Practical Prescribing
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?
To read the response to this question, click here.
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?
To read the response to this question, click here.
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.
To read the reponse to this question, click here.
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?
To read the reponse to this question, click here.
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.
To read the response to this question, click here.
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?
To read the response to this question, click here.
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.
To read the reponse to this question, click here.
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.
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
Categories
Recent Posts
- Professionalism and ethics
- Practice nurses and prescribing
- New CKS topics
- National approach pays off in Ireland
- CDs: Another question asked in Lords
- Patients ‘confident’ about nurse prescribing
- Push for non-medical prescribing in Wales
- Insulin safety guidance issued
- Prescribing book - July publication
- Pharmacist prescribers’ skills going unused
Tags
- Adrian Jones ANP conference BNF Carey Carey N CD CKS Clinical Knowledge Summaries controlled drugs COPD cosmetic treatments Courtenay Courtenay M CPD dermatology DH diabetes doctors generic substitution IN Independent Nurse independent prescribers Matt Griffiths mental health MHRA mixing medicines NICE NIP NMC non-medical prescribing NPC NPF Nurse prescribing nursing practice OTC PGD PGDs practice nurses Prescribing errors PSD Stenner Stenner K supplementary prescribers unlicensed medicines V150
