Requirements for prescribing and prescriptions

Semester 1, 2017

Background

Objectives (Overall)

  1. Understand the purpose and contents of the HDPR in the context of pharmacy practice
  2. Be able to navigate the HDPR
  3. Be able to determine how a pharmacist needs to practice to be in accordance with the law, especially with respect to dispensing controlled drugs and restricted drugs.
  4. Know key regulations for S2 and S3 (over-the-counter) medicines.

This section of the module…

Here we focus on Objective 3

Be able to determine how a pharmacist needs to practice to be in accordance with the law, especially with respect to dispensing controlled drugs and restricted drugs.

Specifically we focus on prescribing and prescriptions

Key concepts

  1. The HDPR endorses a number of professions to prescribe.
  2. Non-medical prescribers are regulated in a number of different ways.
  3. Key regulations regarding prescriptions: s79 and s190
  4. There are different types of prescription that are regulated in slightly different ways: handwritten, computer generated and electronic

Endorsement to prescribe

Medical and non-medical prescribing

A number of professions are endorsed to prescribe.

Non-medical prescribers are more tightly regulated than medical prescribers.

Contrast s58 with s56 and s67(4) (and check whether pharmacists can prescribe)

Regulating non-medical prescribing

There are two main ways that non-medical prescribing is regulated in the HDPR

Dentists are endorsed to prescribe a restricted formulary of controlled drugs (s56).

Nurse Practitioners—nurses who have undergone specific training—are endorsed to prescribe controlled drugs under a “drug therapy protocol” (s67(4)).

Drug therapy protocol

Drug therapy protocol (Appendix 9)
means a certified document published by the department stating circumstances in which, and conditions under which, a person who may act under the protocol may use a stated controlled or restricted drug or poison for stated purposes

This will make more sense with an example.

Implementing drug therapy protocols

A nurse practitioner who works in the emergency department might have a lot of training and expertise in treatment patients following trauma.

This nurse practitioner might have a drug therapy protocol for prescribing opioids for analgesia following trauma.

Another nurse practitioner might have a lot of training and expertise in general practice.

This nurse practitioner might have a drug therapy protocol for prescribing antibiotics to a child with a middle ear infection.

Prescriptions

Types of prescriptions

The HDPR refers to two types of prescriptions: paper prescriptions and electronic prescriptions

Look up the definitions in Appendix 9

Electronic prescriptions

Electronic prescriptions are becoming more common, and happen now in some hospitals and nursing homes.

Electronic prescriptions are also being used in community settings—but at the moment in Queensland they are used as a supplement to paper prescriptions.

Prescription Exchange Services include: eRx and medisecure.

Paper prescriptions

Much of our focus will be on paper prescriptions.

Two types: hand written prescriptions and computer generated prescriptions. (Both examples are modified slightly for teaching purposes).

Hand written prescription. Less common, but still used

Hand written prescription. Less common, but still used

Computer generated prescription

Computer generated prescription

Regulations on prescriptions

The key regulations are s79 for controlled drugs and s190 for restricted drugs.

Read each of these. These regulations are critical for assessing whether a paper prescription is legal

Pharmacists know these regulations by heart.

By the end of second year most pharmacy students know these regulations by heart.

Regulations for different drug schedules

s79 (controlled drugs) and s190 (restricted drugs) are very similar, but there are important differences.

See for example: s79(4)(e), and contrast s79(4)(c) with s190(2)(c)

Regulations for different types of prescription

The regulations are also different for hand written and computer generated prescriptions.

See for example: s190(3,4) and Appendix 4

Summary

We will return the to regulations on prescribing frequently.

Now we discuss another part of the regulations important to day-to-day practice as a pharmacist: labelling dispensed medicines.

But first: do the quiz!