Prescribing: The future of hospital pharmacy
The HPAI Annual Educational Conference featured a keynote speech by Dr Briegeen Girvin, Senior Lecturer and Independent Prescribing Lead at the School of Pharmacy, Queen’s University Belfast, who spoke about the experience of pharmacist prescribing in the North.
Dr Girvin provided a background to the development of prescribing in the UK, including for non-medical prescribers, and the potential barriers, as well as the Royal Pharmaceutical Society’s prescribing competency framework. She described the concept of ‘Independent prescribing’ as “prescribing by a practitioner, for example, by a doctor, dentist, nurse, pharmacist, optometrist [and others] who is responsible and accountable for the assessment of patients with undiagnosed conditions, and for decisions about the clinical management required, including prescribing.
“I guess the big thing really is that you are an autonomous person deciding what to prescribe for that patient in front of you, and you don’t need to go and ask the doctor if that’s alright, But you are also making sure that all the necessary follow-up is happening for that patient, for example any monitoring that might be required.”
Different professional groups have different prescribing powers, she explained, including the nurse and pharmacist independent prescribers (IPs):
“We are basically able to prescribe any medicine at all for any medical condition,” she explained. “The caveat is that it is within your competence. But as pharmacists, we are really good at getting up to speed and being competent before we do take on anything. From research and looking at the rest of the world, I think we are the only area that has this level of autonomy to prescribe,”
“In other places, like Canada or Australia, it seems to be that you are restricted by the formulary, and that formulary may actually change within jurisdictions in different parts of the country.”
Dr Girvin referenced a study undertaken in a Hospital Trust in Leeds, which showed that the prescribing error rate for medics in a hospital was 9.8 per cent, and for pharmacist IPs, that rate was 0.7 per cent. “We have to accept that we will still make mistakes, but that is a massive and statistically significant reduction in errors,” said Dr Girvin (Turner 2021).
The advantages of being IPs for the practitioner include job satisfaction, improved confidence, better use of skills and knowledge, enhanced relationships with colleagues, and a greater recognition of the pharmacist’s role and expertise. Benefits for the organisation include shifting capacity and workload, freeing-up time for more acute/complex cases, reduced error rates, cost-effectiveness and cost-saving benefits, and the potential to enhance physicians’ knowledge of medicines.
This all feeds into the ultimate benefits for the partient, which include improved access to care, more choice and convenience, better quality of care, better control and management of conditions, improved satisfaction, and better continuity of care.
“We all know that we are really well placed to be prescribers, as we are the experts in medicines,” Dr Girvin concluded. “Some of the things we have to think about are legislative changes, medical mentorship, access to clinical systems, the extra training that will be required, and embedding into the undergraduate curriculum. It will require lots of investment and funding, and perhaps working with stakeholders and changing the culture.
“But overall, it’s a really welcome opportunity and I have really enjoyed it in the clinic, and it’s definitely the favourite thing I have done in my career so far.”
Presentation available for members on the Education Forum
Turner E, Kennedy MC, Barrowcliffe A. An investigation into prescribing errors made by independent pharmacist prescribers and medical prescribers at a large acute NHS hospital trust: a cross-sectional study. Eur J Hosp Pharm. 2021 May;28(3):149–53. doi: 10.1136/ejhpharm-2019-002074. Epub 2020 Mar 11. PMCID: PMC8077630.
