Managing medicines: Guidelines

Last updated: Thursday, February 18, 2016

Hospitals have their own clinical guidelines which advise you on what to do, or offer you options, when managing patients with a specified medical condition. For example, a guideline on managing alcohol detoxification in patients admitted to a surgical ward.

You will also encounter policies in the workplace, and these tend to describe compulsory courses of action rather than advice. Many documents produced by the Human Resources department (‘HR’) are policies (e.g. annual leave policy).

In addition, there are standard operating procedures (‘SOPs’), which typically specify a step-by-step approach to managing a particular situation. For example, production units in Pharmacy departments often have SOPs for making and checking pharmaceutical products such as cytotoxics or TPN.

There are two other types of local guideline that you will certainly encounter as a pharmacist, and these are described below:
Shared Care Guidelines
These documents provide guidance to GPs when taking on the responsibility for continuing care of a patient who has been prescribed a medicine that would usually only be given by a specialist (e.g. with special monitoring requirements). It makes clear what the hospital doctor who initiated the prescription will do, and describes the GP’s responsibilities too. Usually, the guideline describes a specific drug for a stated indication such as lanreotide for acromegaly. Shared care guidelines require the agreement of all parties, including the patient. GPs must only agree if they are satisfied that the prescription is needed, appropriate for the patient, and within the limits of their own competence to prescribe.
Patient Group Directions (‘PGDs’)
These are written instructions allowing certain health professionals to supply and/or administer a specified medicine to a pre-defined group of patients, without them having to see a doctor. PGDs are used in situations where this offers an advantage for patient care, without compromising patient safety. There is an NHS website about PGDs where you can read more about them and see examples. NICE has produced guidance describing good practice for PGDs with the aim of ensuring patients receive safe and appropriate care and timely access to medicines, in line with legislation.

To accompany local guidelines of all kinds, you will frequently encounter national guidelines written by authoritative organisations such as the Department of Health, NICE, the Royal Pharmaceutical Society, the Royal College of Physicians, and so forth. These are often published on the website of the body concerned and can relate to management of a medical condition, advice on medicine storage, methods of monitoring safety and so on.

  • Does your Trust have clinical guidelines and policies on its intranet? How easy are they to find? 
  • Where does Pharmacy keep its SOPs? Does every section of Pharmacy keep its own or is there one central location? 
  • Look at some local shared care guidelines and PGDs so that you understand how they are presented and organised.

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