A Patient Specific Direction (PSD)
is a written instruction, signed by a prescriber for medicines to be supplied and/or administered to a named patient after the prescriber has assessed the patient on an individual basis. In practice, a PSD is may be referred to as a “prescription” by those who write and follow them because this indicates that it is written by a prescriber. But this should not be confused with an FP10 or other written prescription given to the patient for supply from a pharmacy or dispensary. The Specialist Pharmacy Service (SPS) Q&A on PSDs
state that these directions must be written and that a verbal instruction is not a valid PSD.
In exceptional circumstances, where medication has been previously prescribed and the prescriber is unable to issue a new prescription, but where changes to the dose are considered necessary, the use of information technology (such as fax, text message or email) may be used but must confirm any change to the original prescription, see the NMC standards for medicines management
standard 11 ‘remote prescription of direction to administer’.
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.
Occupational health setting 'written instructions'
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. The scope of this is much broader and simpler than the use of a PGD. The NHS PGD web site has further information. The BMA guidance for occupational physicians also has some useful information on prescribing in occupational health settings, including an example template for a ‘Specimen operating policy/written instruction’ in the appendix 6.