ࡱ> Oh+'0p   , 8 DPX`h TAX INVOICEAX racpNVOacp Normal.dotDenised13iMicrosoft Word 8.0@_@XB@@׾msg723vidc.M263vidc.M261msacm.msaudio1msac՜.+,D՜.+,< hp  racpm$   TAX INVOICE Title(RZ _PID_GUID _PID_HLINKSAN{792604B6-65F6-47F3-82ED-7C0FC3A40D78}AT  10 February, 2009 Rachel Mackay Manager, Schedule & Contracts PHARMAC PO Box 10 254 Wellington 6143 E-mail -  HYPERLINK mailto:rachel.mackay@pharmac.govt.nz rachel.mackay@pharmac.govt.nz Dear Rachel, Thank you for the opportunity to comment on the proposal to add a definition of relevant practitioner to the Pharmaceutical Schedule This submission has been prepared following discussion by the Pharmacy and Therapeutics Special Interest Group of the Paediatric Society of New Zealand, and with input from the whole membership following circulation by email. Comments: The addition of a definition of relevant practitioner to the Pharmaceutical Schedule is welcomed, however we have reservations relating to some aspects of the proposal. There are significant limitations to using scope of practice as defined by the relevant regulatory body. Scopes of practice as defined by the Medical Council of New Zealand are broad. There is only one scope of practice applying to all paediatricians, including general paediatricians and sub-specialists (for example paediatric neurologists) It cannot therefore be assumed that a practitioner working in the scope of paediatrics will be competent to prescribe for all paediatric problems, particularly for those practitioners who are working in a sub-specialty area or those treating patients that would be appropriately managed by a paediatric sub-specialist. Paediatric sub-specialists may not always be available, especially in very small sub-specialties. Prescribers, whether they are doctors or nurses, must take responsibility for their prescribing decisions. Registered health professionals are expected to act with integrity and professionalism and to seek advice from an appropriately experienced colleague when faced with a situation which they know to be outside their area of expertise. It can and should be assumed that registered health professionals will do this. The issue of defining the meaning of relevant practitioner has arisen with respect to Special Authority applications. The onus for checking that a prescriber completing a Special Authority application has an appropriate scope of practice should reside with Healthpac. The increasing use of online special authority applications, means that this should be linked into the software. This should be feasible as the software can already determine whether a prescriber belongs to a specific specialist group (except for special food renewals, for which the software appears unable to recognise when an applicant is a specialist). For pharmaceuticals prescribed for a small number of patients (for example the proposal to fund vitamin supplements for use with the ketogenic diet) a system of named specialists such as that used for antiretroviral agents is more appropriate than restricting applications to relevant practitioners. It is inappropriate to require pharmacists to determine whether any particular prescriber is operating within their scope of practice. While pharmacists can check the relevant register for the prescriber online and determine their scope of practice as defined by the registration body, this does not provide confirmation that the prescriber has the expertise and competency for the pharmaceutical prescribed for the reasons outlined in point 2. In hospital settings, many prescriptions are written by resident medical officers, working under the supervision of specialists. These prescribers will appear on the medical register as having a general scope of practice, and may move from one specialty area to another frequently. As dispensing systems do not link to the relevant registration bodies, pharmacists record this information and enter it manually. Requiring pharmacists to check the specialty area that each of these doctors is working in would be very time consuming, and could detract from checking vital safety features of a prescription such as the correct dose, route of administration and appropriateness of the medication for the patient. There is the potential for exposing patients to harmful medication errors as a result of this requirement. Requiring pharmacists to ensure that the prescriber has the appropriate training and experience for the prescription that they have written, assumes that all pharmacists have constant access to the internet. This may not always be possible (e.g. during a power failure or civil defence emergency) and may therefore lead to delays in patients receiving timely medication. The issues that we have raised under points 7 & 8 raise the question as to whether pharmacists should withhold medication that they believe to have been prescribed by a practitioner working outside their scope of practice, or where the pharmacist is unable to confirm the scope of practice. This further leads to the question as to what liability the pharmacist would have in the event of an adverse outcome resulting from either withholding a medication or dispensing a medication in this situation. In summary, clarity around the definition of relevant practitioner is welcomed, but at the present time neither the information held by the Regulatory Authorities, nor pharmacy systems are robust enough to provide safeguards. Yours sincerely, Rosemary Marks President THE PAEDIATRIC SOCIETY OF NEW ZEALAND Secretariat: Email:Denise Tringham P O Box 22 234 Wellington 6441 Tel: (04) 938 4827 Fax: (04) 976 4827 psnz@paradise.net.nz  Health of our children: Wealth of our nation %mailto:rachel.mackay@pharmac.govt.nzOMC:\Documents and Settings\Denise\WORK\PSNZ Docs\Letterheads and Logos\RM.JPG.0@_@XB@@׾msg723vidc.M263vidc.M261msacm.msaudio1msac$BJXhWX:;E 0  & F"$BJXhWX:;E 0 klmnop%9NOPQUVYZ[     "   "   "   "   "   "   "   "  " Dklmnop $ !Sn# $ !Sn# $x$ $  & F"%9NOPQUVWXYZ[$ ! $ !n# ! $$ u+#$ $  $ !Sn# $ !Sn#(&P . A!"#$%n+ 0&P . A!"#$%nF% @yV7e\]{WJFIFddC   (1#%(:3=<9387@H\N@DWE78PmQW_bghg>Mqypdx\egc N }!1AQa"q2#BR$3br %&'()*456789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz? 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Submissions

The Paediatric Society believes all children and youth should, by right, attain optimal physical, mental and social health and wellbeing.  By working as a coordinated national network of health professionals the Society dedicates its efforts and resources to making official submissions to both Government and Non-Government organisations on issues that will impact on the health and wellbeing of children and young people.

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