Prescribing Medicines 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

A prescription can be identified as legally authorised written instruction by a prescribing officer to a pharmacist to dispense medication.

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

When making the decision to prescribe there are a number of influence you have to consider. It is important to have an awareness of these influences and take them into consideration when issuing a prescription. It is importance to have knowledge of the DOH (2006) Medicines Matters this give guidance on the mechanisms available for prescribing and administration and supply of products. Team trends and external company’s and there representatives promoting their products have a big influence on your prescribing practice Bradley (2006) found that these influences were of concern to some nurses feeling that their colleague may ask them to prescribe for patients they haven’t seen. Thomas (2008)

This act is an Act of Parliament of the United Kingdom and it governs the manufacture and supply of medicine.

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

1. The current legislation, guideline policies and protocols relevant to the administration of medication are.

Non care setting - Medications are often stored and administered in a variety of non-health care settings. These settings include: primary and secondary schools, Child day care centres, Board and care homes, Jails and prisons. In all these settings, employees frequently are responsible for handling and administering prescription and over-the-counter medications to clients or residents. Some organizations may employ licensed health professionals to directly manage the medication administration process. However, many of these settings have no licensed health professionals involved. Where medications are stored and administered to individuals, written policies and procedures should address the following: Acquisition of medications (e.g., from parents, caregivers, pharmacies), Specification of which personnel are allowed access to medications and allowed to administer medications to students, clients or residents, Labelling and packaging of medications managed for students, clients

* There must be a policy at work place for the receipt, recording, storage, handling, administration and disposal of medicines.

P3 - Explain relevant sections of key legislation and associated guidelines with regard to the administration of medicines

Assisting – At the request of the service user, opening bottles and packets; removing lids; popping pills out of packages when the service user cannot physically do this and has asked the care worker to help with that specific medicine; shaking bottles.

M1 – discuss organisational policies and procedures are by influenced legislation and guidelines with regard to the administration of medication

There are several legislations in place with protocols for the administration of medication which I have listed below. The main policy re admin of drugs and storing of drugs and medicines is the Control Of Substances Hazardous to Health or COSHH but along with this there are other policies in place as per the list below.

The National Prescribing Centre recognize some fundamental differences in the absorption, distribution and excretion of medicines between adults and children. The differences are published in the National Prescribing Centre’s bulletin, produced by

Legislation – The Medicines Act, Control of Substances Hazardous to Health (COSHH) Regulations, The Health and Safety at Work Act, The Misuse of Drugs Act, The Misuse of Drugs (Safe Custody) Regulations, Health and Social Care Act