Ketamine in complex pain in palliative care patients If you are not sure if you are responsible for the care of the patient, you should seek additional information or advice from the doctor with whom care is shared or from another experienced colleague. If you are still not satisfied, you should tell the other doctor and the patient and take appropriate precautions to take care of them. Sometimes it is difficult to give patients as much information or decision-making assistance as you like, due to time constraints or limited resources available. To help you, you need to consider the role that other members of the health team could play and other sources of information and assistance available. These may include, for example, patient information brochures, advocacy services, expert programs for patients, or support groups for people with certain diseases. In the case of the proposal for a common care plan, specialists can advise the patient`s family physician what medication should be prescribed. If you recommend a new or rarely prescribed medication, you should specify the dosage and means of administration and agree on a protocol for treatment. You should explain the use of unauthed medications and deviations from recommended guidelines or treatments and provide sufficient information to the family physician and patient to enable safe treatment of the patient`s condition14. The intention to share care must be explained to the patient by the doctor who introduces the treatment.
It is important that patients are consulted on treatment and agree. Patients receiving the given medication should be followed regularly, which provides opportunities to discuss drug therapy. The submission form must be completed and approved prior to the writing of a new Joint Care Agreement (ACS). Shared care resources are available at the National Prescription Centre; Midlands Therapieics Review – Advisory Committee, which concluded 16 Effective Shared Care Agreements for a large number of drugs/indications; UK Medicines Information, which has published numerous joint care protocols/agreements; and Keele School of Pharmacy, which publishes a toolkit for effective shared care agreement “to help health professionals develop their own common care agreements to support locally agreed prescriptions.” Prescribers are reminded that the doctor who prescribes the drug is legally responsible for the clinical responsibility of the drug and the consequences of its use. A circular from the Ministry of Health first outlined the principles of common care. This was EL91 (127) and can be found below: decisions about who should take responsibility for subsequent care or care after the first diagnosis or assessment should be based on the patient`s well-being and not on your comfort or the cost of the medication, as well as on monitoring or follow-up. Shared care requires the agreement of all parties, including the patient. Effective communication and a permanent link between all parties to a joint care agreement are essential.
Locally approved documents on the common care agreement, which contain details on common care, can be developed for complex treatments that are used regularly in a specialized environment. These documents are known in NHS Lothian as Shared Care Agreements (SCA). These documents provide additional guidance for family physicians for complex treatments that are commonly used in a specialized environment and may be permitted to be used in primary care.