Good medicines management, or optimisation of medicines, is an integral part of most nursing and midwifery practice and includes the administration of medicines, prescribing and supporting people to take their medicines correctly.The term medicines optimisation is now more generally used to encompass a more people centred approach to the use of medicine as part of a person’s care. The Royal Pharmaceutical Society (RPS) good practice guidance states that medicines optimisation is a vital to health care and that the evidence base clearly demonstrates that health care professionals and patients need to work together to improve the quality of medicines use. There is good evidence that medicines management supports better and more cost effective care.
The NICE Guidance Medicines optimisation: the safe and effective use of medicines to enable the best possible outcomes provides the best practice advice on the care of all people who are using medicines and also those who are receiving suboptimal benefit from medicines.
The RCN has published two subject guides on medicines optimisation:
All medicines are classified according to three legal categories which are:
- prescription only medicines (POM): must be sold or supplied according to a prescription prescribed by an appropriately qualified health practitioner, this can be a doctor, dentist, or other independent or supplementary prescriber. They can generally only be supplied at a registered pharmacy premises by or under the supervision of a pharmacist.
- pharmacy (P) medicines: can generally only be sold or supplied at a registered pharmacy premises by or under the supervision of a pharmacist
- general sale list (GSL) medicines: can be sold from a wider range of premises such as supermarkets as long as those premises can be closed to exclude the public (i.e. they are lockable) and the medicines are pre-packed
The legislation on medicines regulation is clearly defined under the Human Medicines Regulations 2012. Prescription only medicines (POMs) cannot be administered or supplied unless one of three types of instruction is in place:
- a signed prescription
- a signed Patient Specific Direction (PSD)
- a Patient Group Direction (PGD)
- The administration of certain parenteral medicines such as adrenaline that can be administered in an emergency without the directions of a prescriber.
- In occupational health settings, the legislation allows for the supply and/or administration of medicines specified in a written instruction signed by a medical practitioner. See the section on medicines optimisation on our occupational health nursing skills and role development page.
From 1 October 2017, schools in England are able to purchase adrenaline auto-injector (AAI) devices without a prescription, for emergency use on children who are at risk of anaphylaxis but whose own device is not available or not working. There is guidance available to support this and help schools develop a policy for using AAIs, see: Using emergency adrenaline auto-injectors in schools.