The Medicines Amendment Act 2013, enacted in July 2014, provided optometrists with the same prescribing authority as nurse practitioners, medical practitioners, dentists, and midwives, in line with a policy to improve access to healthcare by removing barriers to health practitioners practising to the full extent of their scopes of practice. The Board is now pleased to advise that in addition to this, the Medicines (Standing Order) Amendment Regulations 2016 have very recently been enacted and these authorise prescribing optometrists to issue Standing Orders, effective from 17 August 2016.
A Standing Order is a written instruction issued by an authorised health practitioner (doctor, dentist, nurse practitioner or optometrist) which authorises a specified person or class of people who do not have prescribing rights to administer and/or supply specified medicines. The intention is for Standing Orders to be used to improve patients’ timely access to medicines, and the Board also sees that teamwork and efficiency between health providers will be fostered, and that use of Standing Orders will see the best use of optometrists’ knowledge and skill implemented and will reduce the burden on other health practitioners to deliver the right care at the right time. Although the ability to issue Standing Orders includes the ability to issue Standing Orders for some controlled drugs, the Board does not endorse optometrists issuing Standing Orders for controlled drugs under any circumstances.
It is paramount that prescribing optometrists considering the use of Standing Orders read the Medicines (Standing Order) Regulations 2002 and also the Ministry of Health’s Standing Order Guidelines to ensure that they comply with all legal requirements and suggested best practice for the issuing of a Standing Order.
Here is a link to the Standing Order Guidelines issued by the Ministry of Health on the role and responsibilities of health professionals issuing standing orders and those working under standing orders – http://www.health.govt.nz/publication/standing-order-guidelines
Here is a link to the Medicines (Standing Order) Regulations 2002 – http://www.legislation.govt.nz/regulation/public/2002/0373/10.0/DLM170107.html
The Standing Order guidelines also include a Standing Order Template guide, which prescribing Optometrists should use for all Standing Orders issued. Click here for an example Standing Order prepared by the Board.
Prescribing Optometrists are bound by their scope of practice and the HPCA Act and are professionally responsible to undertake only those activities within their scope of practice, and within their knowledge and skill set. It is the Board’s position that Optometrists take their prescribing responsibilities as seriously as other authorised prescribers and understand the accountability for their prescribing decisions. Board monitoring of optometrist prescribing has demonstrated that Optometrists are safe and cautious prescribers, and the Board expects Optometrists to apply this caution and adherence to safety when issuing any Standing Order.
Important information –
To follow are the situations under which the Board considers it may be appropriate for a prescribing optometrist to issue a Standing Order:
- In-practice to suitably trained staff, for example dilation and cycloplegia, so long as they are very aware of, and understand, the limitations of their peers’ knowledge and skill in the administration of medicines.
- In a hospital care setting, where appropriate, to maximise the benefit of having optometrists working to the full extent of their therapeutic scope.
- For mobile clinics (e.g. diabetic photo screening).
Standing Orders are a significant and specific authorisation from the issuer. The issuer of the Standing Order retains overall responsibility to:
- ensure the legislative requirements for the Standing Order are met;
- ensure that anyone operating under the Standing Order has the appropriate training and competency to fulfil the role; and
- countersign, audit and review the Standing Order.
A person who is permitted to administer and/or supply medicines under a Standing Order must be engaged in the delivery of a health service, and to meet regulatory requirements, must have the competency and training to be able to make an assessment that the Standing Order applies to the presenting patient, the competency to administer and/or supply the medicine, and the knowledge to assess the contraindications and/or exclusions.
For clarification, a standing order does not allow a person to generate a prescription and provide it to a patient to take to a pharmacy to be dispensed (with the prescription signed later by the issuer of the standing order). Pharmacies cannot lawfully dispense unsigned prescriptions. Nor does a standing order allow a person to provide a patient with a prescription that has been ‘pre-signed’ by the issuer of the standing order.
If after reviewing the Standing Order Guidelines and template you have questions about the use of Standing Orders by Optometrists, please contact the Board for further advice.