Prescribing in practice

In the following case study, the author will discuss the issues surrounding a seventy-year-old female with a chronic neuropathic ulcer on the sole of her right foot and the rationale and implications of

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

It should be made mandatory for the nurses to read back the documented prescription to the doctor. It should be signed by the doctor for confirmation after been reviewed by the druggist.

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

For nurses extending their role to include prescribing there is much to consider. Revelay (1999) states that, accountability involves an individual giving an account of their actions with the rationale and explanation given for these actions. The decisions regarding boundaries of practice are firmly placed in the hands of the individual practitioner (Carlisle 1992). Accountability means being able to justify any actions and accepting responsibility for them, and is an integral part of nursing practice (Rowe 2000) The NMC Code of Professional Conduct (2004) states that a nurse is personally accountable for her practice, has a duty of care to patients and must work within the laws of the country.

I feel it is important for the purpose of my scenario to acknowledge the new skills which I have acquired whilst undertaking the V150 and explain the background to Nurse Prescribing. The Cumberledge Report (DHSS, 1986) made the initial recommendations for nurses to

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

Easy access to the drugs is another important factor contributing to nurses who substance abuse. As stated by Serghis (1999) the availability of medications in the workplace has been linked to substance abuse among nurses (as cited in Talbert, 2009, p.17). Part of the nurse’s duty every day is to give medication to their patients, which exposes them to have easy access to drugs. Nurses who take medication from their patients for their own personal use are "always using the maximum PRN dosage when other nurses use less" (DeClerk, 2008, p. 12). The healthcare field accepts the use of medication and so nurses may perceive the wrong idea by making use of patients drugs themselves. "Medications are easily accessible to nurses, who may believe erroneously that they have the ability to control their own medications use because of their experience with administering medication to patients" (Talbert, 2009, p. 17). In the case

This paper aims to explore the role of the V100 nurse prescriber. The development of nurse prescribing will be outlined, followed by a reflective case study in which ethical and legal implications will be discussed and finally a reflective conclusion will be drawn. Where appropriate the paper will be written in the first person (Webb 1992).

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).

1. In the workplace there is a generic Medication Management Policy and Procedures for Adult Services (Issue 10, 2012) document. This is kept to hand in a locked cupboard, readily available to read. It requires that all Healthcare Staff are given mandatory training and refreshers are provided. Legislation which surrounds the administration of medication includes The Medicines Act 1968, The Misuse of Drugs Act 1971, The Data Protection Act 1998, The Care Standards Act 2000 and The Health and Social Care Act 2001

Administration of medicines is a key element of nursing care. Every day some 7000 doses of medication are administered in a typical NHS hospital (Audit Commission 2002). So throughout this essay I will be evaluating and highlighting the learning that took place whilst on placement at a day unit.

Generic prescribing is almost universally acknowledged as desirable and representing high quality prescribing in the UK. It has benefits that include reducing the risk of error as each drug has only one international chemical name rather than many brand names and, usually, reducing the cost of prescribing. There is little evidence that it detracts from patient care. European laws have meant that there has been a move from using British Approved Names (BAN) to Recommended International Non-proprietary Names (rINN), which has strengthened the safety argument and ensured that drugs of the same class have similar names which helps reduce confusion (Duerden M. and Hughes D. ,

Over the last two decades, growing number of countries permit nurses to prescribe medicines. The first nurse was given prescribing rights in New Zealand 16 years ago. New Zealand has achieved 0.35% of practising nurses authorised to prescribe. In New Zealand, one third of adult population diagnosed chronic disease such as hypertension, diabetes and other related conditions and it is expected to grow in future (Ministry of Health (MOH), 2016). In the future aging population also expected to raise enormously, which create demand for health care professionals. Therefore, ministry of health established a strategy to address this issue by introducing nurse prescribers. Prescribing by nurses improve the access of health care,