Independent Nurse: Practical Prescribing

June 20, 2008 by admin 

I am a diabetes specialist nurse and dose adjust insulin for my patients under a Patient Group Direction (PGD). Is this acceptable? I am concerned that my manager will want me to undertake training to prescribe. However, I do not want to do this because of the amount of study required.

The dose adjustment of medicines under a PGD is acceptable. However, legislative criteria require that the dose or maximum dose is specified i.e. it is necessary for the PGD to clearly identify a single dose or a range up to a specific maximum dose. Both the doctor and the pharmacist who sign the PGD must be satisfied that the dose range that is specified is clinically appropriate. It is also necessary that the clinical criteria for selecting a dose within that range are specified. Those using a PGD in this manner must be competent to make the decision on dose.

The specifications required if using a PGD for dose adjustment are very rigid and so may well not be of use to the practice of some nurses, for example, if major dose changes are required.
In addition, PGDs were not designed to cover long-term therapy for chronic disease management. Nurse prescribing, and the greater autonomy that this role provides, would resolve these issues. However, prescribing is not for all nurses. With autonomy comes greater responsibility and some nurses do not want this. Some nurses, like yourself, do not want to undertake the training programme because of the amount of study that is required. Indeed, the implementation guidelines for prescribing (Department of Health (DoH) 2006) state quite clearly that nurses should not be nominated for this training unless they want to prescribe. It would therefore be inappropriate for your manager to make you feel pressurized to undertake the prescribing course.

References
DoH (2006) Improving patients’ access to medicines: A guide to implementing nurse and pharmacist independent prescribing within the NHS in England. DoH, London.

Filed under: Practical Prescribing
Tagged:

Comments

Comments are closed.