Adherence: Adherence presumes an agreement between prescriber and patient about the prescriber's recommendations. Adherence to medicines is defined as the extent to which the patient's action matches the agreed recommendations. Non-adherence may limit the benefits of medicines, resulting in lack of improvement or deterioration in health. 8
Antimicrobial stewardship: An organisational or healthcare-system-wide approach to promoting and monitoring judicious use of antimicrobials to preserve their future effectiveness. 9
Carer: A person who provides support and assistance, be that formal or informal, with various activities to patients. This may be emotional or financial support, as well as hands-on help with a range of tasks. Carer, in this document, is also an umbrella term used to cover parents, legal guardians, patient advocates or representatives, including paid and unpaid carers. 10
Competency framework: A structure which describes the competencies (demonstrable knowledge, skills, characteristics, qualities and behaviours) central to a safe and effective performance in a role. 11
Deprescribing: The process of stopping or reducing medicines with the aim of eliminating problematic (inappropriate) polypharmacy, and then monitoring the individual for unintended adverse effects or worsening of disease. It is essential to involve the individual (and their carer) closely in deprescribing decisions to build and maintain their confidence in the process. 10
Designated Prescribing Practitioner (DPP): An umbrella term used in the RPS A Competency Framework for Designated Prescribing Practitioners to describe the experienced prescribing practitioner responsible for supervising the non-medical prescribing trainee’s period of learning in practice. For further information, please see the RPS A Competency Framework for Designated Prescribing Practitioners 12.
Independent prescriber: A prescribing healthcare professional who is responsible and accountable for the assessment of patients with undiagnosed or diagnosed conditions and for decisions about the clinical management required, including prescribing.
Material risk: According to the Montgomery ruling, a material risk occurs if “a reasonable person in the patient’s position would be likely to attach significance to it, or if the doctor is or should reasonably be aware that their patient would be likely to attach significance to it”. 13 This is applicable to all prescribing professionals. All prescribers have a duty of care to ensure that their patient is aware of any material risks involved in proposed treatment and of reasonable alternatives.
Non-medical prescriber (NMP): This term encompasses healthcare professionals (excluding doctors and dentists) working within their clinical competence as an independent and/or supplementary prescribers or community practitioner nurse prescribers. 12 Further information on the types of non-medical prescriber and what they can prescribe can be found in the British National Formulary (BNF).
Off-label: Using a licensed medicinal product outside the terms of its marketing authorisation (licenced use). 14
Patient: Umbrella term to cover the full range of people receiving or registered to receive medical treatment or healthcare; this includes children and young adults, pregnant women, service users and clients. 10
Polypharmacy: Means ’many medicines’ and has often been defined as being present when a patient takes five or more medicines. Polypharmacy is not necessarily a bad thing; it can be both rational and required; however, it is important to distinguish between appropriate and inappropriate polypharmacy. For further information, please see the RPS Polypharmacy guide. 10
Psychosocial: Involving both psychological and social aspects. 15
Scope of practice: The activities a healthcare professional carries out within their professional role. The healthcare professional must have the required training, knowledge, skills and experience to deliver these activities lawfully, safely and effectively. They must also have appropriate indemnity cover for their prescribing role. Scope of practice may be informed by regulatory standards, the professional body’s position, employer guidance, guidance from other relevant organisations and the individual’s professional judgement. 16
Supplementary prescribing: A voluntary partnership between a doctor or dentist and supplementary prescriber, to prescribe within an agreed patient-specific clinical management plan (CMP) with the patient’s agreement. At the time of publication, nurses, midwives, optometrists, pharmacists, physiotherapists, podiatrists, radiographers, paramedics and dietitians may become supplementary prescribers. Once qualified, they may prescribe any medicine (including controlled drugs) within their clinical competence, according to the CMP.
Unlicensed (also known as specials): A medicinal product without a valid UK marketing authorisation. These may be medicinal products that are imported, procured or manufactured under a UK specials manufacturing licence. They are prescribed to meet the special clinical needs of an individual patient on the direct personal responsibility of the prescriber. 14