OCTOBER,Edition # 35, 2001

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Moves are afoot to develop electronic prescribing models in Australia, and all sorts of medical records databases such as the Better Medication Management System (BMMS), but I just hope out of all of this we achieve one thing... prescriptions you can interpret with 100% surety.
Medical Director and similar programs have made huge advances in legibility but there are still plenty of doctors who can't quite grasp the idea of regular software updates (contrast to pharmacy where its basically enforced).
Authorities are incorrect or incomplete, pack sizes are out of date and so on...
But at least you can read them now.
Working with trainee doctors in our local hospital has taught me a lot about the different ways doctors and pharmacists are educated.
We had the legal background for prescriptions writing and interpretation drilled into us repeatedly in four years at university as many would expect, and just about every graduating pharmacist can spot a dodgy prescription at ten paces as a result.
But can new interns in a hospital grasp the idea of writing a legal prescription?
For a large number the answer is simply no.
This morning we saw a medication order for "Oris i mane".
(When you find the Oris tablets in your pharmacy give me a call as this patient must be getting desperate.)
A quick phone call upstairs revealed the patient had his own supply of Adalat OROS 30mg and the mystery was solved, but not before we considered Orudis, Oxis and a range of other alternatives. This highlights for me the basic flaw in the prescribing process.
New doctors are simply not aware of what products are available on the market. Countless times each week we chase up strengths for medication orders such as "Seretide ii bd", "Deralin 1/2 m" and so on.
Surely the trained professionals who have to know the products which are available are better placed to write the final orders after the doctors have decided what course of treatment to follow?
We make it easy to write prescriptions in our hospital. We divide the page into a big table and you fill in the boxes to suit. Even this concept is too difficult to grasp for some and makes me wonder if the prescription writing should just be left to the pharmacist.
Give us the rough idea of what you want and we can fill in the details.
In Britain, programs are now in train to allow pharmacists to become dependant prescribers. In essence a doctor will decide what treatment is to be initiated e.g. an ACE-Inhibitor, but selection of drug and dose will be the role of the prescribing pharmacist. After a period as a dependant prescriber, some of the restrictions will be lifted to allow practice as an independant prescriber.
(This move also allows the medicos to focus on improving their diagnostic and clinical skills.)
Pharmacy lags well behind nursing in this respect.
New South Wales now has Nurse Practitioners in place with limited prescribing rights in areas not serviced by doctors.
In Britain there are plans afoot to expand the range of drugs that nurses are able to prescribe to include a larger range of previously (doctor's) Prescription Only Medicines.
To some extent pharmacists have had their prescribing roles enhanced by the switch to over-the counter (OTC) of former Schedule 4 medications (S4s) such as ranitdine and the steroid nasal sprays.
But here we are against the commercial pressures of Direct-To-Consumer (DTC) advertising, which medical practioners don't have to contend with for S4 medications. (Although it now seems that DTC advertising of prescription drugs is allowed, but only on news and current affairs shows!!)
Of course, a scheme like that described above would require a lot of training for pharmacists, because prescribing is not something that comes naturally to many, and I know a lot who would be uneasy about such a move because they do not feel they are trained appropriately.
The switch in focus to therapeutic decision making in the new four year degree programme is a step in the right direction for the future of our profession.
Let's hope the powerbrokers can see the committment we are making and back it up with some tough decisions.

Ends

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