The following Q&A is intended to be read as a complete document to help provide the full context in practice. In this document the term “prescriber” refers to doctors, dentists and all other registered health professionals who are qualified independent non medical prescribers, supplementary prescribers and Community Practitioner Nurse prescribers. Good practice principles for prescribing are the same for all prescribers and professional codes of conduct should always be referred to. Professionals should consider, where relevant, their own need for professional indemnity cover.
What is a Patient Specific Direction (PSD)?
Whilst not defined in legislation a Patient Specific Direction (PSD) is the traditional written instruction, signed by a doctor, dentist, or non-medical prescriber (hereafter referred to as “the prescriber” unless stated otherwise) for medicines to be supplied and/or administered to a named patient after the prescriber has assessed the patient on an individual basis (1). Where a PSD exists, there is no need for a Patient Group Direction (PGD). In practice a PSD is commonly referred to as a prescription by those who write and follow them because this indicates that it is written by a prescriber.
Examples of PSDs
- Following an assessment of the patient, a written and authorised instruction by a prescriber to administer a medicine to the patient. In a GP practice this may be written in the patient’s notes; in an inpatient setting, this might be an instruction written on the patient’s medicine chart (1). Careful consideration needs to be given to how the instruction is incorporated in the patient record to ensure that the medicine is given safely and in a timely manner. It may be electronic (i.e. an entry in a patient’s clinical record that is appropriately completed).
- A written and authorised instruction to administer a medicine to a list of individually named patients where each patient on the list has been individually assessed by that prescriber. The prescriber must have adequate knowledge of the patient’s health, and be satisfied that the medicine to be administered serves the individual needs of each patient on that list. An example would be a list of patients to receive a seasonal influenza vaccine during a pre-booked vaccination clinic.
- A PSD for the supply of medicines is classified as a prescription form. This form is a legal document and must comply with the requirements for prescriptions as specified in the Human Medicines Regulations 2012 (2). One example of a PSD for a supply is the hospital prescription form (‘TTO’) detailing the medicines to be dispensed for a patient to take home on discharge. If a PSD is for supply of a controlled drug (CD), the form must also meet the legal requirements CD prescriptions.
The following are not PSDs and are not a legal authority for the administration or supply of medicines:
- A written instruction applying to a group of patients where the patient/s are not individually identified i.e. a PSD could not state ‘All patients attending the practice’s ‘flu vaccine clinic on date dd/mm/yyyy’ – it needs to be a list of all named patients due to attend the clinic who have been individually assessed by the prescriber as suitable for treatment and be signed and dated by a prescriber (this does not need to be completed for each entry but can be once for the entire list).
- A verbal instruction.
Commonly asked questions about PSDs