Practical Prescribing
Independent Nurse: Practical Prescribing
September 22, 2009 by admin
I recently started a two-year MSc Advanced Practitioner programme with a special interest in COPD, and work with a community COPD team. I qualified as a nurse independent prescriber/nurse supplementary prescriber in 2005, prescribing within my competence in my specialist area. However, my current line manager says I will not be able to prescribe until the end of the course in 2011. I would appreciate your view.
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Independent Nurse: Practical Prescribing
September 12, 2009 by admin
I am a qualified nurse independent prescriber (NIP) / nurse supplementary prescriber (NSP) and work in a rural minor injury and urgent care unit. Can you advise on the use of intra-nasal diamorphine?
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Independent Nurse: Practical Prescribing
August 21, 2009 by admin
I have worked in general practice for 20 years and see many patients with diabetes and asthma. The doctors in the practice insist that they sign prescriptions for black triangle drugs. Is this right?
Many of the patients I see are on these drugs with a black triangle. If these medicines are within my area of competence, surely I should be able to prescribe them?
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Independent Nurse: Practical Prescribing
July 18, 2009 by admin
I am aware of the restrictions concerning controlled drugs (CD). However, is Diazepam a CD? I am involved in the care of patients with short-term anxiety who would benefit from this medicine. However, the trust in which I work restricts the prescription of Diazepam by Nurse Independent Prescribers (NIPs) to palliative care and alcohol withdrawal.
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Independent Nurse: Practical Prescribing
June 23, 2009 by admin
Q: Some of the vaccines that we administer in our practice, such as yellow fever and meningitis, are licensed for use in this country. However, others, including Japanese encephalits and tick-born encephalitis, are not licensed in the UK. Can a patient group direction (PGD) be used to administer private vavccines? As yellow fever and meningitis are licensed, can a patient specific direction (PSD) be authorised by a nurse prescriber for private patients?
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Independent Nurse: Practical Prescribing
June 8, 2009 by admin
Q: I work in rural Scotland and qualified as a nurse independent prescriber / supplementary prescriber just under a year ago. There are are couple of patients, for whom I am responsible, that I can’t always see for face-to-face consultations. Instead, I provide them with a telephone consultation and then prescribe their medicines on the basis of this. I am unsure if this practice is acceptable.
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Independent Nurse: Practical Prescribing
May 18, 2009 by admin
Q: I am in the process of setting up a “new entrants” community based service which aims to support new arrivals into the country by offering a health access service. One of the objectives of this scheme is to decrease the incidence of TB. Can a nurse independent prescriber (NIP) write a Patient Specific Direction for the Mantoux test, which uses a tuberculin that is unlicensed in the UK?
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Independent Nurse: Practical Prescribing
May 9, 2009 by admin
Q: Further to your advice (IN, 6 Apr) about the issue of “vicarious indemnity” through NHS employers, I would appreciate further clarification. I have been asked to pay my own insurance cover by my GP following advice from the MDU.
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Independent Nurse: Practical Prescribing
May 5, 2009 by admin
I am a practice nurse and have recently successfully completed the prescribing course. The Medical Defence Union (MDU) provide group insurance cover for the practice in which I work. I contacted the MDU to let them know my role had changed. They informed me that I would need to pay £383 per year to have cover with them due to my extended role. Is this right? I am a member of the RCN and therefore have full indemnity insurance.
It would be your employer who would be sued in the event of a claim for compensation as a result of negligence on your part. Therefore, regardless of what activities you undertake (including prescribing), your employer has vicarious liability for yourself and other staff and it is therefore their responsibility to indemnify its staff. Although it is up to the insurance provider (in the case of your practice the MDU) what they chose to charge the practice, you do not have to pay this yourself. Some insurance providers are providing insurance cover for one nurse prescriber per GP at no extra charge to the practice.
Indemnity insurance is included in RCN membership and covers you for all aspects of your role. However, this is primarily for nurses that work independently and are self employed and for cover outside of work.
Independent Nurse: Practical Prescribing
December 20, 2008 by admin
The Primary Care Trust (PCT) in which I work, has recently decided that general practices (GPs) should be responsible for producing their own Patient Group Directions (PGDs). Several GPs have suggested that they use Patient Specific Directions (PSDs) or practice protocols (as opposed to PGDs) to cover nurses for the administration of vaccines. Is this legal?
Practice protocols alone will not cover a nurse to supply and/or administer medicines (e.g. vaccines) to patients. A PSD or a PGD must be in place.
A PSD can be used to supply and/or administer medicines however; under a PSD medicines need to be prescribed for patients on a named patient basis by a registered prescriber. Therefore, if a list of patients to be vaccinated were produced, and signed off by a registered prescriber, this would be classified as a PSD. However, this would not seem practicable in the case of the administration of vaccines.
PGDs can be used to supply and/or administer a Prescription-only-Medicine (POM). In this instance nurses use their own assessment of patient need without necessarily referring back to a doctor for an individual prescription. Therefore, it would seem appropriate that the GP practices in question, adopt PGDs.
If the PCT is willing to share their PGDs, one way forward would be to get them signed off by the lead GP and a community pharmacist. There may however, be a cost involved for the practice as the pharmacist will need to be paid to review the PGD and draw up any new ones in the future.
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