Medicines and prescribing during the pandemic

Find out what you should and should not do during the COVID-19 pandemic.

 

Use of Corticosteroids during the COVID-19 pandemic

Download the guidance on Management of patients with musculoskeletal and rheumatic conditions who: are on corticosteroids; require initiation of oral/IV corticosteroids; require a corticosteroid injection 

The document is supported by: The British Society for Rheumatology, British A ssociation of Orthopaedics, British Association of Spinal Surgeons, Royal College of General Practitioners, British Society of Interventional Radiology, Faculty of Pain Medicine, British Pain Society and Chartered Society of Physiotherapy

Staying within the law during the pandemic

Can I prescribe more medicines than currently allowed as an independent prescriber due to COVID-19?

No. The range of medicines that a physiotherapist independent prescriber can prescribe is set by primary legislation.

The law currently permits an independent prescriber to prescribe any licensed medicines from the BNF and in addition, a limited list of 7 controlled drugs. Supplementary prescribers may prescribe any licensed medicine and most controlled drugs (except those use for drug-addiction) set out within a written clinical management plan. 

If you are a prescriber, you may be asked to work in a new clinical area and/or see patients with a slightly different clinical focus to those whom you normally see. This might require you to prescribe different medicines from those within your usual personal formulary, but within the scope of physiotherapy prescribing as a whole.

We recognise you may be asked to extend and/or adapt your prescribing scope of practice at short notice. In this case, you must familiarise yourself with the relevant prescribing information about the new medicine, which is normally contained within the product’s Summary of Product Characteristics (SPC). You must also ensure you are familiar with any local polices and procedures that your Pharmacy and/or Medicines Governance teams may have in place. You may also wish to access any relevant online learning around the conditions you may be new to treating.

You must understand a person’s full medical and drug history and undertake an appropriate examination, which can be a virtual examination. You may prescribe remotely, which may be necessary for patients who cannot come to clinic. Our Practice Guidance for Prescribers gives more detailed support for prescribers. Your CSP PLI will be in force for your prescribing practice, subject to policy terms and conditions.

Remember, you may be able to use alternative medicines frameworks to support meeting a patient’s medicines need. Any physiotherapist may supply and administer medicines listed within a Patient Group Direction (PGD), provided the physiotherapist is both registered with the HCPC and named within the PGD. Any physiotherapist may also supply and administer any medicine for a specific named patient  in accordance with the written direction of an appropriate prescriber, such as via prescription and/ or a medicines administration chart (PSD).

(last reviewed 14 Oct 2020)


Can I prescribe anticipatory medicines used in end of life care?

A growing number of physiotherapists who work in palliative care settings are using prescribing qualifications to support their work. As a supplementary prescriber physiotherapist, you may prescribe all controlled drugs, including anticipatory medicines, included in the written clinical management plan for your patient, which is created before prescribing occurs.

The CSP has previously explored the issue of physiotherapists independently prescribing a range of anticipatory and other end of life care medicines and, at the current time, there is no case for such a change. Scenarios must always be considered from the patient perspective, and with clear evidence that no other medicines mechanism is available, not from the perspective of equality with other professions. So while we definitely understand members’ frustration around comparison with rights of other professions, it is not a successful argument for change.

End of life care is always delivered through a multidisciplinary team approach and a doctor is always part of this team. In addition, anticipatory medicines can be prescribed in advance of them being needed. This means supplementary prescribing is a suitable mechanism for physiotherapists to use and one that is open to physiotherapist prescribers.

Should members experience any patient-centred barriers to using supplementary prescribing that we may not currently be aware of, please contact us on cdupdate@csp.org.uk

(last reviewed 14 Oct 2020)


Can I still prescribe if I am seeing my patients remotely through telehealth consultations?

Yes. We acknowledge that our Practice Guidance for Prescribers sets out that remote prescribing should not be an ordinary occurrence. However, since 23 March 2020, when lockdown was announced, our prescribers may not be able to work in ‘ordinary’ ways and a significant number of members will now be expected to offer remote consultations and telehealth services.

When working remotely, you must still ensure you have sufficient clinical information to make a reasonable and responsible prescribing decision and this will still include meeting the requirements of Practice Guidance 22.1. You must also continue to follow our Practice Guidance for other aspect of good practice in prescribing.

(last reviewed 14 Oct 2020) 


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