Mixing medicines: Option D wins support
April 10, 2009 by admin
Responses to the MHRA consultation on mixing medicines in palliative care seem to be supporting Option D: that the law be changed to allow nurse and pharmacist independent prescribers to “specially prepare products for their individual patients and direct nurses and pharmacists who are not prescribers to mix drugs prior to administration� and to enable doctors to direct nurses and pharmacists to mix on a similar basis
The Association for Nurse Prescribing (ANP) says that this option would benefit patients and carers by reducing potential delays in accessing treatment, and that mixing licensed medicines in palliative care is long-standing accepted practice. In response to the MHRA request for details of other clinical areas where this practice occurs, the ANP says there are many, including dermatology and respiratory care. It asks that there should be an explicit requirement that no pressure be placed on prescribers to prescribe, dispense or administer medicines mixed in this way if they believe it to be outside their area of competence.
In its response, the RCN also supported Option D, stressing the importance of this issue to palliative care nurses and district nurses in particular, many of whom have contacted the RCN with their concerns. The RCN also said that the consultation should be widened urgently to include other areas of practice. It has received many calls from nurses not in palliative care for whom mixing medicines is part of their day-to-day work: for example, rheumatology nurse specialists mix anti-inflammatories with steroids and analgesics for joint injections; and respiratory nurses mix bronchial dilators with steroids for people in respiratory distress.
The proposals (Option D) are also supported by the Royal Pharmaceutical Society (RPS), which lists many other situations in which ‘mixing’ is established and safe clinical practice. It believes it is essential that the changes apply to any situation in which a doctor, dentist, pharmacist independent prescriber or nurse independent prescriber, acting within their competence, “may be legitimately required to mix medicines, or to order or direct someone else to mix medicines”. The RPS stresses it is not asking that the law support the mixing of random medicines in any circumstances, but rather that it is not in the public interest for the legal position to be changed for palliative care and not for other areas of practice. The RPS recommends that whenever medicine mixing is sanctioned legally in any care setting, it should be done under conditions that identify named practitioners and named drugs under specified conditions.
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