Nurse prescribers to get legal powers to mix medicines

The proposed changes, which were announced earlier this month by the Medicines and Healthcare products Regulatory Agency, are due to come into effect by the end of the year.

Under the new law, nurse independent prescribers will be allowed to mix medicines in all clinical areas as long as it is in the patient’s interest. They will also be given the same powers as doctors to prescribe unlicensed medicines for patients.

The move follows concerns raised last year about a lack of legal clarity on the mixing of medicines by nurse prescribers, which has become common practice in some clinical areas and in particular palliative care.

The NMC issued a statement last August highlighting that nurses were ‘not authorised to prescribe a mixture of licensed medication for administration via, for example, a syringe driver’.

However, in response the MHRA said that it would not prosecute those prescribing or administering mixed licensed medicines in palliative care, as long as it was in the public interest to do so.

The MHRA has now said it will extend this measure to cover other clinical areas where it has become standard practice, ahead of the law change.

This includes rheumatology, where nurse prescribers mix anti-inflammatories with steroids and analgesics for joint injections, and respiratory care where they mix bronchial dilators with steroids for people in respiratory distress.

Nursing groups, including the RCN and the Association for Nurse Prescribing (ANP), have welcomed the move, especially the inclusion of areas beyond palliative care.

RCN primary care adviser, Lynn Young, said: ‘This situation has caused a lot of confusion and anxiety for nurses, and the RCN are glad the position has been clarified.

‘Mixing medicines is not just about managing symptoms and providing pain relief in palliative care, it can be essential in managing acute episodes, and life-saving for people in respiratory distress,’ she added.

Matt Griffiths, senior nurse for medicines management at the University Hospitals of Leicester NHS Trust, said the changes to the law will reinforce that mixing medicines is safe practice.

‘Nurses have had to be pragmatic about mixing medicines, or patient care would have suffered,’ he said. ‘This is the sensible way forward and will mean that nurses – both prescribers and non-prescribers – are no longer legally exposed,’ he added. 

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