NonMedical Prescribing Protocols Guidelines and Patient Group Directives

Non-Medical Prescribing Protocols, Guidelines and Patient Group Directives

Definition ¡ Protocols are “standard specifications for managing particular clinical problems and are intended to improve the outcomes of care by increasing adherence to agreed standards”. (Landry and Mc. Duff, 1991)

Providers use them to Establish agreed standards and goals (e. g. a specific health outcome) ¡ Establish agreed/standard intervention strategies based on evidence of clinically effective practice ¡ Identify methods of measuring outcome in order to monitor the service provided ¡

Purchasers use them to ¡ Provide evidence of effectiveness; in order to choose what to purchase ¡ Provide evidence of comparable outcome; in order to choose where to purchase ¡ Set specific quality requirements for providers

A Protocol should be ¡ Outcomes focused ¡ Based on best evidence ¡ Reliable (and validated by being widely used) ¡ Representatively developed ¡ Clinically applicable/flexible ¡ Meticulously documented ¡ Regularly evaluated and updated

Advantages (I) ¡ ¡ The knowledgeable can provide written instructions for the less able They can be used to achieve consensus/consistency between health care professionals and therefore consistency of care Provides a means of monitoring performance May produce greater professional autonomy

Advantages (II) Improves treatment/patient outcomes by ensuring best practice and is a defence against cost cutting ¡ Improves budgeting by making costs predictable and by eliminating protective practices they will reduce costs ¡ They protect the service from litigation ¡

Disadvantages (I) If “expert” led they may reinforce unsound practice ¡ They may stifle innovation; thus “freezing” practice ¡ May reinforce hierarchies ¡ May reduce the number of qualified professionals ¡ Would reduce the use of professional clinical discretion ¡

Disadvantages (II) ¡ ¡ ¡ Will make it difficult to meet the individual health needs of clients/patients/service users Will reduce professional responsibility/accountability May increase costs They will get very rapidly out of date May stimulate litigation

Litigation “Protocols and standards are all too convenient a yardstick for the legal system to use in measuring a practitioners practice. Standards and protocols are easily breached. Evidence of these breaches can be used to help establish deviation from the (required) standard of care. When this deviation can be construed to cause damage to the patient the practitioner is in a very vulnerable situation. In order to avoid this, practitioners should make minimum standards, if any at all. Once made, the standards must be followed. Protocols should be the minimum requirements for safe care and not the maximum for ideal care. (Adapted from Moniz, D. M. , 1992 – in “Nurse Practitioner” pp. 58 -60, September, 1992)

Patient Group Directions Supply and administration ¡ One-off episodes ¡ Acute care ¡ Predictable pattern of care ¡ ¡ NOT prescribing

PGD: Legal Definition “A written instruction for the sale, supply and/or administration of named medicines in an identified clinical situation. It applies to groups of patients who may not be individually identified before presenting for treatment. ”