SINGAPORE: Experienced pharmacists and advanced practice nurses from the public healthcare sector will be trained to legally prescribe medicines and order tests, without requiring a doctor's countersignature.
This as part of moves to “increase patients’ access to quality care”, Senior Minister of State for Health Dr Amy Khor announced on Wednesday (Mar 7).
“Moving forward, we will revise our rules and put in safeguards to allow experienced and qualified nurses and pharmacists in the public healthcare sector to legally prescribe medicines through collaborative prescribing,” she said during her ministry’s Committee of Supply debate.
They will do so under the supervision of doctors, she added.
Explaining how the move would help, she gave the example of 77-year old Mr Tan, who was diagnosed with prostate cancer and referred to a home palliative care team upon discharge.
“With the introduction of collaborative prescribing rights, Mr Tan’s palliative care nurse can assess his condition, and issue the prescription for antibiotics for example, saving his caregiver an additional trip just to collect the prescription,” Dr Khor said.
ELIGIBLE STAFF TO GO FOR COURSE TO BE QUALIFIED: MOH
To ensure that prescribing services rendered by the nurses and pharmacists are safe and effective, MOH will put in place two safeguards. Only staff who have completed the Collaborative Prescribing Programme organised by the National University of Singapore will be allowed to perform the tasks.
A first batch of 38 people has been selected to go for training, made up of 19 pharmacists and 19 advanced practice nurses from National Healthcare Group, National University Health System and Singhealth, an MOH spokesperson said.
These pharmacists and advanced practice nurses have a minimum five years’ experience - three of which are in their respective areas of practice.
The programme will be conducted over three months and the inaugural course will start on Mar 19.
As a second safeguard, healthcare institutions offering such services will have to set up a “Credentialing Committee” which will verify and approve the nurses and pharmacists and a Service Review Committee to monitor, audit and review these services to ensure that quality and safety are maintained, MOH said.
QUALIFIED NURSES, PHARMACISTS CAN ONLY PRESCRIBE CERTAIN MEDICINES
In addition, qualified staff can prescribe only from the list of medications found in the Collaborative Prescribing Agreement.
The qualified nurses and pharmacists will work with their collaborating doctors to define the framework which includes the types of patients and medical conditions they can attend to, the list of medicines they can prescribe and the tests they can order.
For example, advanced practice nurses attending to diabetic patients may order blood tests to monitor the patient’s blood glucose level while pharmacists attending to patients on blood thinners will be able to order blood tests to assess the patient’s response to anticoagulant therapy, MOH said.
Patients will see the attending doctor for follow-ups at fixed intervals or when there are changes in their medical condition.
In response to media queries, MOH said the team will hold joint accountability for the services rendered as long as the nurses and pharmacists follow the pre-agreed treatment plan with their collaborating doctors.
The employing institution will submit an application to MOH for a license to offer collaborative prescribing services. Once approved, the qualified staff may start collaborative prescribing services with their doctors. The first collaborative practise service is expected to start in July 2018.
CHANGES EXPECTED TO BRING BENEFITS TO PATIENTS
Collaborative prescribing aims to increase patients’ accessibility to healthcare particularly in the community, while empowering selected senior pharmacists and advanced practice nurses to perform bigger roles, and increasing productivity, MOH said.
“For the individual patient it should eventually entail greater convenience and holistic care with less unnecessary waiting time to receive their medications,” it added.
Echoing the same sentiment, Ms Juvena Gan said that the change will save time for advanced practice nurses like her, as they do not have to find a doctor to confirm their prescriptions. This will translate to shorter waiting time for patients, she said.
Ms Gan, 35, who works with the National University Heart Centre, said that overall, the new powers for qualified staff will facilitate care transformation by providing holistic care and improving access.
"The continuity of care that we provide has a positive effect on the quality of care and relationship with our patients. Our ability to build rapport will make it easier for patients to engage in self-care which is especially critical for chronic disease management," she said.