Pharmacy support for CHS staff needs to include access to advice and information, input to the development of policies, procedures, and associated education and training.
CHS professionals and their roles
Pharmacy support for CHS staff needs to include access to advice and information, input to the development of policies, procedures, and associated education and training. Information on the medicines that the different pro-fessionals can prescribe, supply and/or administer can be found in Medicines, Ethics and Practice. A document on the National electronic Library for Medicines explains more fully the training, qualifications and roles of these CHS professionals.
District nurses (DN)
are registered general nurses with a postregistration specialist qualification
who provide skilled nursing care to patients, generally within their own homes.
DN are located in community clinics or in GP practices. DN are community
practitioner nurse prescribers who prescribe from a limited list of medicines
providing they have fulfilled the educational requirements. The majority of
pharmaceutical items that they use should be obtained on FP10 or private
prescription. However, the local policy may be to have a stock supply system
for dressings. At the back of the British National Formulary there is a list of
the medicines they can prescribe. As DN prescribe and administer medicines they
need to be able to access pharmacy advice about, for example, product
information, stability, routes of administration and support for compliance.
Health visitors (HV)
are registered general nurses with a postregistration qualification. Their
roles mainly involve health promotion and develop-ment of the family,
particularly relating to children less than 5 years of age. Some HV specialise
in providing services to older people, well-woman groups, smoking cessation and
so on. HV are also community practitioner nurse prescribers but as their roles
are advisory and educational they tend to prescribe less than DN and have a
minimal need for pharmaceutical supplies. HV need to be able to access
pharmaceutical advice on topics such as drugs in breast milk, medicines in
pregnancy, immunisation, treat-ment of head lice infection and use of medicines
in children and in the elderly.
School nurses (SN)
are responsible for the health of children in primary and secondary school,
both in providing medical checks at key stages of develop-ment and in
implementing the school vaccination programme that includes school-leaver
boosters. The support they need from pharmacy is mainly information about, for
example, maintaining the cold chain for vaccines, working under patient group
directions (PGDs) and specific vaccine queries. They may also need to access
advice about the management of prescribed medicines in schools. SN also work in
special schools to support children with severe learning and physical
disabilities. These SN need access to more spe-cific advice relating to the
safe management of prescribed medicines, for example, for treatment of
epilepsy.
Some nurses develop
specialist expertise in defined areas such as stoma care, diabetes,
paediatrics, continence and palliative care, and need pharmaceutical advice
such as on policies and procedures. Many of these nurses will be nurse
independent prescribers.
Many nurses now work
in ‘walk-in’ centres and other first contact care facilities. These services
are often nurse-led, although some have sessional medical input. These nurses
will supply and administer an agreed range of medicines, either under PGDs or
they may be qualified as nurse independent prescribers.
With care moving
closer to the patient’s home the role of the community matron has developed in
England, their role including to assess and support patients, and thus prevent
unnecessary admission to hospital. Many of these nurses will also be
non-medical prescribers.
Community dental
officers are generally based in community clinics (these are those employed
rather than the contractor dentists who provide general dental services). They
provide dental care for the community with particular emphasis on
schoolchildren, antenatal and postnatal women and people with physical or
learning disabilities. They may also provide domiciliary care to patients who
are unable to attend a clinic, including those living in care homes. Most individual
patient treatment is provided on FP10 prescription. Local anaesthetics and
other pharmaceuticals routinely needed in dental ses-sions will generally be
supplied by the pharmacy service. General anaesthesia is now almost exclusively
performed in a hospital setting but some community dental services may provide
conscious sedation. Dentists need to comply with current guidelines for dental
emergencies such as anaphylactic shock and cardiac arrest.
Podiatrists
(registered as chiropodists) who work within CHS are registered with the Health
Professions Council and provide services to older people, diabetics and to the
same groups of patients as dentists. Podiatrists who hold a certificate of
competence in the use of medicines may sell or supply certain medicines in the
course of their professional practice. It is important to ensure that proper
labelling requirements are being met. Podiatrists who hold a certificate of
competence in the use of analgesics may administer certain local anaesthetics
parenterally. Podiatrists are also included in the list of health
pro-fessionals who can administer and supply medicines under a PGD. Podiatrists
who have additional training can offer surgical foot services. Many podiatrists
now provide services within GP practices.
Other healthcare
professionals who work in CHS include dieticians, speech and language
therapists, physiotherapists and occupational therapists.
Although use of
medicines may not be a major component of the roles of these professionals,
they may need access to pharmacy advice and support. Examples include:
dieticians involved in advising on/initiating sip feeds or recommending the use
of fortified recipes; speech and language therapists involved in poststroke
support and treating swallowing difficulties; physio-therapists providing
musculoskeletal services who may be injecting intra-articular steroids; and
occupational therapists in rehabilitation services who assess activities of
daily living, including ability to open containers.
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