References
An audit of the prescription and supply of medicines by podiatric surgery teams in the UK
Abstract
Aim
To gain a greater understanding of the methods used by podiatric surgeons to access medicines in the UK. Within that, it is also relevant to establish the range and quantity of medicines utilised to support patient care. With the advent of independent prescribing for podiatrists, the authors were keen to identify whether prescribing was being adopted by a sub-speciality of the podiatry profession and whether alternate means of accessing medicines, such as Patient Group Directions or exemptions remain relevant in clinical practice.
Methods
The PASCOM 10 system was accessed to generate reports for the 2019 calendar year relating to podiatric surgery. The following reports were requested; procedures, fixations, anaesthesia, demographics, medications, post-treatment sequelae, patient satisfaction (PSQ-10), Manchester Oxford foot/ankle questionnaire (MOXFQ), providers and referrals.
Results
In 2019 there were 11189 admissions for podiatric surgery in England recorded on the PASCOM 10 database. A total of 103 surgery centres contributed data resulting in 18497 procedures. Care was primarily offered in NHS settings accounting for 91% of activity, 94% of these procedures were performed under a local anaesthetic block. 18576 medicines were supplied, administered or prescribed from a list of 70 individual items. 29% of all medicines were prescribed by a podiatrist. Controlled drugs accounted for 28.7% of all recorded medicines.
Conclusions
Through analysis of PASCOM 10 data, the range of medicines accessed by podiatric surgeons and their teams to support patient care perioperatively and the routes of accessing these medicines have been identified. Encouragingly, independent prescribing appears to be a frequent choice for accessing certain medicines. There is thorough evidence of a need for greater prescribing rights. Of note, it appears the management of postoperative pain could be improved with wider access to controlled drugs, namely opioid analgesics. PASCOM-10 has the capacity to provide revealing data on prescribing in podiatric clinical practice that is unique in the UK, though more work is required to ensure the validity of the dataset.
In the UK, ‘prescription only’ medicines are one of three distinct categories of medicine, reflecting the relative risk associated with their use (Borthwick et al, 2010). Designated as such within the terms of the Medicines Act (1968), prescription-only medicines (POMs) were initially intended to be issued by a very limited number of ‘approved prescriber’ professions, notably doctors, dentists and vets (Borthwick, 2008). At the time, nurses or allied health professionals (including podiatrists) were not considered potential prescribers. In the years since, it has become clear that advances in scope of practice and requirements in educational qualifications amongs these professions have shifted significantly (Borthwick and Maher, 2020).
One such example is the development of podiatric surgery in England, which would not have been possible without first securing access to medicines. Within this area, perhaps the most important class of medicines was local anaesthetics (Dagnall, 1995; Borthwick, 2001). Access to local anaesthetics allowed for the safe development of pain-free skin and nail surgery procedures but surgical techniques soon evolved and with that, the requirement for greater access to medicines. More advanced surgical techniques brought with them a need for post-operative analgesia, pre-operative antibiotic prophylaxis and perioperative thromboprophylaxis, to name a few. In the latter part of the 20th century, there was then a pressing need to improve access to medicines.
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