Independent Nurse: Practical Prescribing

November 20, 2008 by admin 

Q: I work in a minor injuries unit. Since qualifying and receiving my prescription pad I have not yet written a prescription due to rules around controlled drugs that I did not realise existed. I thought restrictions only applied to Patient Group Directions, not prescribing. Could you advise?

A: In your full letter, you explain that, as an independent prescriber, you believed you would be able to administer adequate pain relief to patients under your care who present with severe pain after trauma and also cardiac chest pain. However, you have been advised by your lead nurse for non-medical prescribing that, because you are working in a minor injury department, this does not cover you to administer controlled drugs (CDs).

The CDs that a nurse can prescribe as an independent prescriber are linked to certain conditions and are as follows: diamorphine, morphine or oxycodone for use in palliative care;
buprenorphone or fentanyl for transdermal use in palliative care; diamorphine or morphine for pain relief in respect of suspected myocardial infarction or for relief of acute or severe pain after trauma including, in either case, post-operative pain relief; and chlordiaepoxide hydrochloride or diazepam for treatment of initial or acute withdrawal symptoms caused by withdrawal of alcohol from persons habituated to it.

Therefore, as an independent prescriber you can administer diamorphine or morphine for patients experiencing severe pain following trauma and also cardiac chest pain.

Regarding patient group directions, these can only be used to supply and/or administer diamorphine for the treatment of cardiac pain by nurses working in coronary care units and A&E departments. Therefore, as you work in a minor injury department, you would not be able to use a PGD to administer diamorphine to these patients. The results of a consultation that proposes the removal of the restrictions on the location which govern the supply/administration of CDs are currently awaited (1).

References
Patient Group Directions (MLX 336). MHRA

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