Skip to main content

Advertisement

SpringerLink
Log in

Pharmacist independent prescribing in secondary care: opportunities and challenges

  • Commentary
  • Published:
International Journal of Clinical Pharmacy Aims and scope Submit manuscript

Abstract

In recent years a number of countries have extended prescribing rights to pharmacists in a variety of formats. The latter includes independent prescribing, which is a developing area of practice for pharmacists in secondary care. Potential opportunities presented by wide scale implementation of pharmacist prescribing in secondary care include improved prescribing safety, more efficient pharmacist medication reviews, increased scope of practice with greater pharmacist integration into acute patient care pathways and enhanced professional or job satisfaction. However, notable challenges remain and these need to be acknowledged and addressed if a pharmacist prescribing is to develop sufficiently within developing healthcare systems. These barriers can be broadly categorised as lack of support (financial and time resources), medical staff acceptance and the pharmacy profession itself (adoption, implementation strategy, research resources, second pharmacist clinical check). Larger multicentre studies that investigate the contribution of hospital-based pharmacist prescribers to medicines optimisation and patient-related outcomes are still needed. Furthermore, a strategic approach from the pharmacy profession and leadership is required to ensure that pharmacist prescribers are fully integrated into future healthcare service and workforce strategies.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

References

  1. Emmerton L, Marriott J, Bessell T, Nissen L, Dean L. Pharmacists and prescribing rights: review of international developments. J Pharm Pharm Sci. 2005;8:217–25.

    PubMed  Google Scholar 

  2. Baqir W, Miller D, Richardson G. A brief history of pharmacist prescribing in the UK. Eur J Hosp Pharm Sci Pract. 2012;19:487–8.

    Article  Google Scholar 

  3. Yuksel N, Eberhart G, Bungard TJ. Prescribing by pharmacists in Alberta. Am J Health Syst Pharm. 2008;65:2126–32.

    Article  PubMed  Google Scholar 

  4. Phelps A, Agur M, Nass L, Blake M. GPhC Registrant Survey 2013. General Pharmaceutical Council 2014. http://www.pharmacyregulation.org/sites/default/files/gphc_registrant_survey_2013_main_report_by_natcen.pdf. Accessed 10 Nov 2015.

  5. Hinchliffe A. Pharmacist independent prescribing-a review of the evidence. NHS Wales 2015. https://www2.nphs.wales.nhs.uk/PharmaceuticalPHTDocs.nsf/($All)/45E9469550B09BB280257DF6004058CE/$File/Pharmacist%20independent%20prescribingv1.1.pdf?OpenElement. Accessed 27 Aug 2015.

  6. Al Hamarneh YN, Charrois T, Lewanczuk R, Tsuyuki RT. Pharmacist intervention for glycaemic control in the community (the RxING study). BMJ Open. 2013;3:e003154.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Houle SK, Chuck AW, McAlister FA, Tsuyuki RT. Effect of a pharmacist managed hypertension program on health system costs: an Evaluation of the Study of Cardiovascular Risk Intervention by Pharmacists-Hypertension (SCRIP-HTN). Pharmacotherapy. 2012;32:527–37.

    Article  PubMed  Google Scholar 

  8. McAlister FA, Majumdar SR, Padwal RS, Fradette M, Thompson A, Buck B, et al. Case management for blood pressure and lipid level control after minor stroke: PREVENTION randomized controlled trial. CMAJ. 2014;186:577–84.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Tsuyuki R, Houle S, Charrois T, Kolber M, Rosenthal M, Lewanczuk R, et al. A randomized trial of the effect of pharmacist prescribing on improving blood pressure in the community: the Alberta clinical trial in optimizing hypertension (RxACTION). Circulation. 2015;132:93–100.

    Article  PubMed  Google Scholar 

  10. Health Education England. Investing in people for health and healthcare. Workforce plan for England. Proposed education and training commisions for 2014–15. 2014. http://hee.nhs.uk/wp-content/uploads/sites/321/2013/12/Workforce-plan-investing-in-people.pdf. Accessed 27 Aug 2015.

  11. Scottish Government Department of Health and Wellbeing. Prescription for excellence: a vision and action plan for the right pharmaceutical care through integrated partnerships and innovation. 2013. http://www.gov.scot/resource/0043/00434053.pdf. Accessed 27 Aug 2015.

  12. Tonna AP, Stewart DC, West B, McCaig DJ. Exploring pharmacists’ perceptions of the feasibility and value of pharmacist prescribing of antimicrobials in secondary care in Scotland. Int J Pharm Pract. 2010;18:312–9.

    Article  PubMed  Google Scholar 

  13. National Institute for Health and Care Excellence. Medicines optimisation: the safe and effective use of medicines to enable the best possible outcomes. 2015. https://www.nice.org.uk/guidance/ng5. Accessed 27 Aug 2015.

  14. Dornan T, Ashcroft D, Heathfield H, Lewis P, Miles J, Taylor D, et al. An in depth investigation into causes of prescribing errors by foundation trainees in relation to their medical education. EQUIP study. General Medical Council, 2009. http://www.gmc-uk.org/FINAL_Report_prevalence_and_causes_of_prescribing_errors.pdf_28935150.pdf. Accessed 27 Aug 2015.

  15. Ryan C, Ross S, Davey P, Duncan EM, Francis JJ, Fielding S, et al. Prevalence and causes of prescribing errors: the PRescribing Outcomes for Trainee doctors Engaged in Clinical Training (PROTECT) study. PLoS One. 2014;9:e79802.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Dean B, Schachter M, Vincent C, Barber N. Causes of prescribing errors in hospital inpatients: a prospective study. Lancet. 2002;359:1373–8.

    Article  PubMed  Google Scholar 

  17. Ross S, Ryan C, Duncan EM, Francis JJ, Johnston M, Ker JS, et al. Perceived causes of prescribing errors by junior doctors in hospital inpatients: a study from the PROTECT programme. BMJ Qual Saf. 2013;22:97–102.

    Article  PubMed  Google Scholar 

  18. Tully MP. Prescribing errors in hospital practice. Br J Clin Pharmacol. 2012;74:668–75.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Baqir W, Crehan O, Murray R, Campbell D, Copeland R. Pharmacist prescribing within a UK NHS hospital trust: nature and extent of prescribing, and prevalence of errors. Eur J Hosp Pharm Sci Pract. 2014;22:79–82.

    Article  Google Scholar 

  20. Onatade R, Al-Azeib S, Gore S. Description and evaluation of the quality of pharmacist-written discharge medication. Int J Pharm Pract. 2014;22(S2):82–83.

    Google Scholar 

  21. Seden K, Kirkham JJ, Kennedy T, Lloyd M, James S, Mcmanus A, et al. Cross-sectional study of prescribing errors in patients admitted to nine hospitals across North West England. BMJ Open. 2013;3:e002036.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Graabæk T, Kjeldsen LJ. Medication reviews by clinical pharmacists at hospitals lead to improved patient outcomes: a systematic review. Basic Clin Pharmacol Toxicol. 2013;112:359–73.

    Article  PubMed  Google Scholar 

  23. Marotti SB, Kerridge RK, Grimer MD. A randomised controlled trial of pharmacist medication histories and supplementary prescribing on medication errors in postoperative medications. Anaesth Intensive Care. 2011;39:1064–70.

    CAS  PubMed  Google Scholar 

  24. Mergenhagen KA, Blum SS, Kugler A, Livote EE, Nebeker JR, Ott MC, et al. Pharmacist- versus physician-initiated admission medication reconciliation: impact on adverse drug events. Am J Geriatr Pharmacother. 2012;10:242–50.

    Article  PubMed  Google Scholar 

  25. Tonna A, Stewart D, West B, McCaig D. Pharmacist prescribing in the UK—a literature review of current practice and research. J Clin Pharm Ther. 2007;32:545–56.

    Article  CAS  PubMed  Google Scholar 

  26. Latter S, Blenkinsopp A. Non-medical prescribing: current and future contribution of pharmacists and nurses. Int J Pharm Pract. 2011;19:381–2.

    Article  PubMed  Google Scholar 

  27. Royal Pharmaceutical Society. Improving Urgent and Emergency Care through better use of pharmacists. 2014. http://www.rpharms.com/policy-pdfs/urgent-and-emergency-care.pdf. Accessed 27 Aug 2015.

  28. Weeks GR, Ciabotti L, Gorman E, Abbott L, Marriott JL, George J. Can a redesign of emergency pharmacist roles improve medication management? A prospective study in three Australian hospitals. Res Social Adm Pharm. 2014;10:679–92.

    Article  PubMed  Google Scholar 

  29. Rosenthal MM, Houle SK, Eberhart G, Tsuyuki RT. Prescribing by pharmacists in Alberta and its relation to culture and personality traits. Res Social Adm Pharm. 2015;11:401–11.

    Article  PubMed  Google Scholar 

  30. Hassell K. GPhC Register Analysis 2011. Centre for Pharmacy Workforce Studies 2012. http://www.pharmacyregulation.org/sites/default/files/Analysis%20of%20GPhC%20Pharmacist%20Register%202011.pdf. Accessed 10 Nov 2015.

  31. Buckley P, Grime J, Blenkinsopp A. Inter-and intra-professional perspectives on non-medical prescribing in an NHS trust. Pharm J. 2006;277:394–8.

    Google Scholar 

  32. Royal Pharmaceutical Society. Medicines Optimisation: Helping patients to make the most of medicines. 2013. https://www.rpharms.com/promoting-pharmacy-pdfs/helping-patients-make-the-most-of-their-medicines.pdf. Accessed 27 Aug 2015.

  33. Rosenthal M, Austin Z, Tsuyuki RT. Are pharmacists the ultimate barrier to pharmacy practice change? Can Pharm J. 2010;143:37–42.

    Article  Google Scholar 

  34. Bourne RS, Whiting P, Brown LS, Borthwick M. Pharmacist independent prescribing in critical care: results of a national questionnaire to establish the 2014 UK position. Int J Pharm Pract. 2015;. doi:10.1111/ijpp.12219.

    PubMed  Google Scholar 

  35. Medical Education England. Modernising Pharmacy Careers programme. Pharmacist Prescriber Training Working Group Report. 2010. http://hee.nhs.uk/healtheducationengland/files/2012/10/Pharmacist-Prescriber-Training-Report-for-MPC.pdf. Accessed 27 Aug 2015.

  36. Tonna A, McCaig D, Diack L, West B, Stewart D. Development of consensus guidance to facilitate service redesign around pharmacist prescribing in UK hospital practice. Int J Clin Pharm. 2014;36:1069–76.

    Article  PubMed  Google Scholar 

  37. Royal Pharmaceutical Society. Professional Standards for Hospital Pharmacy Services. Optimising Patient Outcomes from Medicines. 2014. http://www.rpharms.com/support-pdfs/rps—professional-standards-for-hospital-pharmacy.pdf. Accessed 27 Aug 2015.

Download references

Funding

None.

Author information

Authors and Affiliations

  1. Departments of Pharmacy and Critical Care, Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Herries Road, Sheffield, S5 7AU, UK

    Richard S. Bourne

  2. Pharmacy Department, Northumbria Healthcare NHS Foundation Trust, North Tyneside Hospital, North Shields, NE29 8NH, UK

    Wasim Baqir

  3. Pharmacy Department, King’s College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK

    Raliat Onatade

Authors
  1. Richard S. Bourne
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Wasim Baqir
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Raliat Onatade
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Richard S. Bourne.

Ethics declarations

Conflicts of interest

None.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bourne, R.S., Baqir, W. & Onatade, R. Pharmacist independent prescribing in secondary care: opportunities and challenges. Int J Clin Pharm 38, 1–6 (2016). https://doi.org/10.1007/s11096-015-0226-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11096-015-0226-9

Keywords

Search

Navigation