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Nurse prescribing: a policy overview

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VOL: 98, ISSUE: 17, PAGE NO: 34

Rosemary Cook, MSc, RGN, PNCert, is nursing officer, Department of Health, Leeds

Nurse prescribing represents a significant step forward in nursing roles and has understandably received much attention. This article looks at the important role of the nurse prescriber and outlines the forthcoming policy on the prescription and supply of medicines by nurses.


Nurse prescribing represents a significant step forward in nursing roles and has understandably received much attention. This article looks at the important role of the nurse prescriber and outlines the forthcoming policy on the prescription and supply of medicines by nurses.



Nurses and medicines
In the course of a normal working day, most nurses will be involved with medicines in a variety of ways. They may:



- Administer medicines directly to a patient;



- Supply medicines that a patient will take at a later date;



- Explain to patients how their medication works, how it will help them and how they should take it;



- Advise patients on how to alter the dosage of their medication, in the light of changes in their condition;



- Recognise if a patient’s symptoms are a side-effect of their medication, advise them and, if appropriate, report the adverse effect of a medicine to the prescriber;



- Use their specialist knowledge to advise medical colleagues on the choice of medicine to be prescribed;



- Supervise the safe and appropriate storage of medicines.



After the roll-out of nurse prescribing, which was completed in spring last year, some nurses - currently health visitors, district nurses and certain practice nurses - also prescribe medicines to patients.



All these activities are equally important to the desired outcome: that patients should be provided with safe, appropriate and effective information and medicines to restore health, alleviate suffering or prevent disease. To achieve these aims, all need to be undertaken competently, professionally and in accordance with local policies and the law (Fig 1).



New roles for nurses
Making a Difference (Department of Health, 1999a), the government’s strategy for nursing, sets the direction for nursing policy. Alongside changes to nurse education and regulation, the creation of nurse consultant posts and the current focus on clinical governance, it signals the development of new roles for nurses. One of these is the broadening of nurse prescribing to include more nurses and more medicines.



The NHS Plan (Department of Health, 2000a) sets a specific target - that most nurses should be qualified to prescribe or supply (under patient group directions) medicines by 2004 (Box 1). The document also includes ‘prescribing medicines and treatments’ in a list of 10 key roles for nurses. These roles aim to enhance patients’ experience of health care by breaking down the traditional barriers between professions. With this clear policy direction and the work of the Changing Workforce Programme, which helps trusts to redesign services and remodel their workforces, why haven’t nurses seized the initiative and begun to prescribe?



Medicines and the law
The answer lies in the legislation that governs prescribing and other aspects of the possession, supply and administration of medicines. Box 2 clarifies some legal definitions. The two main pieces of primary legislation related to medicines are the Medicines Act 1968, and the Misuse of Drugs Act 1971. Another, the Medicinal Products: Prescription by Nurses etc. Act 1992 is the primary legislation that allows nurses to prescribe.



To ensure nurse prescribing was introduced safely, secondary legislation under the Medicines Act 1968 defined which nurses could be prescribers and which medicines they could prescribe. All these pieces of legislation will be amended to enable the extension of independent nurse prescribing to more nurses (first-level registered nurses and registered midwives who have completed the specified programme of training and have recorded their qualification on the professional register). These nurses will be able to prescribe from a wider formulary.



The pace of implementation of this policy has been set by the need to proceed within the law at all stages and to ensure that all changes to the law are independently scrutinised against the principle that patient safety is paramount.



Current policy activity on medicines
Three pieces of policy activity relating to medicines will be of interest to nurses:



- The extension of the scope of patient group directions (PGDs) (DoH, 2000b);



- The extension of independent nurse prescribing;



- The introduction of supplementary prescribing.



The Medicines Control Agency (MCA) is consulting on the extension of the use of PGDs to the independent health care sector. The consultation document can be found on its website. In addition, the DoH is working with the Home Office on ways to include controlled drugs in PGDs where this would benefit patients. One example is in coronary care, where it would enable the rapid administration of morphine to patients who have had a myocardial infarction.



The extension of independent nurse prescribing covers minor illnesses, minor injuries, health promotion and palliative care. The first students began three-month courses in January last year (Box 3). The cost of training about 10,000 NHS nurses and midwives by 2004 is to be met by central funding. More can be trained if employers fund them.



A formulary has been approved by ministers. It includes all pharmacy and general sales list medicines currently prescribable by GPs and about 130 prescription-only medicines, including analgesics, contraceptives, anti-inflammatories and antibiotics, details of which can be found on the DoH website. At the same time, the DoH has concluded a series of informal consultations with nursing, medical and pharmaceutical professional bodies to discuss proposals for introducing supplementary prescribing (Box 4). A formal DoH/MCA consultation paper is planned, with a view to introducing supplementary prescribing for nurses from the end of the year.



The future
Nurses are already involved in various aspects of managing medicines, from giving patients advice to prescribing, and this role is set to expand. With the extension of PGDs to new areas of practice and new medicines, the extension of independent nurse prescribing in four key areas and the introduction of supplementary prescribing for long-term conditions and mental illness, many more nurses will be performing these new roles. In doing so, it is important to remember that the purpose of these changes is to benefit patients in a service centred on their needs.n



- See also PDNT, Medicines 3: Managing medicines, p43-46.






- Medicines Control Agency:



- Department of Health:

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