Non-medical prescribing by community Macmillan nurses
July 17, 2012 by admin
Cancer patients are getting faster access to treatment, and therefore symptom relief, as a result of non-medical prescribing, according to an account of its introduction into a community-based team of Macmillan clinical nurse specialists.
Two nurses in the team, which covers two Trusts, have qualified as independent prescribers, with others undergoing the training. They describe the now-familiar issues of communication and access to medical records. The team only has limited access to information held by GPs, such as pathology results, which means they have had to adopt a cautious approach to their prescribing; they hope to overcome some of these barriers with new systems, including better IT access.
Helen Coxon, Senior Community Macmillan Clinical Nurse Specialist, Nottingham CityCare Partnership, one of the authors of the article, told the ANP that the team has recently been given access to their patients’ electronic hospital records. This means they can get blood and other pathology results, helping them make informed and safe prescribing decisions. As for the controlled drugs changes, their employing organisation is carrying out a risk assessment, looking at risks to patients and staff, and assessing competencies, before making a decision.
CDs: prescribing, mixing and PGDs - more information now available
May 2, 2012 by admin
The Home Office, the NMC and the NPC have all now provided further information about the legal changes affecting prescribing of controlled drugs by nurse and pharmacist independent prescribers, and about mixing medicines containing controlled drugs, which took effect on 23 April.
The Home Office has issued a circular, setting out the background and explaining the amendments, and the NPC has also issued a Controlled Drugs Alert (dated April 2012) and will be updating its FAQs soon. Briefly, they cover:
- new regulations that allow nurse and pharmacist independent prescribers to prescribe schedule 2-5 controlled drugs for any medical condition (but not to prescribe cocaine, diamorphine and dipipanone for the treatment of addiction), provided they prescribe within their clinical competence. This is the key change that nurse prescribers have been waiting for. Some of the other changes relate to this, for example about, requisitioning, possession and directing others to administer controlled drugs.
- nurse independent prescribers who work in substance misuse can now supply articles for administering or preparing controlled drugs.
- nurses and pharmacists may now supply, or offer to supply, diamorphine and morphine under a patient group direction (PGD) for, “the immediate, necessary treatment of sick or injured persons (excluding the treatment of addiction)”.
- mixing medicines: nurse and pharmacist independent prescribers can mix schedule 2-5 controlled drugs for administering to a patient and provide written directions for others to do so; supplementary prescribers may also do this under the terms of a clinical management plan.
The NPC stresses that nurse and pharmacist independent prescribers should ensure that they always prescribe only within their clinical competence, and “that they have up to date knowledge of the doses, side-effects, interactions, cautions and contraindications of the controlled drugs they intend to prescribe”, and says that organisational governance arrangements should be followed. This, of course, also applies to supplying and administering any medicine under PGDs, where nurses and pharmacists must also work within their clinical competence, ensure their knowledge is up to date and follow organisational and governance arrangements.
The NMC says that, “Nurses and midwives should in the first instance refer to local organisational governance arrangements, and standard operating procedures” and reminds nurses and midwives of the importance of practitioners working “within their own competence, in line with robust education, training and governance arrangements.” It also points out that Northern Ireland has yet to make these changes. The NMC has recently said that, in future, its primary focus will be core regulatory activities.
23 April: CD changes come into effect
April 19, 2012 by admin
The long-awaited Statutory Instrument, needed to allow nurse and pharmacist independent prescribing of controlled drugs, and regularise the situation about mixing of medicines containing them, came into effect on 23 April 2012. The relevant changes to medicines legislation were made some years ago, but where controlled drugs are involved, Home Office legislation also needs updating and that has been a slow process under successive governments.
ANP Chair Dr Barbara Stuttle said, “At last, we have some excellent news. Patients will benefit as independent nurse prescribers will be able to provide the right care at the right time. Our thanks go to Baroness Cumberlege, Chris Beasley, Matt Griffiths and others, who have lobbied tirelessly over many years. At the ANP, we have also been lobbying, and are delighted that the frustrating wait to put in place something that will benefit patients, and which all parties agreed to years ago”.
The NMC said before the SI was passed that it would provide information about the changes once it had heard from the Department of Health. The situation is complex and advice from the regulators will be needed.
Home Office says CD changes expected in April
March 30, 2012 by admin
The changes on controlled drugs and independent prescribing can now be expected for April 2012, according to a written Parliamentary answer by Home Office minister James Brokenshire on 19 March 2012. He said that subject to his consideration, the necessary statutory instrument will be laid this month, with the changes taking effect in April.
The changes are expected to allow nurse and pharmacist non-medical prescribers to prescribe controlled drugs within their competence, and to regularise the practice of mixing medicines that include controlled drugs. Again…watch this space!
Nurse prescribers urged to sign controlled drugs e-petition
March 2, 2012 by admin
Nurse and pharmacist prescribers are being urged by ANP Chair Barbara Stuttle to sign an e-petition started by Professor Matt Griffiths, visiting professor of prescribing and medicines management at the University of the West of England. Professor Griffiths last month called on Andrew Lansley or David Cameron to intervene on this issue (see here), after it emerged that there is now no date set for the necessary amendments to be made to the Misuse of Drugs Act. Barbara Stuttle points out that these changes would lead to efficiency savings, so topical at the moment, as well as allowing qualified professionals to do their jobs properly.
No news is bad news on CD changes
January 26, 2012 by admin
After hopes were raised in the autumn (see here), the Home Office said on 9 January that it is still unable to provide a date for the long-awaited amendments to the Misuse of Drugs Act about independent prescribers and controlled drugs. The statement was made in correspondence with pharmacist prescriber Mark Hutton, who specialises in the management of chronic pain, in the East Midlands, and who has been pursuing the Home Office since 2008 about these amendments. He said,’It is ridiculous that I cannot prescribe a drug such as co-codamol yet a patient can purchase it in a pharmacy, and that as a qualified independent prescriber, I have to use supplementary prescribing to prescribe controlled drugs for patients. There is a shortage of pain consultants compared with the number of people with chronic pain, and the Home Office has given no reason for the delays in allowing non-medical prescribers to provide a better service to patients in pain.’
Matt Griffiths, visiting professor of prescribing and medicines management at the University of the West of England, who has also been urging the Home Office to act and highlighting the consequence of delay for some years, had this to say:
‘We have been promised these changes since 2008. As well as non-medical prescribers and their patients, this also affects nurses who want to mix medicines that include a controlled drug, as these amendments will be made at the same time. There are daily restrictions on my practice, where legislation has not kept up with the needs of the modern day health service. I can work as a visiting clinician on a daily basis. I can prescribe certain controlled drugs for palliative care patients, but I can’t carry them out to their homes unless it is on a named patient basis. Despite correspondence with Lord Henley, the Home Office minister responsible, and earlier promises from the Home Office, no date has been given, and the reasons behind the delays of nearly four years do not justify them. I believe that Secretary of State for Health Andrew Lansley, or Prime Minister David Cameron need to intervene as patient care is being affected on a daily basis’.
The statutory instrument was most recently promised for the end of October 2011 (see here) and will allow nurse and pharmacist prescribers to prescribe controlled drugs, within their competence, as well as making the promised changes on mixing medicines, where one or more is a controlled drug (see here).
ANP Chair Barbara Stuttle, who wrote to David Cameron about this issue last year, points out the anomaly involved in this long delay: ‘We keep being told about the £20 billion that needs to be saved in the NHS but something that could so easily address some efficiency concerns - but relies on Ministers - is constantly delayed! All the relevant bodies agree about these legislative changes: all it needs is the statutory instrument. If the government is serious about supporting clinicians to work efficiently and effectively, then I urge the Home Office to make these legislative changes urgently. This will enable nurses to do their job and look after patients by providing the right care at the right time.’
CD changes promised by end of October
October 20, 2011 by admin
The Home Office says it is finalising the long-planned regulatory changes to the Misuse of Drugs Regulations 2001 about controlled drugs (see here and here) and that the appropriate statutory instrument will be laid before parliament by the end of October. The changes would then be expected to come into effect in November.
The most recent parliamentary answer can be seen here and Fiona Culley of the NMC told the ANP at its annual meeting on 19 October that she had received similar assurances from the Home Office. Professor Matt Griffiths, who has been pursuing this matter over the years, has told the ANP that he, too, has been given this information. So…..watch this space!
DH consults on independent prescribing by podiatrists and physiotherapists
October 20, 2011 by admin
Should independent prescribing be extended to podiatrists and physiotherapists? The Department of Health and MHRA have published two consultations with these proposals, which can be found here. The deadline for responses to both is 8 December 2011.
The physiotherapist consultation proposes that physiotherapists can become independent prescribers and that physiotherapist independent prescribers should be able to mix medicines before administration, and direct others to do so, and to prescribe some specified controlled drugs independently. Those physiotherapists who are currently supplementary prescribers would have to undergo additional training to become independent prescribers. The proposals would need changes to the Misuse of Drugs Regulations 2001, as well as to the Medicines Act 1968. Independent prescribing of unlicensed medicines is not included in either document.
The consultation sets out the list of options, ranging from prescribing for any condition from the complete formulary, to prescribing for specified conditions from a specified formulary. The proposals for podiatrists are similar and both consultations give examples of areas where independent prescribing could be useful.
An analysis of the responses to last year’s engagement exercise (see here) is included in the consultations, and shows a lot of support for the option of prescribing for any condition from the full formulary (option 5). The most limited extension - independent prescribing for specified conditions from a specified formulary - found support with the BMA and the Royal College of Physicians, among others. The more limited versions are likely to require frequent revisions to the lists of conditions and/or formularies, a process that those nurses who were prescribing before the formulary was opened up will remember only too well!
Controlled drugs rules change: SI being prepared?
September 28, 2011 by admin
The latest news on the long-delayed but promised changes to the Misuse of Drugs Regulations is that the Home Office is said to be preparing a statutory instrument that will both allow non-medical prescribers to prescribe all controlled drugs within their competence and regularise the practice of mixing of medicines that include controlled drugs before administration. This information - although still no date - was given in a written answer to a question asked in the House of Commons by David Mowat MP which can be seen here for the discussion at last year’s ANP conference of this issue.
ANP urges Prime Minister to act on controlled drugs legislation
April 28, 2011 by admin
“We can therefore see no reason for continuing delay” in making the necessary changes to controlled drugs legislation (see here), writes ANP Chair Barbara Stuttle recently in a letter to the Prime Minister, David Cameron. She points out that all political parties and all professional groups support the changes and that, until they are implemented, very seriously ill people are facing delays in getting adequate pain relief. One consequence can be unnecessary hospital admission.
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