Lektion 1, Thema 1
Responsibilities of Prescribers
HaH receive prescription from the NHS and Private Medical Prescribers. It is their responsibility to supply prescription where the prescriber has responsibility for:
- Checking the allergy status of the patient and for any potential interaction between patient’s current medicines and their supportive care medicines.
- Confirming the appropriate dosage and regimen.
- Ensuring that all calculations of dosages are appropriate and use recently measured variables such as a recent weight.
- Ensuring accurate dosing. A maximum of +/-5% variance (according to protocol dosages) in dosage calculation is permitted, or as defined by Trust policies.
- Prescribing and monitoring all anticancer drugs and supportive therapies including antiemetic and hydration. This includes the ongoing monitoring of toxicities and amendment of supportive medicines where required.
- Ensuring that maximum cumulative doses of Anthracyclines and Bleomycin have not been exceeded. If these drugs have been given to the patient at other Trusts e.g. tertiary referral to a Cancer Centre from a District General Hospital, the referring unit must provide information on cumulative doses already received, as appropriate.
- Specifying the route of administration and for parenteral doses, the duration of infusion on the prescription.
- Ensuring the patient has appropriate venous access prior to prescribing infusions of vesicants.
- In the case of systemic anticancer therapies (SACT) ensuring there is an appropriate interval between each treatment day and cycle, within a course, as defined by the protocol.
- Ensuring the patient is given written information regarding treatments they will be given.
- Ensuring the patient is fully informed of their treatment and has given consent.
- Informing the patient’s general practitioner in writing of the intention to start the course of treatment and provide sufficient information for action to be taken in the event of the patient experiencing side effects.
- Ensuring that all relevant safety parameters e.g., blood counts, renal, hepatic and cardiac function have been checked and that the patient is fit to receive treatment. If doses are modified due to variance of these parameters, the reason for dose modification must be recorded on the prescription and in the patient’s healthcare record.
- If a patient is to be treated with a SACT-radiation protocol, it is essential that the prescriber makes this clear on the prescription, and notifies the relevant nursing and pharmacy staff.
- Wherever possible, SACT must be initiated during normal working hours when access to specialist staff is more likely to be available. Only in exceptional circumstances is SACT permitted to be initiated outside of normal working hours after discussion with the patient’s consultant and key operational staff (i.e. cancer nurses and pharmacists). The reasons for initiating SACT out-of-hours must be documented in the patient’s clinical evaluation form.
- Prescriptions for all SACT must be electronic (or pre-printed proforma, not hand written), not verbal, and changes to any of these prescriptions must be documented electronically or in writing. If a prescription is amended, the changes should be signed and dated by the doctor or prescriber.
- After the final cycle, within a given course, the prescriber must ensure that there is a treatment record for each patient, stating whether the course was completed or not. If the course was not completed, the reasons for cessation must be documented. For completed courses of non-adjuvant treatment, a reference to the response must be documented.