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W3C-validated CSS 2.14.10 The process: IP prescribing
"I'm suggesting that whoever provides the diagnosis should be the trigger point for the information being provided. That will be the GP or the consultant who would trigger it." — patient interviewed
Prescribing information
Prescribing is the process through which the information needs of users and carers are identified and an IP template is completed.
There are five types of prescribing process.
1. Signposting
Strictly speaking, signposting is not prescribing, as it does not entail the completion of a tailored IP. But it is useful as a quick way for professionals to point users in the direction of the information they need.
2. Pre-prescribing
Pre-prescribing is the term we use to describe the phase – prior to prescribing proper – in which the information needs of a service user or carer are discussed with a professional. See the box below that shows how Evelina pharmacists, together with NHS Direct have used the pre-prescribing method.
3. Single stage prescribing
Another possibility is for the information needs of a user to be established, a prescription completed, and information dispensed at the same time.
4. Multi-stage prescribing
In some places, prescribing takes place over several distinct stages. In such cases, the information needs are discussed in a clinical or other front-line care setting and the more detailed prescribing is done by health information specialists or health and social care workers with specialist knowledge of information sources. In this model, the people who do the detailed prescribing may also be the dispensers. In multi-stage approaches, it may be helpful to describe the first phase as the 'pre-prescribing' or 'needs identification' phase, to distinguish it from the main and more detailed part of the prescribing.
5. Self-prescribing
Self-prescribing involves users identifying their own health needs, and selecting appropriate information to support themselves, generally through websites. The important feature of self-prescribing is that there is no need for professionals to be directly involved in the process.
The Evelina Children's Hospital and several community pharmacists -- working in partnership with NHS Direct -- have put pharmacists at the heart of the IP process. The pharmacists help parents complete a simple information prescription request when a medicine is dispensed. Parents can request information about their child's condition, support groups, how medicines work, adverse effects, what to do if the child experiences adverse effects, what to do if a dose is missed and what to do if the condition deteriorates. Download a copy of the NHS Direct leaflet that explains IP and includes the request form [PDF, not tagged, 2.5MB]
The request form is forwarded to NHS Direct's online enquiry service, which then compiles information and delivers it to parents by email or post within 48 hours. An NHS Direct helpline is also made available. The pharmacists can log in to the NHS Direct system to see what information has been dispensed.
Pharmacists are well-placed to provide tailored information prescriptions about medicines because they are easily accessible and have the patients' full list of current medicines to hand. Pharmacists' knowledge means they can address some queries verbally and also request written information to reinforce verbal information.
A partnership approach such as this makes it possible for busy pharmacists to deliver consistent, validated, accessible information that is needed by a patient or carer as part of on-going care.
On the next page: using prompts or scripts to assess what information is needed
