Managing medicines: Guidelines
You will also encounter policies in the workplace, and these tend to describe compulsory courses of action rather than advice. Many documents produced by the Human Resources department (‘HR’) are policies (e.g. annual leave policy).
In addition, there are standard operating procedures (‘SOPs’), which typically specify a step-by-step approach to managing a particular situation. For example, production units in Pharmacy departments often have SOPs for making and checking pharmaceutical products such as cytotoxics or TPN.
There are two other types of local guideline that you will certainly encounter as a pharmacist, and these are described below:
1. Shared Care Guidelines
‘Shared care’ is a term used in the NHS to describe a situation where a specialist doctor seeks agreement to pass some of the patient’s care, such as prescribing of medication, to their general practitioner (GP).
Shared care guidelines (or shared care protocols or agreements) are documents provide guidance to GPs when taking on the responsibility for continuing care of a patient who has been prescribed a medicine that would usually only be given by a specialist (e.g. with special monitoring requirements). They may be developed locally or nationally. They make clear what the specialist doctor who initiated the prescription will do, and also describe the GP’s and patient’s and/or carer’s responsibilities.
Usually, the guideline describes a specific drug for a stated indication or indications such as riluzole for treatment of amyotrophic lateral sclerosis or ciclosporin for various inflammatory disorders (e.g. rheumatoid arthritis, psoriasis, atopic dermatitis, ulcerative colitis etc.). Shared care guidelines are voluntary and require the agreement of all parties, including the patient. GPs must only agree if they are satisfied that the prescription is needed, appropriate for the patient, and within the limits of their own clinical competence and workload capacity to prescribe.
2. Patient Group Directions (‘PGDs’)
These are written instructions allowing certain health professionals to supply and/or administer a specified medicine to a pre-defined group of patients, without them having to see a doctor. PGDs are used in situations where this offers an advantage for patient care, without compromising patient safety. NICE has produced guidance describing good practice for PGDs with the aim of ensuring patients receive safe and appropriate care and timely access to medicines, in line with legislation.. The Specialist Pharmacy Service has also produced some support materials on PGDs including national templates that can be adapted for use locally.
‘Shared care’ is a term used in the NHS to describe a situation where a specialist doctor seeks agreement to pass some of the patient’s care, such as prescribing of medication, to their general practitioner (GP).
Shared care guidelines (or shared care protocols or agreements) are documents provide guidance to GPs when taking on the responsibility for continuing care of a patient who has been prescribed a medicine that would usually only be given by a specialist (e.g. with special monitoring requirements). They may be developed locally or nationally. They make clear what the specialist doctor who initiated the prescription will do, and also describe the GP’s and patient’s and/or carer’s responsibilities.
Usually, the guideline describes a specific drug for a stated indication or indications such as riluzole for treatment of amyotrophic lateral sclerosis or ciclosporin for various inflammatory disorders (e.g. rheumatoid arthritis, psoriasis, atopic dermatitis, ulcerative colitis etc.). Shared care guidelines are voluntary and require the agreement of all parties, including the patient. GPs must only agree if they are satisfied that the prescription is needed, appropriate for the patient, and within the limits of their own clinical competence and workload capacity to prescribe.
2. Patient Group Directions (‘PGDs’)
These are written instructions allowing certain health professionals to supply and/or administer a specified medicine to a pre-defined group of patients, without them having to see a doctor. PGDs are used in situations where this offers an advantage for patient care, without compromising patient safety. NICE has produced guidance describing good practice for PGDs with the aim of ensuring patients receive safe and appropriate care and timely access to medicines, in line with legislation.. The Specialist Pharmacy Service has also produced some support materials on PGDs including national templates that can be adapted for use locally.
To accompany local guidelines of all kinds, you will frequently encounter national guidelines published by authoritative organisations such as NHS England, NICE, the Royal Pharmaceutical Society, the Royal College of Physicians, and so forth. These are often available on the website of the body concerned and can relate to the law, management of a medical condition, advice on medicine storage, methods of monitoring safety and so on.
- Does your trust have clinical guidelines and policies on its intranet? How easy are they to find?
- Where does pharmacy keep its SOPs? Does every section of pharmacy keep its own or is there one central location?
- Look at some local shared care guidelines and PGDs so that you understand how they are presented and organised.
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