Where a verbal instruction is given to alter the dose of a medicine previously prescribed, there would need to be a clear record of the discussion rational and treatment actions carried out documented in the clinical record. For prescribers see the NMC circular: Remote assessment and prescribing, and the NMC standards of proficiency for nurse and midwife prescribers practice standard 20 ‘Remote prescribing via telephone, email, fax, video link or website’.
Patient Group Directions (PGDs) are written instructions for the supply or administration of medicines to groups of patients who may not be individually identified before presentation for treatment.'
PGDs provide a legal framework that allows the supply and/or administration of a specified medicine(s), by named, authorised, registered health professionals, to a pre-defined group of patients needing prophylaxis or treatment for a condition described in the PGD, without the need for a prescription or an instruction from a prescriber. Using a PGD is not a form of prescribing.The supply and/or administering of medicines under PGDs should be reserved for situations in which this offers an advantage for patient care, without compromising patient safety. Organisations should have policies and processes in place to consider all options before a service is designed or commissioned using PGDs. Before a PGD is developed, the organisation must ensure that PGDs are appropriate, legal and that relevant governance arrangements are in place.
- The NHS PGD information pages; “To PGD or not to PGD”
- The National Institute for Health and Care Excellence (NICE) has published a suite of guidance, advice and support for delivering quality, safety and efficiency in the use of medicines.
- The MHRA has also issued some guidance on PSDs (Patient Specific Directions).
- The BMA has updated their guidance for Patient Group and Patient Specific Directions. This guidance is for England only.
- The CQC Myth buster on Patient Group Directions and Patient Specific Directions
- NMC standards for medicines management
- NMC standards of proficiency for nurses and midwives
- The Medicines and Healthcare products Regulatory Agency (MHRA) regulates medicines, medical devices and blood components for transfusion in the UK.
- The Yellow Card Scheme is vital in helping the MHRA monitor the safety of all healthcare products in the UK to ensure they are acceptably safe for patients and users. Reports can be made for all medicines including vaccines, and all medical devices available on the UK market.