Changes in the Misuse of Drugs Regulations 2001 that came into force this year have enabled appropriately qualified nurses to independently prescribe controlled drugs (CDs), mix controlled drugs with another medicine, and use CDs in patient group directions.
This is a vote of confidence for nursing and demonstrates that nurses have successfully taken on this complex role despite the strongly expressed doubts of many people outside the profession.
The legislation being passed is cause for celebration. It will improve patient access to appropriate medication and means that nurses have the same prescribing rights as doctors.
Although nurses and midwives have the legal right to prescribe CDs independently, restrictions remain on schedule 1 medications and the prescribing of some CDs for people addicted to drugs such as morphine and cocaine.
Prescribing of CDs by nurse independent prescribers used to be limited to 12 drugs that could be prescribed for specific conditions, for example morphine in palliative care or acute traumatic pain relief. These restrictions meant that if a nurse independent prescriber assessed a patient and decided they needed a controlled drug for a condition not specified in the British National Formulary, they would not have been able to prescribe the medication independently.
One way of working around this was where the nurse acted as a supplementary prescriber and used a patient-specific clinical management plan. However, this is not possible in many circumstances, especially in acute settings where a nurse makes the diagnosis. Patient access to appropriate medication and analgesia was frequently impaired. Restrictions on the independent prescribing of CDs did not only affect pain management but also a variety of conditions including, for example, the use of methadone in the management of addiction, diazepam in acute anxiety and methylphenidate in ADHD.
The restriction of independent prescribing of CDs inhibited patient care and did not recognise the education and competence of nurses to prescribe these medications safely and appropriately.
The recent changes have the potential to further improve patient access to appropriate medication and to increase the autonomous working of nurses.
Now that they can prescribe from the whole BNF, nurse prescribers must be acutely aware of their accountability and prescribe within their clinical area and competence. Before beginning to prescribe CDs independently, nurses should discuss local clinical governance arrangements with employers and ensure they are acting within their contract of employment.
The role of nurse prescribers in the UK has evolved to the point where it plays an important part in care delivery, improving patient access to medication and enabling service redesign. Evidence demonstrates that nurses do prescribe effectively, appropriately, safely and cost effectively within their competence.
Paul Warburton is senior lecturer, Faculty of Health and Social Care, Edge Hill University.
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