Clinical governance

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Chapter: Hospital pharmacy : Pharmacist prescribing

‘A framework through which NHS organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment.

Clinical governance


‘A framework through which NHS organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish’ is how clinical governance was defined by the Department of Health. It can be argued that non-medical prescribing sits easily with this approach, as it uses appropriately trained individuals to provide excellent care and it helps to improve patient services. Non-medical prescribing is based firmly on a foundation of competence; prescribers are required by their regis-tering body to maintain their competence within their area of expertise and their competence to prescribe.

·            Pharmacists are instructed by the Code of Ethics:


·           At all stages of your professional working life you must ensure that your knowledge, skills and performance are of a high quality, up to date and relevant to your field of practice.


Although independent prescribers have the ability to prescribe any item from the entire British National Formulary, it is embedded in non-medical pre-scribing education that practitioners must have a full knowledge of the medi-cine they prescribe and the disease they are treating. In practice, pharmacist prescribers work to a personal formulary based around their area of practice. A further fundamental part of any pharmacist prescriber’s practice must be the participation in continuing professional development and reflection upon how new learning influences prescribing practice. Discussion groups have been set up for prescribing pharmacists to allow them access to other pre-scribers for advice and support.


The National Prescribing Centre has developed a competency framework to aid pharmacist prescribers, those who commission their services and pro-vide governance. The framework is divided into three main areas: (1) the consultation; (2) prescribing effectively; and (3) prescribing in context. The areas of competency are set out in Table 10.1. The framework can be used by individuals to inform their continuing professional development or by an organisation to ensure quality.


It is incumbent on individual prescribers to apply clinical governance principles to their practice; however, the organisation within which they conduct that practice also has a duty of care to both the patient and the prescriber.21 Organisations have established non-medical prescribing com-mittees to provide a governance framework for prescribers to work within. Committees vary in their practice. However they:


·      keep a register of non-medical prescribers operating within their organisation


·      ensure that the relevant organisational policies include and incorporate non-medical prescribing


·      agree and approve clinical management plans and personal formularies.


They also have a role in agreeing which staff groups and individuals will be supported by the organisation to train as non-medical prescribers. With the involvement of the organisation in the selection of candidates for training it is hoped that prescribers will utilise those skills once gained, as their position in the service will already be established.


Within the clinical governance arena we have seen the emergence of quality being allied to waste reduction within patient services. Pharmacist prescribers are using their knowledge of medicines regimens and their expertise in individualising patients’ medicines to reduce medication errors within healthcare and this can only improve the quality of care offered to those patients.


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