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Pharmacists overruling nurse prescribers 'poses safety risk'


Nurse prescribers could have their decisions overruled by pharmacists, posing a potential safety risk to patients, under latest proposals.

The Medicines and Healthcare products Regulatory Agency’s proposals to “consolidate and review” UK medicines legislation are included in a consultation which ends next week.

Currently pharmacists can only change the prescribed medicine and directions for use, including the dose, if they have tried and failed to get in touch with the prescriber.

But this could change if the new proposals are implemented. The consultation document proposes the removal of the requirement for a pharmacist “to attempt to seek the prescriber’s permission before making a change”.

However, nurse prescribers warned in some cases pharmacists were likely to make dangerous mistakes if they tried to change prescriptions.

June Rogers, a paediatric continence nursing expert and team director at PromoCon UK, which advises on bladder and bowel services, said she had experienced patients being endangered by pharmacists changing prescriptions, even under the current rules.

She said children and the elderly in particular were often correctly given unusual prescriptions, which pharmacists may try to change. Ms Rogers said the problem would be exacerbated by a change in the law.

Matt Griffiths, an independent consultant nurse and prescribing expert, told Nursing Times pharmacists might replace medicines with generic alternatives, which in some cases could endanger patients.

He said: “People can be quite specific about medicines. Even though something is the same drug generically, it can have a different release profile.”


Readers' comments (12)

  • Given the amount of prescriber errors we pick up when checking drugs I think it is a bit rich to be stating that pharmacists are the problem - part of it, but not the whole!

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  • Hang on a second....... are we being led to believe that nurse prescribers now don't need an accuracy check by a Pharmacist? If that is the case that is absolutely breathtaking arrogance. Pharmacists make decisions based on extremely high quality knowledge and use of medicines information systems.

    Pharmacy staff will also challenge the use of proprietary medications based on expense where there is little to no evidence of increased efficacy over generic preparations.

    I'll be interested to hear what the Pharmaceutical Society has to say about what appears to be a slur upon their profession.

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  • Surely the key is to maintain communication. I doubt people are saying that nurses shouldn't have their presriptions checked but if changes are going to be made they need to be discussed.

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  • it would seem normal that pharmacists are legally responsible for any medicines they dispense and have to check them and the prescriptions. How about nurses, who are responsible for administering medicines to patients? How often do they have to check and withhold medicines prescribed by doctors?
    surely it is the safety of the patient and safeguard of the job or professionals that is the issue here and not a case of individual wounded pride so typical in the NHS and English establishments?

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  • I think you're missing the point of the article. No one has a problem with changing things if an error has occured. This is talking about changing choice of medications prescribed. This is when communication is paramount.

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  • Anonymous | 13-Jan-2012 1:47 pm

    sorry, that's what comes of reading and commenting in too much of a rush but I agree with you. nothing should be changed without discussing the reasons first as it is the prescriber who sees and knows the patient.

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  • This proposal is not just aimed at nurse prescribers - it covers GP's as well! It is potentially worrying as a pharmacist may well not be aware of the patients full medical background - we have had experiences of pharmacists refusing to dispense laxatives for children at the dose prescribed as it was 'an adult dose' yet was required for therapeutic reasons.

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  • Why can Drs, Nurse Prescribers and Pharmacists not work together in the best interests of the patient? Must we always be complaining about something?
    Some people may require different, more unusual drugs and this may be queried, but surely having a system of checks in place is a good thing?

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  • I'm sorry but if the strongest objection is that pharmacists might substitute a generic then we really do not have too much to worry about. Sure there are small number of drugs where this should not happen for clinical reasons, a few patients who exert their right to choice and waste tax payers money on a brand (thus denying other patients choices in a cash limited system!), a few others who may have an intolerance to excipients and a handful more who get confused by changes. But lets get things into perspective here, there are times when pharmacists detect serious errors and there are times when they have to make a clinical decision based on the information available to them, but this would be done in consultation with the patient and with their optimal health outcome as the primary driver.

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  • Angus Thompson | 20-Jan-2012 10:49 am

    "...but this would be done in consultation with the patient..."

    hopefully with the prescriber as well as this may confuse the patient and further damage confidence and therapeutic relationships!

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