How do you develop sufficient experience?
Right. Pay attention now because this is important.
Let’s say you are a community pharmacist and you have a passion for helping people reduce their risk of a stroke and so decide to embark on a journey to diagnose and treat hypertension.
Well, the first step will be to develop your theoretical skills regarding the condition itself. This involves you having an in-depth understanding of the disease state, ie. Its causes, diagnosis, and management. Once you have this underpinning knowledge, you need to practice managing these patients in a safe environment.
And finally, once you have been exposed to many patients and feel comfortable managing these patients, albeit, under the supervision of an experienced colleague, you are ready to undertake your prescribing qualification.
Selecting your scope of practice
I am hoping from the above you have realized that selecting your scope of practice isn’t necessarily as simple as following your passion. You will need to consider the following; (1) do you have the underlying theoretical knowledge about the disease state? If not, are you willing to learn?; (2) are there clear guidelines that can help support you as you develop your skills? ; (3) do you have access to patients whom you can apply your knowledge under the supervision of an experienced colleague?
If you think about it, the above is no different from when we as pharmacists undertook our pre-registration training, and that is; (1) you gained the theoretical skills at university and (2) you applied them under supervision during your pre-reg year.
The similarity exists because that is how you learn. Remember how you gained your driving license? The theory first and then practice under supervision and then exam. It’s no different here.
Factors to consider
Initially, I would suggest you begin to develop your skills and gain experience in areas that meet the following; (1) you’re passionate about that particular area; (2) there are clear, well-defined guidelines to support your decision making and practice ; (3) you have access to patients and a mentor to support you and ; (4) there a demand for it.
Examples well-defined scope of practice
Hypertension stages 1, 2, and 3 with no comorbidities. Notice how the scope of practice is narrow, and there are clear guidelines.
An example of a broad scope of practice would simply be stating you were comfortable managing all types of hypertension, including but not limited to patients with evidence of end-organ damage or those who have other pre-existing conditions such as diabetes.
What about asthma? Can you think of defining a narrow scope of practice? If you think about classifying asthma as mild, moderate, or severe, then you are on the right track. But, what about a patient who has mild asthma but presents with symptoms of an exacerbation? Do you have the skills to treat this? It might be that you define your scope of practice as mild to moderate well-controlled asthma with no signs of an exacerbation?
Scope of practice and your Independent Prescriber course
I wanted to include this section because your scope of practice is not one that can not be expanded as you learn and gain experience.
For example, you may start out by mastering – if such a thing is possible – mild to moderate well-controlled asthma, and during your prescribing course, stick to this area.
But, as you gain more experience and become confident, you may decide to expand your scope of practice to include the management of acute exacerbations, or you may even start to develop your skills in a different area such as management of hypertension – again, make sure it’s narrow and then expand – or minor illnesses, etc.
A well-defined scope of practice is not just to satisfy a university but is intended to keep you safe and assist you in developing your skills in an environment that is also safe for patients.