I hear that at the Non-Medical Prescribing leads meeting on 21st June, there was a discussion about an NHS Trust which is allowing its community practitioner nurse prescribers to prescribe oral antifungal medicines [miconazole and nystatin] ‘off-label’ to neonates.
After the meeting, the Department of Health (DH) sought advice from nursing, pharmacy and medical colleagues in the DH, who recommended that Community Practitioner Nurse Prescribers should be able to prescribe nystatin off-label for neonates. Members of the DH Non-Medical Prescribing Core Delivery Group then brought this recommendation to the Nurse Prescribers’ Advisory Group for the BNF [formerly the Nurse Prescribers’ Formulary Subcommittee of the Joint Formulary Committee] on July 4.
I understand that the Nurse Prescribers’ Advisory Group also recommended that where Community Practitioner Nurse Prescribers are positive that the diagnosis is one of oral thrush, they should be able to prescribe nystatin at the dose recommended in the BNF for Children. The Advisory Group agreed on this exception [for nystatin], on the basis that there is no systemic absorption of the product and that the use of nystatin in treatment of oral thrush is long established.
Apparently the Advisory Group was not content for Community Practitioner Nurse Prescribers to prescribe miconazole off-label.
The DH advises that Community Practitioner Nurse Prescribers who prescribe nystatin off-label must be clear that they accept clinical and medico-legal responsibility for prescribing that medicine. Community Practitioner Nurse Prescribers should only prescribe nystatin off-label/off-license within their own competence.
This decision by the DH [to allow Community Practitioner Nurse Prescribers to prescribe off-label], is without precedent and there are no other exceptions for off-label prescribing by Community Practitioner nurse prescribers.
The DH Non-Medical Prescribing website will shortly be updated to reflect this information. The effective date is August 1.
This is great news both for patients and Community Practitioner Nurse Prescribers, especially Health Visitors many of whom encounter neonates with oral thrush on a regular basis.