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.
Related Topics
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