Working with doctors Working for patients

Endnotes

1. General Medical Council (2013) Good medical practice London, General Medical Council

2. Electronic prescribing services can also be used. In England prescriptions can be sent electronically to a pharmacy; in Wales and Scotland, information is held in a barcode on a paper prescription. For more details see Get Started with EPS, Health and social Care information Centre; Prescriptions electronically, NHS Wales Informatics Service; Electronic Transfer of Prescriptions (ETP) (pdf), Scottish Government

3. See clinicalindications.com

4. See explanatory guidance on Delegation and referral (2013). See also Supply and administration of Botox®, Vistabel®, Dysport® and other Injectable medicines in cosmetic procedures, Medicines and Healthcare products Regulatory Agency.

5. General Medical Council (2008) Consent: patients and doctors making decisions together London, General Medical Council

6. See The use of antipsychotic medication for people with dementia: Time for action (Department of Health, 2009), which reported that ‘around 180,000 people with dementia are treated with antipsychotic medication across the country per year… use at this level equates to an additional 1,800 deaths, and an additional 1,620 cerebrovascular adverse events, around half of which may be severe, per year’, and NICE clinical guideline 42: Dementia. The National Prescribing Centre website and the joint NHS Institute and Dementia Action Alliance’s Call to action: the use of antipsychotic drugs for people with dementia also contains guides, case studies and other materials to support good prescribing practice and alternative care strategies for patients with dementia.

7. or, where appropriate, parents or carers with authority to make decision on behalf of patients. Medicines may be prescribed without consent if it is likely to be of overall benefit to adults who lack capacity, or in accordance with mental health legislation.

8. A number of patient decision aids are available on the National Prescribing Centre website.

9. NHS Choices and information bearing The Information Standard quality mark, for example.

10. The National Prescribing Centre website includes information, guidance and tools for understanding and improving adherence. See also NICE’s Clinical guidelines CG76 on medicines adherence.

11. See Keeping patients safe when they transfer between care providers – getting the medicines right (Royal Pharmaceutical Society, July 2011).

12. See the EQUIP (Errors – Questioning Undergraduate Impact on Prescribing) study (pdf) regarding inappropriate delegation of responsibility for writing up discharge summaries to junior staff with insufficient pharmacology training or knowledge of patients.

13. See Medicines Reconciliation: A guide to implementation (pdf) (National Prescribing Centre, 2008)

14. Shared care resources are available from the National Prescribing Centre; Midlands Therapeutics Review & Advisory Committee, which has produced 16 ‘Effective Shared Care Agreements’ covering a variety of medicines/indications; UK Medicines Information, which has published many shared care protocols/agreements; and Keele School of Pharmacy which publishes an Effective Shared Care Agreement Toolkit ‘to assist healthcare professionals in the development of their own shared care agreements to support locally agreed prescribing’.

15. See the EQUIP (Errors – Questioning Undergraduate Impact on Prescribing) study (pdf) and Investigating the prevalence and causes of prescribing errors in general practice: The PRACtICe study.

16. See Raising and acting on concerns about patient safety (2012).

17. You should anonymise or code the information or seek consent, if practicable, or see our confidentiality guidance for more advice.

18. You must also make sure dangerous occurrences and accidents are reported to the Health and Safety Executive in accordance with the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 1995, and that local procedures for reporting and learning from similar issues are followed.

19. The MHRA collects data on licensed and unlicensed prescription-only, pharmacy and over-the-counter medicines.

20. Further guidance on reporting is available from the MHRA: Reporting Adverse Incidents. Incidents involving medical devices in England and Wales should be reported to MHRA reporting adverse incidents. In Northern Ireland they should be reported to Northern Ireland Adverse Incident Centre; and in Scotland to Health Facilities Scotland online incident reporting.

21. See The Medicines (Advertising) Regulations 1994 and The Medicines (Monitoring of Advertising) Regulations 1994, both as amended, and The Blue Guide: Advertising and Promotion of Medicines in the UK (MHRA, 2005).

22. This definition is based on information published by the Medicines and Healthcare Products Regulatory Authority (MHRA) which is the licensing and regulatory body for the supply and use of medicines and medical devices. MHRA guidance on the lawful supply and use of unlicensed medicines is set out in the MHRA publication The supply of unlicensed medicinal products (“specials”), MHRA Guidance Note 14.

23. We cannot foresee every circumstance in which it may be necessary to prescribe an unlicensed medicine to meet a particular patient’s assessed needs. If in doubt consult MHRA or seek legal advice.

24. The Medicines for Children leaflets on unlicensed medicines produced by the Royal College of Paediatrics and Child Health/Neonatal and Paediatric Pharmacists Group Standing Committee on Medicines may be helpful in explaining to children and parents why such practice is common in caring for children. The British Pain Society publishes Using medicines beyond licence: Information for patients (pdf).