Current prescribing practice

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Chapter: Hospital pharmacy : Pharmacist prescribing

The second Crown report and the architects of non-medical prescribing saw its use mainly in the primary care setting.


Current prescribing practice

 

The second Crown report and the architects of non-medical prescribing saw its use mainly in the primary care setting. The hope was that information technology (IT) solutions would allow pharmacists in health centres and community pharmacies to share records and thus facilitate prescribing part-nerships. However, this IT solution is not yet available in community phar-macy, a decade after this vision of pharmacist prescribing was described. The inclusion of pharmacists within the multidisciplinary team caring for hospital patients has perhaps allowed them to take on the role of prescriber with greater ease. There are still barriers to setting up prescribing practice within the hospital setting but, where an institution is supportive and resources are available, the skills of the pharmacist can be capitalised upon to improve patient care. The greatest success of pharmacist prescribing has been within outpatient clinics, on admissions units and within services utilising complex medicine regimens requiring expert monitoring.

 

Although numerous pharmacists have been trained as prescribers, not all of these individuals use their qualification in practice. A recently reported study noted that only 25% of pharmacists, interviewed and practising in Northern Ireland, who had trained as supplementary prescribers before September 2006 currently used their prescribing rights. The ability to become an independent prescriber was, and still is, hoped to correct the disparity between training and utility. Another However, it did find that 67% of trained pharmacist prescribers had used their prescribing rights, the majority of them practising within secondary care.

 

Pharmacist prescribing seems to be used most commonly in a clinic setting and often in the management of chronic disorders. Independent prescribing has been used to facilitate prescribing on admission to and discharge from hospital. However, further research is required to see if, as many practi-tioners believe, this form of pharmacist prescribing is of greater benefit in all areas of clinical practice. Many obstacles are cited in the literature to explain why there is a disparity between those who have trained to prescribe and those who use the qualification, but common themes appear: logistics, lack of strategic implementation and lack of funding. Within hospital practice the easy access to support from the multidisciplinary team is often given as a positive encouragement to establishing pharmacist prescribing. Where strong relationships exist between a medical team and a pharmacist or phar-macists, the pharmacists appear more likely to take on a prescribing role. Thus we can see that the innovation may be driven by individuals rather than the vision of the organisation.

 

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