Publications approval reference: 001559 / C0279
14 April 2020, Version 1
During the COVID-19 pandemic, it is expected that some aspects of healthcare in health and justice (HJ) sites may need to be delivered by remote technology, for example, using video appointments. Prescribers should be aware of the processes for prescribing responsibly remotely. Processes have been described separately for controlled drugs (CDs) and non-CDs. Providers should have written procedures underpinning how remote prescribing is undertaken.
There are two options for issuing prescriptions for non-CDs remotely:
1. Prescription signed by the remote clinical prescriber
The remote clinical prescriber is the remote clinician providing care and making a prescribing decision for the patient.
Once the remote clinical prescriber has made a prescribing decision, the prescription should be printed off remotely by the remote clinical prescriber and signed immediately. The prescription should then be scanned into the Health and Justice Information System (HJIS) record and/or emailed to the relevant HJ site. The HJ site will use the signed prescription to follow usual procedures to arrange a supply of the medicine from a pharmacy. This is equivalent to usual practice where prescriptions are faxed to pharmacies.
2. Prescription signed by prison-based prescriber
If a remote prescriber is unable to print, sign or scan a prescription onto the HJIS, this option could be used. Once the remote clinical prescriber has made a prescribing decision, the prescription should be issued by the prescriber on the HJIS. This prescription will be printed at the HJ site and signed by another prescriber at the HJ site within 24 hours (i.e. the same or next day). This is equivalent to a) the prescriber giving the nurse/pharmacist a verbal order for a prescription or b) equivalent to a GP practice where a non-prescribing nurse asks a GP to sign a medicine they have issued. In the HJ case we will have two prescribers in the audit trail with the HJIS log-in for the remote clinical prescriber who issues it.
Prescription for CDs must be printed off and hand signed immediately by the remote clinical prescriber and scanned into HJIS. Unless the supply to the patient is from stock supplies of the CD, the original prescription will need to reach the dispensing pharmacy (who prepare the labelled supply). This is a requirement in regulations.
Remote consultations that may result in a prescription for a CD (Schedules 2 and 3 including pregabalin, gabapentin and tramadol) may cause problems with ensuring prompt access to drugs prescribed within 24 hours, unless stock is used for supply or there is an on-site prison pharmacy.
Information on remote prescribing can be found on the Royal College of Nursing website.