To Audit A Pharmacist Independent Prescribers Experience where

To Audit – A Pharmacist Independent Prescribers Experience where did I start? Non Medical Prescribers Conference 2012 Graham Rodgers Pharmacist IP

Introduction • Clinical governance requires auditing, monitoring and evaluating our own prescribing practice General Pharmaceutical Council’s standards of Conduct, Ethics and Performance

Background information • By the beginning of 2010 – 9 acute sector Pharmacists In Grampian qualified as Independent Prescribers (PIP) • My regulatory body requires I audit my own prescribing practice • My indemnity insurance also requires my prescribing practice follows my regulatory bodies guidelines • I also wanted to see where and what prescribing activities were undertaken by pharmacists to help plan a strategy for pharmacist prescribing in the acute sector

Aim • To evaluate the development of the prescribing practice of Pharmacist Independent Prescribers within the acute Grampian sector after 1 year of qualification

The main objectives of the audit were: • To identify how Pharmacist Independent Prescribing is being developed within the acute sector in NHS Grampian • To identify the range of drugs being prescribed and the reasons for prescribing by Pharmacist Independent Prescribers (PIP)

Objectives breakdown • to know what other pharmacist independent prescribers were prescribing in the acute sector and …. • Where they were prescribing? • What drugs? • Why they were prescribing? • And was I doing the same as them?

Method and Sample • Which Areas/patients covered/ included in the audit e. g. ARI, Woodend, RACH and/or surgical/kids/elderly • How the data was collected? e. g. weekly/monthly • How to record data collection?

Methodology breakdown • First, I needed a recording sheet for my results and one that everyone else could use • I developed a prescribers log sheet • I piloted this in my own clinical area for a week and reviewed my results and how well the log sheet worked

Example of draft Pharmacy Non medical Prescriber (NMP) Prescribing Log Date Patient initials/ CHI Medicine prescribed Continuation of existing therapy, Amendment, New prescription, Discontinuation Reason for prescription Prescription document Time taken

Next step • I persuaded 9 colleagues to participate in the audit • We chose a week • Carried out the self audit • I collated the data and produced two tables • I presented back to my colleagues and pharmacy management

2011 Pharmacist Independent Prescribers (PIP) audit Results table 1 Total No. of drugs prescribed 374 Non Formulary drugs changed (%) 3 (100%) (0. 8) Continuatio n of existing therapy e. g. IV to oral (%) Amendme nt of therapy (%) New Prescriptio n (%) 113 54 134 (30. 2) (14. 5) (35. 8) Discontinuatio n (%) Number of wards audited 70 (18. 7) 18+

Results table 2 Break down of reasons for new or amended prescribing by PIP • • • New diagnosis Titration of dose Change to guideline New drug Omissions TPN Switch Route of administration Change to renal dose Frequency switch Medical staff unavailable 45% 13% 7% 7% 6% 6% 6% 5% 3% 2%

Results summery • 9 PIPs carried out audit over 1 week • 18+ wards covered in ARI and RACH (TPN covered several surgical and medical wards) • 63 different drugs were prescribed • 374 prescriptions were signed by a PIP • More than a third (35. 8%) of PIP prescription involved new medications • Nearly half (45%) of Pharmacist prescribing was for newly diagnosed conditions

Discussion • This audit shows that all the Pharmacist independent prescribers involved have developed the role within their clinical areas (18+ wards) • Medications prescribed have varied from simple laxatives and analgesics to chemotherapy • Pharmacist independent prescribers are confident independent prescribers and able to start new drug therapies for newly diagnosed conditions

Conclusion This audit is self limiting and generates more questions? Future Audit ideas With the expansion of the number of Pharmacist independent prescribers within the acute sector a more structured audit is required to independently review the prescribing practice of Pharmacists which may focus on reasons for not prescribing, training and support requirements, safety, patient and service needs, strategy and development of pharmacist independent prescribers etc Watch this space

Action Plan • The action plan should reflect what was discussed and concluded. Also an agreed date for each action to be completed and who to complete the action Action Point Dissemination of results To request Clinical Governance & Risk Management Unit support for Repeat audit (more PIP registered 2012 -13) To identify what should be audited in collaboration with Pharmacy and Clinical Governance & Risk Management Unit Continue and evaluate future audit data Date Action to be completed by Actioned by whom 2011 GR + team End of 2012 GR + pharmacy management help On going GR + help from team and management 2013 Audit group