Patient Specific Directions (PSDs) and Patient Group Directions (PGDs)

In practice, a PSD may be referred to as a “prescription” by those who write and follow them because this indicates that it is written by a prescriber. However,  this should not be confused with an FP10 or other written prescription given to the patient for supply from a pharmacy or dispensary. The Specialist Pharmacy Service (SPS) Q&A on PSDs state that these directions must be written and that a verbal instruction is not a valid PSD.  

 

In exceptional circumstances, where medication has been previously prescribed and the prescriber is unable to issue a new prescription, but where changes to the dose are considered necessary, the use of information technology (such as fax, text message or email) may be used but must confirm any change to the original prescription. Find out more by reading the Royal Pharmaceutical's pharmacy guide for independent prescribers. 

Where a verbal instruction is given to alter the dose of a medicine previously prescribed, there would need to be a clear record of the discussion rational and treatment actions carried out documented in the clinical record.

PGDs are written instructions for the supply or administration of medicines to groups of patients who may not be individually identified before presentation for treatment.'

There is guidance from the Specialist Pharmacy Service on storage of PGDs, see: Retaining PGD documentation. Also, for guidance on when PGDs are not appropriate and should not be used, see: When Patient Group Directions are not required.

 

 

PGDs can only be used by those health care professionals listed in the legislation. Nursing Associates are currently not included so cannot operate under a PGD See the Specialist Pharmacy Services guidance. 

 

The supply and/or administering of medicines under PGDs should be reserved for situations in which this offers an advantage for patient care, without compromising patient safety. Organisations should have policies and processes in place to consider all options before a service is designed or commissioned using PGDs. Before a PGD is developed, the organisation must ensure that PGDs are appropriate, legal and that relevant governance arrangements are in place. There is guidance from the Specialist Pharmacy Service gives advice on storage of PGDs, see: Retaining PGD documentation.

• Royal Pharmaceutical Society (2019) Professional Guidance on the Administration of Medicines in Healthcare Settings
• Royal Pharmaceutical Society (2019) Practical guide for independent prescribers
• National Institute for Health and Care Excellence (NICE) has published a suite of guidance, advice and support for delivering quality, safety and efficiency in the use of medicines. 
• BMA has updated their guidance for Patient Group and Patient Specific Directions. This guidance is for England only.
• CQC Myth buster on Patient Group Directions and Patient Specific Directions 
• Medicines and Healthcare products Regulatory Agency (MHRA) regulates medicines, medical devices and blood components for transfusion in the UK. 
• MHRA yellow Card Scheme is vital in helping the MHRA monitor the safety of all healthcare products in the UK to ensure they are acceptably safe for patients and users. Reports can be made for all medicines including vaccines, and all medical devices available on the UK market.
• Specialist Pharmacy Service.Influenza vaccine. This includes written instruction templates for adoption.
• Specialist Pharmacy Service. When not to use a PGD. Understanding when PGDs are an unsuitable mechanism for the supply and/or administration of medicines ensures an alternative legal framework is applied.
• Specialist Pharmacy Service. Patient Group Direction use in End of Life Care.
• Specialist Pharmacy Service. Patient Group Direction (PGD) use in a service provided by multiple organisations.
• Specialist Pharmacy Service. Supplying contrast agents under a Patient Group Direction