Checks in place to ensure safe prescribing by nurses, pharmacists

MOH's reply

The Straits Times, 13 Jul 2018

Checks in place to ensure safe prescribing by nurses, pharmacists

We refer to the letter by Mr Cheng Choon Fei (Nurses, pharmacists prescribing medicine raises concerns; July 9).

In collaborative prescribing, experienced and qualified advanced practice nurses and senior pharmacists prescribe medicines to and order tests for patients, under the supervision of doctors.

This way of organising care in teams aims to improve patients' accessibility to quality care, and reduce delays in treatment.

Patient welfare is of utmost importance to us. The Ministry of Health has put in place two levels of safeguards to ensure the prescribing services of these nurses and pharmacists are safe and effective.

First, healthcare institutions offering collaborative prescribing services are required to set up:

• A Credentialing Committee, which will verify and approve the participating nurses, pharmacists and their collaborative prescribing services; and

• A Service Review Committee, which will monitor, audit and review these prescribing services to ensure that quality and safety are upheld.

Second, only suitably qualified and trained nurses and senior pharmacists who have completed the National Collaborative Prescribing Programme, a three-month course by the National University of Singapore, will qualify to prescribe.

The supervising doctor and these collaborative prescribing practitioners will jointly draw up a collaborative practice agreement (CPA), which describes their scope of practice under the doctor's responsibilities and oversight. As long as they are prescribing within their CPA with their collaborating doctors, the team will hold accountability for the patients' care.

Doctors will continue to oversee and manage the patients, adjusting treatment plans where necessary. At determined intervals, the patient will return to this attending doctor for review. Care will be escalated to the doctor if the patient's condition evolves outside of the treatment plan. Doctors, nurses and pharmacists are also regulated by their respective councils. This ensures we uphold high standards of care provided by the team.

Lim Siok Peng (Ms)
Director, Corporate Communications
Ministry of Health

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Forum Letter

The Straits Times, 9 Jul 2018

Nurses, pharmacists prescribing medicine raises concerns

Under the Medical Registration Act, only registered medical practitioners competent and fit to practise medicine are allowed to prescribe medicine and order tests on patients, to protect the health and safety of the public and to maintain public confidence in the medical profession (Group of pharmacists, nurses certified to prescribe medicine; July 3).

With pharmacists and nurses now certified to do the same, will the Medical Registration Act be updated to include them?

Will they also be regulated by the Singapore Medical Council?

What recourse is there for patients if something should go wrong? Will they face the same disciplinary hearing as doctors?

It is also unclear if these pharmacists and nurses follow the independent, protocol-based model or the supplementary prescriptions model.

For instance, are they allowed to diagnose from predefined medication or based on a specific area of medicine? Or can they prescribe only via protocol developed by a team of medical professionals or according to a doctor's plan for a specific patient?

Prescribing is not easy. It is a decision made after careful consideration of all facts and possibilities and after a consultation with a highly educated and responsible professional.

Although one may enhance one's skills, there is also such a thing as respecting boundaries of practice.

Why continue to blur the line? Will patients be the ones to pay if mistakes arise?

Let's focus on what each profession does best. Doctors diagnose and prescribe; pharmacists dispense, modify and monitor pharmaceutical therapy as well as act as a gatekeeper between patients and harmful drug interactions; and nurses are experts in administration and delivering care to patients.

Cheng Choon Fei