Patient Specific Directions (PSD)

Patient Specific Directions (PSD)

By authority of the Medicines and Procedures Committee of the Institute of Podiatrists and applicable to those issuing or using Patient Specific Directions (PSD’s) within the United Kingdom.

NB. Only applicable to instructions given by a Podiatrist Independent Prescriber (annotation IP by the HCPC), or such other appropriately licensed and registered medical or non-medical independent prescriber. PSD instructions may not be issued by podiatrists who are annotated to use medicines act exemptions (annotations POM-S and POM-A) who may only use their annotations themselves on a personal basis, not delegate them to others. In respect of the foregoing, this restriction does not apply where such other is the patient receiving the medicine and such instructions form part of the usual instructions for the self-administration of a lawfully supplied medicine under POM-S such as painkillers or antibiotics for example.

A PSD is an instruction to supply and/or administer a medicine written and signed by the prescriber. It could be an electronic record made in the patient notes where it is identifiable to the prescriber.

A PSD can also be an instruction to administer a medicine to a list of patients. Each patient on the list must be individually assessed by that prescriber. The prescriber must have knowledge of the patient’s health and be satisfied the medicine meets the individual needs of each patient on that list. For example, a healthcare assistant may be running an influenza immunisation clinic. The prescriber must review the patients attending the clinic and sign a list of those who they authorise to be immunised.

The PSD must include the:

  • name(s) of patient(s) and/or other individual patient identifiers including age if a child
  • name, form and strength of medicine
  • route of administration
  • dose
  • frequency
  • date of treatment/number of doses/frequency/date treatment ends as applicable
  • signature of prescriber.

Responsibilities and accountabilities

  • The prescriber is responsible for assessing the patient and making the decision to allow the supply or administration of the medicine.
  • The prescriber must be satisfied that the person to whom administration is delegated has relevant qualifications, experience, knowledge and skills.
  • A person supplying or administering medicine must be trained and competent.
  • They must act in line with their level of competence and the directions of the prescriber.

What clinical governance arrangements should be in place?

In law, anyone whom the prescriber has:

  • assessed as competent
  • has the necessary knowledge and skills, and
  • has been delegated the task may follow a PSD.

Some organisations may extend or limit those who are authorised to supply or administer medicines under a PSD. This must be documented in their local medicines policies and governance arrangements.

Should such an organisation or practice employ the individual using a PSD it has a duty of care to the patient and staff. They are responsible for making sure staff are properly trained and undertake only those responsibilities written in agreed job descriptions. If expecting non-regulated staff, for example healthcare assistants, to administer medicines, those delegating the duty must make sure these staff are competent to do so safely.

A locally approved procedure or guideline would support the safe administration of medicines by a suitably trained and competent healthcare professional where such is given in accord with statutory national legislation applicable to the nation involved.

Acknowledgement. – Prepared from verified information supplied by the UK Care Quality Commission, the independent regulator of health and social care in England 2021.

Guidance approved by the Medicines and Procedures Committee of the Institute of Podiatrists 2021