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Reflection on Supplementary Prescribing in Healthcare
Supplementary prescribing refers to a voluntary form of prescribing partnership between a supplementary prescriber and an independent prescriber to implement an accepted patient-specific clinical management plan that duly involves the patient. The independent prescriber has to be a doctor. Nonetheless, other health practitioners such as optometrists, pharmacists, chiropodists, physiotherapists, radiographers, podiatrists and even nurses have been allowed to train and perform supplementary prescribing. This is meant to improve access to health care by patients while reducing the burden on doctors. However, these healthcare providers are required to operate with the stipulated clinical management plan for the patient. This paper presents my reflection on supplementary prescribing alongside a clinical management plan for a specific patient. Other aspects which this paper seeks to address include the legal accountability framework for safe and cost effective prescribing, development and implementation of a clinical management plan, ethical aspects in prescribing at individual, local and national level and finally the ability to monitor, record and respond to a medicine.
Role of a Supplementary Prescriber
The responsibilities of a supplementary prescriber involve conducting an assessment of the patient and her or his condition so as to give her or him an appropriate continued care. The professional has to work with an independent prescriber in fulfilling a clinical management plan that had been formulated and accepted between himself/herself and the prescriber. The work of a supplementary prescriber also entails promotion of the healing process for the patient’s condition through use of such physical techniques as manipulation and massage. What is more, the practitioner is in a position to prescribe the required medicine, including controlled drugs for the client. However, they are required to adhere to the stipulated clinical management plan for the patient (Healthcare and Professional Council, 2016).
As for nurse independent prescribers, they are mandated to prescribe any form of medicine for any illness within their jurisdiction and competency. These also includes any controlled drug in schedule 2, 3,4, or 5 of the 2002 MDR amended regulations. This mandate is provided by the Medicine Act of 1968 which restricts the prescription only drugs to certain practitioners who are defined as medical, veterinary or dental practitioners (National Prescribing Centre, 2012).
The Need for Clinical Management Plan in Supplementary Prescribing
The clinical management plan is the centre for supplementary prescribing. Prior to commencement of supplementary prescribing, practitioners are required to ensure that there is an accepted CMP in place, whether electronic or written in relation to the particular patient as well as the patient’s specified condition that is set to be managed by the supplementary prescriber who in this case is me. Further, the practitioner need to ensure that adherence to this condition has been specified in the patient’s record (ACI no date).
According to UK Department of Health (2011), various aspects must be included in CMP. These are a description of the type or class of medicines, appliances prescribed under the plan, the date of the plan implementation, how and when is the plan monitored or reviewed by the nurse, the type of condition or illnesses that is treated by the supplementary prescriber and the patient’s name who the plan relates with. Further, the CMP ought to include limitations, or restrictions on the specific dose or efficacy of the prescribed medicine, the administration period and the use of appliance or medicine that could be administered under the plan. The CMP could include relevant warning concerning common sensitivities, difficulties or reactions which the patient encounters under the plan. This is in regard to the prescribed appliances and, or medicines prescribed.
Benefits of Supplementary Prescribing
There are immense benefits the patient obtains from an independent nurse prescribing. For this case, the patient was able to enjoy a more efficient care that was not only quicker, but also accessible. There was also a more enhanced capacity for primary care, convenience, and choice for the patient. As an independent prescriber, I found it easy to monitor the quality of the services provide while ensuring patient’s safety is maintained at the maximum. Further, the quality and overall outcome was maximum out of the support provided by the inter-professional practices that were involved in the practice. In addition, this is also the platform where the patient was involved accordingly in the whole treatment process. In this context, patients are considered as partners who are also required to make their contributions regarding the appropriate treatment program suited for them. This treatment program takes into account the patients beliefs, values and views.
As a nurse prescriber, the situation and context gave me an opportunity to utilize my skills extensively, as well as working in a flexible team environment across the healthcare environment. I also learnt the need for inter-professional practice and collaboration. Furthermore, I as well learnt to always ensure safety alongside the need for continuing professional development.
Legal Framework of Accountability for Nurse Independent Prescribing
The Medicinal Products Prescriptions Act includes the provision that specific nurses could prescribe some products from a selected nurse prescriber formulary. However, such nurses have to complete a course as a nurse prescriber and nurse prescribing with professional regulators. Further, The Social And Health Care Act Of 2001 have mandated supplementary prescribing to be developed by nurses upon attaining a three level training or attain a qualification in health visitor and must need to be authorized in order to be allowed to prescribe (Nursing and Midwifery Council 2015).
The independent and supplementary subscribers are required to involve the patient and obtain his or her consent in regard to the treatment plans. Upon agreement of the proposed care plan by the supplementary and independent prescriber, the healthcare practitioners are expected to sign the CMP. The practitioners must make sure to enter the management plan in a database which is shared with the independent prescriber within a one day period (National Prescribing Centre 2005).
It is critical for supplementary and independent prescribers to have the capability of working in collaboration in order to come up with a proper CMP for a particular clinical context (NHS Modernisation Agency 2005). The CMP plans to be developed ought to be simple, adhere to the appropriate guideline for the treatment of a particular health issue and should as well be flexible enough. Currently, it is only the independent prescriber who has a mandate to conduct patient diagnosis and establishing the boundary for CMP. The independent and supplementary prescriber must also have the ability to monitor record and respond to a negative reaction by the patient. Further, these nurses must be adept, knowledgeable and ready to work according to the laid down code of professional conduct. Moreover, these nurses must harbour the necessary expertise to enable them effectively prescribe and be aware of the limitation inherent in their practice (NHS 2005).