Independent Nurse: Practical Prescribing

October 20, 2008 by admin 

I have just qualified as an independent supplementary prescriber and work in the area of palliative care. I have been told by my employer that I am unable to mix medicines for delivery in a syringe driver even if I am instructed to do so by a doctor. Is this correct?

Yes, this is correct – even though mixing of licensed medicines in the field of palliative care is long-standing accepted practice and there is evidence available that provides supports that this practice is safe. When this issue first arose, initial advice from a number of NHS bodies was that mixing of medicines could continue under the specific directions of a doctor or, if listed on the patients clinical management plan. However, further clarification from the MHRA has confirmed that under current legislation a doctor is unable to instruct a practitioner to mix licensed medicines and the use of supplementary prescribing is also inappropriate. Therefore, there are currently no circumstances in which medicines can be mixed by a palliative care practitioner.

As you will be aware proposal have been developed by the MHRA1 aimed at relaxing these legal requirements - comments for which must be submitted by the 13th February 2009.
Four options are proposed in this consultation; however, support is given to Option D which would enable Nurse and Pharmacist Independent Prescribers to prepare products for their patients and also direct nurses and pharmacists non prescribers to mix drugs prior to administration. Doctors would also be able to direct nurses and pharmacists to mix medicines.

1) Public consultation (MLX 356): Proposals for amendment to medicines legislation to allow mixing of medicines in palliative care

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