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Section 1 – Principles of Good Prescribing Practice

This section provides guidance on good prescribing practice. Having achieved the competencies for prescribing, radiographers are expected to follow this advice in their practice. The guidance provided in this document applies to all settings in which a radiographer may prescribe – within the NHS, private practice, prison service, armed forces, sporting settings or any other health and social care sector.

The SCoR considers it good practice that where radiographers are employed, the employing organisation signs off all protocols and procedures. Where possible, radiographer prescribers should follow organisational-level policies and procedures, and should only create local department-level procedures where no national or organisational policy or procedure is in existence.

Practice Guidance 1: License to prescribe

1.1 You must only prescribe once you have successfully completed an HCPC approved prescribing programme and had your entry on the HCPC register annotated to show your prescribing status as a independent  and/or supplementary  prescriber.

1.2 You should comply with this Practice Guidance, other guidance issued by the SCoR, and with any statutory requirements applicable to your prescribing practice. Failure to do so may put your HCPC registration at risk if concerns are raised about your fitness to practise.

1.3 You must only prescribe within your own defined scope of practice and clinical specialty.

1.4 You must understand which legal framework you are using to prescribe medicines and which types of medicine you are permitted to prescribe within that framework.

Practice Guidance 2: Accountability

2.1 You are professionally accountable for your own prescribing decisions, including actions and omissions. You cannot delegate this accountability to any other person, nor can any other person accept accountability on your behalf for your actions. As an independent prescriber you are wholly responsible for all aspects of the prescribing process. As a supplementary prescriber you are wholly responsible for your decision to prescribe or use the medicines listed within the written CMP. The content of a CMP is developed and agreed jointly by the doctor and supplementary prescriber as well as with the agreement of the patient.  

2.2 You must only prescribe within your level of education, training and competence. You must act in accordance with the HCPC’s Standards of Proficiency, Standards of Conduct, Performance and Ethics and Standards for Prescribing, and the SCoR’s Code of Professional Conduct.

2.3 If you move to another area of practice you may need to undertake further training in order to establish your competency to prescribe in your new clinical specialty.

2.4 Your employer may operate a specific prescribing formulary and may not allow you to prescribe outside of this formulary. This restricted formulary would only apply to your practice for that employer.

2.5 You must also inform the relevant authorities if you have any formal regulatory restrictions placed on your prescribing activity, for example, if the HCPC places any conditions on your practice. 

Practice Guidance 3: Assessment

3.1 In order to prescribe for a patient you must satisfy yourself that you have undertaken a full assessment of the patient, including a thorough history and, where possible, accessing a full clinical record including medication and allergy history. This process may involve carers, especially if the patient has additional needs.

3.2 You should prescribe only where you have relevant knowledge of the patient’s health and medical history commensurate with the prescribing decisions you are taking.

3.3 You should ensure you have considered the patient’s current medication and any potential interactions with other medicines.

3.4 You should take steps to ensure that the patient is not suffering from any medical condition, allergy or receiving any other treatment, that would make the prescription of any medicine unsuitable or dangerous.

3.5 You should ensure you consider the effects of your patient’s lifestyle which may affect the safety of the medicines you prescribe. This will include: 

  • the effects of smoking, caffeine, alcohol 
  • the effects of ‘recreational’ or  ‘street’ drugs or those used to enhance physical or sporting performance 
  • the effects of over-the-counter medicines including herbal preparations.

3.6 Where necessary you should have the ability to request and/or have access to the results of additional appropriate tests. These tests should be relevant to the presenting condition and/or appropriate to the prescribing decisions to be made in order to assist your prescribing decisions. These may include: 

  • blood haematology 
  • blood biochemistry tests eg liver, thyroid and/or kidney function 
  • imaging investigations.

3.7 You may be asked to assess and prescribe during out-of-hours or on-call settings. You should refer to another appropriate prescriber if you do not fully understand the implications of your prescribing actions even though you may be able to take a thorough and appropriate history which leads to a diagnosis.

Practice Guidance 4: Clinical need

4.1 You must only prescribe where you have assessed the patient and there is a genuine clinical need for the prescription of medicines.

4.2 You should consider the circumstances in which you may decide to withdraw medication, cease to continue prescribing a named medication or alter the prescribed dose of a medication. Patients may also wish to discuss with you withdrawal from medication. Any withdrawal from medicines needs to be planned in partnership with the patient and anyone involved with their care. It should take place over an agreed time period.

4.3 You should never prescribe for your own convenience, or simply because a patient demands that you do.

4.4 You should prescribe in the patient’s best interests and achieve this by reaching agreement with the patient on the use of any proposed medicine where possible. The amount of information you discuss with your patient will vary according to the nature of the patient’s condition, the risks and benefits of the medicine, any alternatives, and the patient’s wishes, but in all circumstances will include the provision of “sufficient information” to allow the patient to make an informed choice i.e. to give their informed consent. You should aim to: 

  • establish the patient’s priorities, preferences and concerns 
  • discuss alternative treatment options available to the patient 
  • satisfy yourself that you have enough relevant information to make a prescribing decision 
  • satisfy yourself that the patient understands how to take the medicine as prescribed

4.5 You should only prescribe for patients who are part of your own caseload or under your own care. You should not prescribe for patients simply because you are the only prescriber available.

5.1 You should explain your role as a non-medical prescriber to the patient. 

5.2 You should provide your patient with “sufficient information” relating to the risks, benefits and outcomes of the medicines management you are considering, as well as the comparative risks of alternative treatment options to medication that may be considered in order that the patient can give their informed consent to treatment.

5.3 You should be aware of the variety of social, cultural and religious factors that may impact upon the choices your patient makes in agreeing prescribing decisions with you.

5.4 You should act in accordance with Department of Health, SCoR, and employer guidance on the obtaining and documenting of consent.

5.5 The patient has the right to refuse to accept any medication you propose to prescribe for them, but if they do so you should explain the risks, benefits and outcomes of their decision.

5.6 The patient should be provided with the relevant Patient Information Leaflet (PIL) about the medicine you propose to prescribe. This would normally be provided with the medicine but, if not, the PIL or equivalent information should be provided by the prescriber (See Practice Guidance 10: Information given to patients about their medicines). 

Practice Guidance 6: Communication

6.1 You should communicate effectively, using the most appropriate media, with other practitioners involved in the care of the patient. This includes communication across NHS/private practice boundaries where necessary. You should refer the patient to another prescriber when it is necessary to do so.

6.2 Prescribing decisions should be made in partnership with the patient, where practicable to do so. This will include taking into account the patient’s personal views and beliefs and discussing prescribing and medication decisions in relation to these. You should ensure that patients have understood what they have been told and the consequences of decisions that have been agreed.

6.3 Prescribing is not an activity that occurs in isolation. Prescribing information must be shared with other health professionals who need to know the information for the benefit of the patient and this will include the patient’s GP and/or medical consultant. You should decide the best methods of sharing this information. Where possible, you should have access to other professionals’ prescribing decisions where they impact upon your own decisions. This will include communication across NHS-private practice boundaries where it is necessary to ensure that clinicians have appropriate information to inform their prescribing practice.

6.4 You must inform anyone else who may be in a position to prescribe for that patient of your actions to avoid prescribing errors. This is most likely to be the patient’s GP, but may also include other medical consultant or health and social care professionals. If the patient refuses to consent to you sharing such information you should offer an explanation of the risks of not doing so. If the patient continues to refuse to give consent, you should consider which course of action (including not prescribing) would be in the best interests of the patient. This must be documented in their records.

6.5 You should know what medication the patient is currently taking including over-the-counter and herbal preparations before prescribing new medicines and you should take steps to ensure you have access to the primary source of prescribing information, which is likely to be the GP record.

6.6 When sending patient data, it is vital that the data is secure, and that the risk of data loss (including misdirection) is minimised. The Health & Social Care Information Centre have produced a detailed Information Governance Toolkit3 regarding the safe transfer of patient data which lists the most commonly used methods of communication along with the minimum standards required for safe and secure data transfer. These include:-

  • Verbal Communications: The security and confidentiality of telephone and personal conversations should be considered within the organisation’s policy and procedures (eg confidentiality code of practice) and included in staff training. Staff should be mindful of the need to maintain security and confidentiality when discussing personal or other sensitive information
  • Telephone answering machines: These can be used where the recipient is known (i.e. GP practice) and the message will be retrieved in an appropriate manner. Best practice suggests using password protected voicemail wherever possible. 
  • Faxing: Patient data which is faxed should be done following the NHS IG Safe Haven principles. 
  • Email: Emails containing patient identifiable data should only be sent using (and receiving) NHSmail email accounts or other approved government email domains.
  • Postal/Courier Services: Items must be tracked and traceable, and should include arrangements for redirected or undeliverable items.
  • Portable storage devices (USB Sticks): Use of these devices must only be used following an Information Risk Assessment.
  • Internet protocol (IP) phones (including systems such as Skype): These should only be used “point to point” within the secure N3 network. (It is accepted that clinician/patient conversations occur using this method but it is not advised for conversations about patients/clients between healthcare professionals).
  • Web Based Applications: Movement of patient data within electronic systems must be encrypted and comply with the Confidentiality NHS Code of Practice.
  • Short Messaging System (SMS “texting”): SMS should not be used to convey patient data due to the lack of secure transfer methods and retention of sent data. 

Practice Guidance 7: Record keeping

7.1 This practice guidance relates specifically to the record keeping of your prescribing actions. You should refer to other standards and guidance for information relating to clinical record keeping in general. Prescribing activity (eg writing an FP10, using a hospital based treatment/drug card or using an electronic prescribing application, or a private prescription) should occur at the time of contact with the patient in order to ensure contemporaneous activity is captured in the clinical record.

7.2 Documentation of the prescribing activity should be recorded in clinical records at the time of treatment of the patient. It is not good practice to document prescribing activity after the event eg at the end of the clinic session or the end of the day. Only in exceptional circumstances should documentation be delayed, but in any event the delay should not exceed 24 hours.

7.3 In supplementary prescribing, the doctor/dentist and supplementary prescriber must share access to, consult and, wherever possible, use the same common patient record.

7.4 Records must include the prescription details, together with relevant details of the consultation with the patient.

7.5 Your records should show that you have communicated with the primary healthcare record keeper (usually the GP) especially with regards to repeat, ongoing or withdrawn prescriptions. For hospital in-patients, this may be in the form of the hospital discharge letter and/or clinic letter.

Practice Guidance 8: Evidence based prescribing / prescribing in the patient’s best interests

8.1 You should ensure that your prescribing practice is appropriate, responsible and in the patient’s best interests. Every medicine that is prescribable will have an evidence base recommending its use in conjunction with any NICE guidance and, if appropriate, the current evidence supporting the use of a given medicine.

8.2 You should prescribe according to the available evidence base. Evidence-based prescribing involves the application of the best available evidence when making prescribing decisions. Reference to the evidence base can minimise the risk of adverse drug reactions and ensure the most appropriate medicine is chosen for a patient’s needs.

8.3 You should use national sources of evidence as your primary source of evidence-based prescribing. Where you can clearly demonstrate that a national source of evidence is not available, then locally agreed practice- based evidence or protocols should be followed. 

8.4 When prescribing antibiotics you should consider antimicrobial stewardship and follow local policies for antibiotic use. The local policy is required to be based on national guidance and should be evidence-based, relevant to the local healthcare setting and take into account local antibiotic resistance patterns. They should cover diagnosis and treatment of common infections and prophylaxis of infection. As with the Competency Framework for all Prescribers (Royal Pharmaceutical Society)10, the 2013 Public Health England / ARHAI Antimicrobial Prescribing and Stewardship Competencies5 and NICE Guidelines6 should be used by anyone prescribing medicines to help develop their practice at any point in their professional development in relation to the supply of antimicrobials.

8.5 You should ensure your prescribing is appropriate and that patients have enough information to make an informed choice. You should consider the following factors to ensure you: 

  • are familiar with the current national sources of evidence for the medicine 
  • are familiar with the current national sources of evidence for the condition you are treating which may also include current evidence for which medicine groups should be used, or not used, and a hierarchy of medicines use 
  • have taken an appropriate assessment of the patient 
  • have taken into account the patient’s preferences and expressed wishes with regard to medicines use 
  • have prescribed the appropriate dose for your patient’s age and weight

Practice Guidance 9: Delegation

9.1 You may delegate the administration of a medicine that you have prescribed to another healthcare worker or to the patient themselves. You remain accountable for your prescribing decision and you are also accountable for your decision to delegate the task of administration to someone else including the patient. This includes your assessment that the person is competent to carry out the task and has received sufficient training to carry out your instructions. You are not accountable for the outcome of an action performed by another person.

9.2 Where the delegation information is not clearly identifiable from your written prescription, then the information should be separately recorded in the patient record.

Practice Guidance 10: Information given to patients about their medicines

10.1 Patients, or those authorising treatment on behalf of the patient, should be given sufficient information as they require in order for them to make an informed choice with regard to prescribing decisions. You should include: 

  • diagnosis giving rise to prescribing need 
  • any known serious or common side effects of the proposed medicine 
  • how the medicine works
  • how long to take the medicine for
  • how to stop taking the medicine
  • who to contact and how to contact them in the event of a condition worsening or for advice should they become anxious. 

10.2 Information provided should be appropriate to the patient/carer’s level of understanding. Any issues noted related to normal cognition, learning disability or language barrier must be documented and a plan provided to minimise the impact of the issue.

10.3 Where practicable, you should support information given to your patients in writing.

10.4 You should tell the patient that their medicines will come with a manufacturer Patient Information Leaflet (PIL) which will give them additional information.  In settings where the PIL is not routinely supplied, patients can request such information if they wish.  In patients with visual impairment you should make them aware that they can view this online as an X-PIL or can receive large print, Braille or audio versions from the RNIB medicines leaflet line7.

Practice Guidance 11: Clinical management plans (CMP)

11.1 If you are prescribing as a supplementary prescriber, you must prescribe in accordance with a patient’s individual written clinical management plan (CMP). For a CMP to be legally valid, the independent prescriber must be a medical doctor or a dentist.

11.2 Where standard written CMPs are in place as a starting point, you must tailor them to reflect the individual patient’s personal, medical and medicines history. The CMP must be agreed with you by a medical prescriber, and with the consent of the patient, before supplementary prescribing begins. This could be in the form of a signature, or for an electronic record, a recordable indication of agreement.

11.3 The supplementary prescriber and independent prescriber may agree to modify a CMP in the light of a patient’s changing needs, and may also decide to terminate the use of a CMP if it is no longer appropriate. The supplementary prescriber must always refer back to the independent prescriber if the patient’s condition changes such that the current CMP is no longer appropriate.

11.4 Within supplementary prescribing, you must never prescribe medicines in the absence of a written clinical management plan which has been agreed with the independent prescriber and with the consent of the patient. The independent prescriber may agree verbally to a CMP providing that it is confirmed by fax or secure email in writing before prescribing occurs, and is formally recorded within two working days.

11.5 If you are both an independent and supplementary prescriber, you must adhere to the terms of the CMP when managing the patient’s condition as a supplementary prescriber. This does not preclude you from prescribing for the patient for an unrelated condition, where you are acting as an independent prescriber and are competent to treat the condition concerned.

Practice Guidance 12: Transcribing

12.1 In some circumstances you may be asked to transfer medicines information from one document to another, a process known as transcribing. Transcribing should not be a routine or regular occurrence. If you transcribe, you are accountable for your actions and omissions and this will include any errors you make in transferring the information from one document to another.

12.2 You should satisfy yourself that transcribing is a necessary activity that cannot be eliminated by reviewing and improving the care pathway. If transcribing must occur, you should ensure that the activity meets local clinical governance requirements.

12.3 Any transcription must include: 

  • patient’s full name 
  • date of birth 
  • name of medicine 
  • drug dosage, strength, timing, frequency and route of administration.

Practice Guidance 13: Electronic prescribing

13.1 If you prescribe using e-Prescribing software you should also be using a compatible electronic clinical record software package that allows your prescribing activities to be referenced and cross-checked against the main electronic clinical record. The purpose of electronic prescribing is to reduce medicine errors and reduce patient morbidity and mortality; therefore the prescribing record should be linked to the clinical record.

13.2 You may prescribe via computer-generated prescriptions providing the necessary software is available.

13.3 A traceable audit trail of your prescribing actions should be maintained.

Practice Guidance 14: Writing NHS prescriptions

14.1 In order to write an NHS prescription, the medicine must be permitted to be prescribed at NHS expense. You should check the BNF or specialist guidance and information if you are not sure if a medicine is available on the NHS. If a medicine is not available at NHS expense, it can only be prescribed against a private prescription.

14.2 Your written prescription must comply with local requirements and contain the information required by law such as:

  • your signature in ink 
  • your name and workplace address 
  • your prescribing designation
  • the date on which the prescription was signed by you and/or the date after which it can be dispensed 
  • your profession 
  • the name and address of the patient 
  • the age of the patient if they are under 12 years old.

14.3 The names of the medicines must be written clearly using approved names only. You must not use abbreviations in the name of the medicine.

14.4 A non-repeat prescription is valid for six months after the date of signing, however you should ensure that the medicines prescribed are appropriate for the patient’s needs as you have assessed them, therefore the reasons for any significant delay between assessment and prescription dispensing should be documented.

14.5 You must only write prescriptions for your NHS patients on an in-patient drug chart, an in-patient hospital discharge and/or clinic letter, an in-patient To-Take-Out (TTO) form, an FP10 for out-patients or form provided by local trust/pharmacy. You must follow local medicines management policy and only use the forms that have been issued specifically to you for your NHS practice.  Your name and HCPC registration number (or local NMP number) should be written on the form (if not pre-printed). All the details listed in section 14.2 must be included but for local trust in house prescription forms it may not be a requirement to have the patients address (unless CD) or profession.

14.6 You must never tamper with an existing prescriber’s details on a prescription form or add your own prescribing details.

14.7 You must sign your prescriptions immediately after they are produced. If this is not possible (eg the prescription is printed in a dispensary away from your clinic room), the unsigned prescriptions must be securely stored until you can sign them. You must sign them within 24 hours.

14.8 You must never sign a blank prescription form in advance and then store them for future use.

14.9 You must never print off blank prescriptions in advance and then store them for future use.

14.10 Supplementary prescribers may prescribe controlled drugs if on the CMP. Subject to legislation changes, therapeutic radiographer independent prescribers may be able to prescribe from a limited list of controlled drugs See Practice Guidance 25 Controlled drugs. 

Practice Guidance 15: Writing private prescriptions

15.1 You may write a private prescription for a patient who is receiving non-NHS care when working in private practice. Private prescriptions can be written for medicines that are not available on the NHS. You must not use an NHS prescription form to prescribe medicines privately. A private prescription cannot be used for NHS funded care.

15.2 A private prescription may be written on any document and it must contain the following:

  • your signature in ink
  • your name and workplace address 
  • the date on which the prescription was signed by you and/or the date after which it can be dispensed 
  • your profession 
  • the name and address of the patient 
  • the age of the patient if they are under 12 years old.
  • designation as an independent (IP) or supplementary (SP) prescriber

15.3 The names of the medicines must be written clearly using approved names only. You must not use abbreviations in the name of the medicine.

15.4 NHS prescription forms (FP10s) must not be used to meet the medicines needs of patients whose healthcare is being provided by the non-NHS sector. Patients receiving medicines as part of private healthcare provision are liable for the actual costs of the medicines and any private prescription charge. You must not ask the patient’s GP to prescribe medicines at NHS expense which are subsequently to be administered as part of private healthcare provision.

Practice Guidance 16: Reviewing prescriptions

16.1 You should review a patient’s medication when you are starting a new medication, stopping a medication or changing the dose of a current medication.

Practice Guidance 17: Repeat prescriptions

17.1 Repeat prescriptions are valid for six months and, unless otherwise specified in writing on the prescription, the medicine may be dispensed twice within the validity of the prescription (with the exception of contraceptives which may be dispensed six times). You should ensure that you review your patient’s medication at regular intervals to ensure the prescription remains appropriate for your patient’s needs.

17.2 If you issue repeat prescriptions you must ensure that you prescribe safely and responsibly. Before signing repeat prescriptions, you must be satisfied that it is safe and appropriate to do so. You should review repeat prescriptions regularly and do not issue medicines for longer than is clinically required. You must ensure the correct dose is prescribed for medicines where the dose varies according to the stage of the treatment.

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