JRCALC combines expert advice with practical guidance to ensure uniformity in the delivery of high‐quality patient care. The book, available as either a comprehensive reference edition or pocket guide, covers a wide range of topics, from resuscitation, medical emergencies, trauma, obstetrics and medicines, to major incidents and staff wellbeing. It includes an extensive UK drugs formulary and Page for Age drugs tables to assist in making medicines administration simple. A digital version, via an app, of the official JRCALC guidelines is also available for pre‐hospital clinicians to download.
Clinical considerations
There are also numerous prescribing and drug handbooks available, predominantly developed and produced for healthcare staff within the United States (US).
They can be a useful resource, but be aware the recommended medicines within these guides will not be based on UK NICE/SIGN guidelines and/or the medicinal products may not even have a license to be used within the UK.
Prescribing Drug Therapy
You may also come across other prescribing guides (in electronic and paper format) such as ‘Prescribing Drug Therapy’. This guide is written for Advanced Practice Registered Nurse (APRN) students and practitioners in the US who prescribe drugs for acute, episodic and chronic health problems. This guide provides details on treatment details for more than 600 diagnoses for healthcare providers in all primary care settings. Drug information is presented in a condensed and summary format for ease of use. The print format includes an eBook with digital updates to assure immediate access to essential information.
The guide is simple to use with diagnoses listed alphabetically. For each diagnosis there is a list of:
medicinal treatment recommendations;
drug choices listed by generic name;
Food and Drug Administration (FDA) pregnancy category;
generic and over‐the‐counter availability;
adult and paediatric dosing regimens;
brand names, forms of dosage and additives;
other clinically useful information, such as laboratory values to be monitored, patient teaching points and safety information.
Prescribing Drug Therapy also has an alphabetical cross‐reference index of drugs by generic and brand name, with FDA pregnancy category and controlled drug schedule.
The evidence base to prescribing: prescribing guidelines
There are many medications that can be used to treat the same condition; it is important to know which drug to use and when. To assist with choosing the most appropriate medication, in terms of efficacy, safety and cost effectiveness, clinical guidelines (where available) must be adhered to. Clinical guidelines are systematically developed statements to assist practitioners and patients make decisions about the most appropriate healthcare for specific clinical circumstances. Guidelines provide recommendations for effective practice in the management of clinical conditions where variations in practice are known to occur and where effective care may not be delivered in a uniform way. There are many guidelines available, but most are based on a consensus of ‘expert opinion’ or a non‐systematic review of the scientific literature. Prescribing clinical guidelines can be local or national (Table 2.3 provides some examples).
NICE prescribing guidance
NICE is a non‐departmental public body that provides national guidance and advice to improve health and social care in England.
NICE guidelines make evidence‐based recommendations on a wide range of topics including:
preventing and managing specific conditions;
improving health;
managing medicines in different settings;
providing social care and support to adults and children;
planning broader services and interventions to improve the health of communities.
Within each NICE guideline, there are recommendations regarding the care (including medications) and services that are suitable for most people with a specific condition or need. NICE guidelines are used by NHS England and NHS clinical commissioners to develop services and are a reference guide for healthcare professionals, with recommendations about medications that should and should not be prescribed. The guidelines also cover areas that patients should be able to manage themselves and obtain, if necessary, appropriate over‐the‐counter medications.
Table 2.3 Examples of local and national prescribing guidelines
| Local Guidance | National Guidance |
|---|---|
| to your team, service or condition you are working withinNHS organisation/employergeographical region | NICE or SIGN guidancenational networksclinical groupscharities |
Clinical considerations
In your area of practice, choose a medical condition that you are familiar with.
Check to see if there is a local (to your Trust/employer) and/or national guideline for this condition.
Is the guidance the same as within the BNF?
Are there are any differences in recommendations? If so, think why this may be.
Scottish Intercollegiate Guidelines Network (SIGN)
The SIGN was formed to improve the quality of healthcare for patients in Scotland by reducing variation in practice and outcome. SIGN collaborate with a network of clinicians, other health and social care professionals, patient organisations and individuals to develop evidence‐based guidelines. SIGN guidelines are based on a systematic review of the scientific literature and are aimed at aiding the translation of new knowledge into action. The guidelines are intended to:
help health and social care professionals and patients understand medical evidence and use it to make decisions about healthcare;
reduce unwarranted variations in practice and make sure patients get the best care available, no matter where they live;
improve healthcare across Scotland by focusing on patient‐important outcomes.
NICE and SIGN both produce patient booklets that are a lay translation of the clinical guidelines. These booklets explain the recommendations in the clinical guideline and help to make patients aware of the treatment they should expect to receive. They are intended to:
help patients and carers understand the latest evidence about diagnosis, treatment and self‐care;
empower
