Independent Prescribing Case Study

Supplementary and independent nurse prescribing has taken some years to materialise; this movement was facilitated by Department of Health (DoH), nursing regulators, nursing professional bodies, and general practice (GP) supporters (RCN, 2012). Following the Medicines Act (1992) where only Health Visitors and District Nurses were allowed to prescribe from a limited formulary, over time legislations were subsequently amended allowing non community nurses to prescribe from an extended formulary. In 2003, supplementary prescribing was being recognised and by 2012 The Misuse of Drugs Regulations allowed the nursing formulary to access all of the British National Formulary including controlled drugs. In line with these changes and to ensure that

Nurses should be encouraged to question the doctors if a wrong drug is prescribed. They should also restrain from taking verbal orders. Written signed orders should be mandated.

the roles and responsibilities of the person prescribing medication are to prescribe in the best interests of the persons. They will need be know the patient’s medical history and the current medication they are taking, give all information to the patient so the patient can make an informed choice, know the current guidance which is published in the BNF, prescribe the current dosage and make a follow up appointment.

Accountability means:” being accountable for one’s own action”. The American Nursing Association (ANA) states in its code that the nurse will assume accountability for individual nursing judgments and actions. Professional nurses are accountable in several areas including accountability to the public, client, profession, employer, and self (Hood, 2010, p. 307). All professional nurses have the responsibility to work within their scope of practice to provide the best possible care to patients. Nurses’ should have a thorough knowledge about their accountability in specific areas of practice. The level of responsibility and accountability depends on professional levels. A nursing supervisor has more responsibility than a charge- nurse. A

Nurse prescribing was first suggested by the Royal Collage of nursing (RCN) in 1980, it was to take another six years for it to become part of the government’s agenda with the Cumberlege Report in 1986 (Department of Health and Social Security (DHSS)(1986). These two report

Nurse prescribing has an important contribution to make in improving the service to patient’s clients within the primary health care setting, its benefits was highlighted in the crown

The scope of practice for non-medical prescribers (NMP) has expanded greatly over the last 2 decades, with legislation now allowing NMP’s to prescribe from the whole BNF (with the exception of treatment in addiction and within the prescribers competency). Since the introduction of the Medicines Act in 1986 there have been over 15 different governmental reports and legislative changes (see Appendix 1 timeline) that have allowed for the development and growth of the NMP role. Initiated by The Cumberledge report of 1986 and followed by advisory group report in 1989 legislation was introduced with the Medicinal products: Prescription by nurses act of 1992 which allowed primary care nurses to prescribe from a limited formulary (V100 & V200). This advancement in legislation recognised previous recommendations and placed the improvement of patient care and effective use of resources at the core of its practice. However these acts did not reflect on other areas like secondary care or pharmacist and it wasn’t until 1998 The Crown Report and its second report published a year later that led to supplementary and independent prescribing (V300). In 2003 legislation was passed allowing some prescribing of controlled drugs in palliative care with restricted circumstances (amendment to Misuse of drugs Act 1971). In May 2006 nurses were empowered to prescribe from the whole BNF with the exception of some controlled drugs, and in 2009 further legislative changes were made to include the

“Non-medical prescribing is prescribing which is taken by a health professional who is not a doctor” (Non-medical prescribing 2012).To become a non-medical prescriber the relevant training must be undertaken to ensure the patients’ safety is most important. The health care professional who is the non-medical prescribers is only legally allowed to prescribe within their area of expertise and they must remain competent within that area, through maintenance of various continuing education and training programmes.

The person dispensing must also be appropriately trained, follow safe systems of work and understand the side effects of various drugs; be able to access appropriate information and understand when to access advice or further information

Nurse prescribing was first recommended, by the RCN, in 1980 and became part of the government’s policy agenda in 1986 with the Cumberlege Report (DH 1986). Further, the Crown Report (DH 1989) advocated prescribing by trained community nurses from a limited formulary. Legislation was introduced in 1992 -The Medicinal Products: Prescription By Nurses Act, 1992 followed by secondary legislation,

In the UK, nurse prescribing was born out of the need to increase efficiency in the NHS by making best use of its resources. Nurse-led services are one means of improving healthcare provision and a string of legislative change has gradually broadened the scope of nurse prescribing in the UK. (Courtenay et al 2007).

‘Only nurses with relevant knowledge, competence, skills and experience in nursing children should prescribe for children. This is particularly important in primary care (e.g. out of hours, walk-in clinics and general practice settings). Any one prescribing for a child in these situations must be able to demonstrate competence in prescribing for children and refer to another prescriber when working outside their level of expertise or level of competence.’ The Nursing and Midwifery Council standards of proficiency for nurse and midwife prescribers’ (NMC, 2006)

6.2. Explain how risk assessment can be used to support an individual's independence in managing medication.

3.1. Describe the roles and responsibilities of those involved in prescribing, dispensing and supporting use of medication

Drug administration forms a major part of the clinical nurse’s role. Medicines are prescribed by the doctor and dispensed by the