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Prescribing and medicines management

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Nurse prescribing has grown significantly in the past eight years and since May 2006, nurses can prescribe almost every licensed medicine in the British National Formulary.

In 1998 the first limited nursing formulary was published for district nurses and health visitors to use and is now called the Nurse Prescribers’ Formulary for Community Practitioners, but it was not until 2002 that nurse prescribing expanded radically.

The government then introduced the Nurse Prescribers’ Extended Formulary (NPEF), originally for four therapeutic areas – minor injuries, minor ailments, health promotion and palliative care. It also set a target for there to be 10,000 extended formulary nurse prescribers by 2004, but that target has been extended to the end of 2006.

The NPEF was expanded in 2003 and again in 2005, to cover an extended range of medicines and conditions outside the original therapeutic areas, mainly for emergency care and first contact care.

At the same time, supplementary prescribing was introduced in 2003. This is a voluntary partnership between an independent prescriber (doctor or dentist) and a supplementary prescriber (nurse) who draw up and agree an individual clinical management plan for a patient’s condition.

The real breakthrough came this year when almost all of the BNF was opened to independent and supplementary nurse prescribers, replacing any need for the NPEF.

There have been objections to the extension of nurse prescribing, most notably from doctors’ representative body the BMA, which has expressed concerns that the move was a ‘dangerous’ one because nurses are not as highly trained as doctors.

Many nurses have rejected such arguments, stressing that only very experienced and well trained nurses will be prescribing and nurses are a natural choice to prescribe because many already make recommendations or write prescriptions for doctors to sign, and work more closely with patients than other health professionals to monitor their requirements.

The new independent nurse prescriber needs three years’ clinical experience and to be deemed competent, supported by their employer and be able to study at degree level.

Nursing regulator the NMC has set tough new training standards, effective from autumn 2007 that will mean these nurses will also have to sit tests in pharmacology and maths.

The new prescribing training will include:
- 26 days of training plus 12 additional days of supervised learning in practice
- A written examination of 20 short answer questions and/or multiple choice questions to test pharmacological knowledge – an 80% pass mark is required
- Numeracy assessment within prescribing practice context – a 100% pass mark is required
- Preparing a portfolio or learning log showing application of theory to practice and evidence of numeracy skills, writing prescriptions and prescribing in range of scenarios
- Either an Objective Structured Clinical Examination (OSCE) – a detailed examination of practice either within a simulated learning environment or in practice, or a video consultation in a live practice setting
- Satisfactory completion of the period of practice experience, including sign off by both the designated medical supervisor and the employer.

Updated: September 2006

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