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Patient safety

PDA issues 'urgent' guidance following serious incidents involving primary care pharmacist prescribers

The Pharmacists’ Defence Association has become “increasingly concerned” about incidents of unsafe practice that have started to emerge as the number of pharmacy independent prescribers working in GP practices has risen.

The Pharmacists’ Defence Association (PDA) has issued “urgent” guidance for its members following several “serious incidents”, including reported fatalities, involving pharmacist independent prescribers (PIPs) working in primary care.

In a statement issued on 19 November 2019, the PDA said that its defence team had become “increasingly concerned” about incidents of unsafe practice that have started to emerge as the number of PIPs working in GP practices had risen.

The statement said said that the team was currently “in the early stages of dealing with cases where patient deaths have been reported”. 

“Some of these recent cases are linked in some way to pharmacists prescribing inappropriately or offering poor advice, often underpinned by an assumption of competence which was ill-founded,” the PDA wrote in its statement.

“We cannot impress upon members strongly enough the importance of seriously considering their levels of experience and skill at all times before making a clinical decision and issuing a prescription,” it continued.

The PDA highlighted four “high-risk scenarios” for PIPs, including undertaking prescribing or providing clinical advice for patients who are not physically present; without reference to their clinical records; or for walk-in patients where a diagnosis may be required.

It also suggested that PIPs check with a GP or colleague with relevant specialist experience before prescribing alternative medicines as a result of shortages.

“If you are about to prescribe a medicine for the first time, significant levels of caution should be used — even if you have routinely supplied that medicine previously in a community pharmacy setting. The two settings or activities should not be conflated, or experience in one assumed to automatically confer expertise in the other,” the PDA said.

The guidance also raised the issue of remote prescribing and said that, in some cases it was aware that employers in online pharmacies may place expectations upon their pharmacist employees to prescribe high-risk medicines, such as controlled drugs, without any communication with the patient’s GP.

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2019.20207376

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