June 13, 2010 by admin
The Department of Health (DH) has now published guidance about the mixing of medicines before administration, following the recent legislative changes (see here for guidance and here for more information).
The National Prescribing Centre (NPC) has produced a resource with tools and advice about how to implement the guidance points (here).
The DH guidance points out that, “These changes apply not only to palliative care, but to all clinical areas where the mixing of medicines prior to administration is accepted practice and supported by the employer’s policies for the delivery of healthcare.” It reiterates the advice from the Medicines and Healthcare products Regulatory Agency - that it would not consider ‘enforcement action against those prescribing and administering mixtures of licensed medicines in clinical practice, unless it would be in the public interest to do.’ So, for controlled drugs (where the legislative changes do not yet apply) existing good practice arrangements should continue.
The NPC resource provides advice on when medicines should be mixed, emphasising that this should only happen when it is essential to meet the needs of the patient, what issues the prescriber and the person doing the mixing should consider, what counts as instructions ‘in writing’ and much else. It suggests that organisations and practitioners should review systematically their current practice in the light of the new guidance, using this resource.
May 30, 2010 by admin
This article provides an account of the legal situation around independent nurse prescribing, unlicensed medicines, and mixing medicines (see here and here). Although it is the responsibility of the relevant health professional to decide if the person has needs that can only be met by an unlicensed medicine, the author believes it is likely that trusts and boards will seek to limit their use on cost grounds. At present, the situation about controlled drugs has not changed, so mixing products that would create an unlicensed controlled drug is not covered.
Have the legislative changes and recent guidance made any difference to your practice? Why not log into the members’ forum and share your experiences?
Griffith R and Tengnah C. Prescribing and administering unlicensed medicines. Br J Community Nursing 2010; 15(5): 232-235.
July 11, 2009 by admin
The announcement this week by the MHRA about mixing medicines is good news for the professionals involved and for patients, and follows months of uncertainty about the legal situation around what has become common clinical practice in many areas, not just palliative care.
The planned changes to the law, due by the end of the year, will mean that:
- Doctors and dentists - who can already mix medicines themselves - will be able to direct others to mix (other than a pharmacist under existing legislative provisions, or by a person holding a manufacturer’s licence).
- Non-medical prescribers will also be able to mix medicines themselves - or direct others to mix, as above.
- The changes will apply to “all clinical areas where the mixing of medicines is accepted practice”.
- Nurse and pharmacist independent prescribers will be able to prescribe unlicensed medicines for their patients, on the same basis as doctors and supplementary prescribers.
The MHRA also says that its previous advice - that it will “not consider taking enforcement action against those prescribing and administering mixtures of licensed medicines in palliative care unless it would be in the public interest to do so”, with each case being considered individually - is now extended to cover other areas of clinical practice, to reflect the legal changes planned.
The ANP has said that there are many other areas of clinical practice where mixing medicines occurs and supported this approach (see here).
One example, says Matt Griffiths of the ANP and the Senior Nurse for Medicines Management at The University Hospitals of Leicester NHS Trust, is the mixing of nebuliser solutions: guidelines for asthma recommend mixing salbutamol with ipratropium bromide in some circumstances.
He added that, “This is great news for non-medical prescribers: they can now follow best practice and provide excellent care, without confusion over what is legal and what is not.” David Pruce, Director of Policy at the Royal Pharmaceutical Society of
Great Britain, said “We are pleased that ministers have accepted the recommendation of the Commission on Human Medicines. This will legalise the established clinical practice of mixing medicines in clinical areas and will allow nurse and pharmacist independent prescribers to prescribe unlicensed medicines. We believe that this settles a long standing anomaly that was never intended when nurse and pharmacist independent prescribing was introduced.”
July 8, 2009 by admin
Non-medical prescribers will be able to mix medicines legally - and direct others to do so - by the end of the year, under planned changes to the law announced yesterday by the MHRA. This will apply to any clinical area where mixing medicines is accepted practice. Nurse and pharmacist independent prescribers will also be able to prescribe unlicensed medicines for their patients.
The mixing of medicines has been a matter of huge concern for non-medical prescribers, and the ANP and other organisations have consistently lobbied for legislative changes to clarify the situation.
We will be covering this in more detail in the next few days but in the meantime, Matt Griffiths of the ANP, said “This is great news for non-medical prescribers: they can now follow best practice and provide excellent care, without confusion over what is legal and what is not.”
For the MHRA’s revised statement on medical and non-medical prescribing and mixing medicines in clinical practice click here.