Because of the way that pharmacist prescribing was implemented, practitioners tended to start their prescribing careers supporting patients with chronic conditions. This was in no small way due to supplementary prescribing being introduced before independent prescribing. Many pharmacist prescribers feel restricted to prescribe only for chronic conditions in clinic settings. Reasons given for this include a lack of support from employers and perceived restrictions in proving their competence.
I was delighted to read about the new single competency framework for all prescribers, developed by the then National Prescribing Centre (Clinical Pharmacist 2012;4:157). I was discussing this at a recent prescribing conference and was heartened by the positivity of participants. The general feeling was that the framework would allow pharmacist prescribers to become more involved in patient care, especially when managing acutely ill patients.
The fact that the framework is for all prescribers — including pharmacists, doctors and nurses — means that each profession’s skill set can be used in a complementary way to benefit patients. We can learn a lot from our medical colleagues about how to assess and prescribe for acutely ill patients. The consultants I work with will use the resources available to them to arrive at a diagnosis and formulate a treatment plan. For instance, when a patient is admitted with pneumonia they will use a radiologist to help interpret the chest X-ray, a microbiologist to inform them of the most likely causative organisms and a pharmacist to determine the most appropriate antibiotic treatment. Now that we are working from the same competency framework, all pharmacist prescribers could adapt such an approach to their practice.
Recently I helped to manage a patient admitted following an overdose of a toxic chemical. Using regional specialist biochemistry services I was able to determine the severity of the toxicity. I then liaised with the regional poisons centre for advice and the doctors ensured that the patient was not suffering any complications from the overdose. I then prescribed the required dose of antidote and obtained an urgent supply of the drug from a specialist importer. I was able to use my knowledge of poisoning, unlicensed drugs and medicines supply to ensure the patient received the correct drug, at the right dose, in a timely fashion. The single competency framework has certainly empowered me to take a more progressive role in prescribing for patients with complex acute illnesses.
David Gibson is lead clinical pharmacist at Darlington Memorial Hospital