Review of the Medical Council’s statements

Review of the Medical Council’s statements on Good prescribing practice and Prescribing drugs of abuse

The Medical Council of New Zealand (the Council) is currently reviewing its statements on Good prescribing practice and Prescribing drugs of abuse, and is seeking your comment.

Both statements were first published in April 2010. Since then, several overseas medical regulators and health authorities have also published their own resources and guidelines on safer prescribing practices. Some of these publications include points that are not presently covered in our statements such as medicine reconciliation and prescribing for patients travelling overseas. Council’s revised statement includes several new areas and amalgamates the two existing statements by incorporating relevant provisions from each. The reasons for merging both statements are that:
• Some of the issues covered in the existing statements are similar.
• The legislation around prescribing is complex, and Council considers that it would be preferable to incorporate into one document the points pertinent to this area of medical practice.

It is Council’s intention that our statement remains comprehensive, encourages doctors towards better and safer prescribing practices, and aligns with international practice. The changes that Council is proposing (outlined below) are also intended to facilitate more communication between doctors and other health professionals as well as a team-based approach to care.

New expectations
The revised statement includes a number of new insertions. For ease of reference, these have been tracked (in red) in the enclosed draft revised statement and are also outlined below:
• That doctors consider the input that other health care professionals might be able to offer regarding the medication they prescribe such as information on its dosage, possible interactions with other medications and side effects. This insertion is in response to studies conducted locally and in the United Kingdom which identified common prescribing errors by doctors such as the dosage, strength and number of times the medication should be taken, and recommended that doctors involve other health care professionals such as pharmacists as they are able to offer more detailed advice on drug interactions and side effects as well as instructions on appropriate use and consumption of medicines (new bullet point in paragraph 1).

• That doctors share information about the medicines they prescribe with other health professionals involved in the patient’s care to ensure continuity of care and patient safety. This is especially important in instances where the prescribing doctor is not the patient’s primary care provider and may not have a full picture of the patient’s medication history (new bullet point in paragraph 1).

• That doctors consider a medicine reconciliation when a patient’s care is transferred between health professionals or between care facilities. This entails supplying the health professional or care facility taking over the patient’s care with the patient’s most updated list of medicines, allergies and adverse drug reactions, and documenting, reconciling and explaining any changes to the medication. As transitions of care can result in medication errors and cause harm to the patient, compiling the patient’s most updated list of medicines, allergies and adverse drug reactions would go some way towards reducing errors (paragraph 12).

• That doctors review prescriptions for rest home and long-stay hospital residents every 3 months to ascertain the need for continuing a particular medication and the appropriateness of the dose prescribed. This is another measure to reduce medication errors (paragraph 13).

• Advice on the factors to consider and the importance of providing support when doctors recommend that their colleagues prescribe a particular medicine for a patient (paragraph 26).

• A new bullet point stating that as part of reviewing a repeat prescription, doctors should have appropriate information available about the patient which may include access to the patient’s clinical records (paragraph 32).

• Additional factors to consider when reviewing and issuing repeat prescriptions (paragraph 33) in that:
o The doctor should be satisfied that the patient is taking their medication as directed;
o It is at the doctor’s discretion whether a patient is given a repeat prescription;
o Decisions not to issue a repeat prescription should be explained to the patient and documented accordingly.

• A new section on prescribing for patients living abroad or travelling abroad (paragraphs 34-35).

Other insertions
The revised statement on Good prescribing practice also incorporates provisions from and expands on several points in both our existing statements such as:
• Outlining in the preamble what inappropriate prescribing includes and the possible consequences of prescribing inappropriately.
• An expectation that doctors make the care of patients their first concern (paragraph 1).
• A reference to section 23 of the Misuse of Drugs Act 1975 alongside the existing reference to section 48 of the Medicines Act 1981 in relation to inappropriate prescribing by doctors (paragraph 7).
• Insertion of the section titled ‘Prescribing drugs of dependence and psychotropic medication’ from the existing Prescribing drugs of abuse statement (paragraphs 16-23).
• Advice that doctors consider checking whether other health professionals they are working with have prescribing rights in light of the changes to the Medicines Act 1981 which expands the list of health professionals with prescribing rights (paragraph 28).
• Explanation of what a standing order is (paragraph 29).

In addition, references to specific paragraphs in Good Medical Practice and to the Ministry of Health’s publication on standing orders have also been updated in the revised statement.

Consultation process
Enclosed with this letter is a copy of the Council’s draft revised statement on Good prescribing practice. (For ease of reference, the proposed changes have been tracked in red in the draft revised statement.) We have circulated this widely to the profession and consumer health groups. I encourage you to review the draft, and to give us your views on what we are proposing as prescribing standards for doctors.

In particular, the Council is interested in obtaining your views on the following:
1. Do you agree with amalgamating the existing Good prescribing practice and Prescribing drugs of abuse into a single statement?
2. Which sections of the revised statement do you find most useful or relevant?
3. Which sections of the revised statement do you find least useful or relevant?
4. Do you agree with the amendments made to the revised statement on Good prescribing practice?
5. Are there any other areas that Council should include in its revised Good prescribing practice statement?

I would be grateful if you could forward your comments to the Council by 14 August 2015. The consultation document is also available on the Council’s website, www.mcnz.org.nz>>News and publications

ENDS

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