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.
September 20, 2010 by admin
Updated advice on the use of Patient Group Directions (PGDs) and Patient-Specific Directions (PSDs) in general practice has been issued by the General Practitioners’ Committee (GPC) of the BMA. The GPC has clarified the advice because there were differences between its position and those of the RCN and the Nursing and Midwifery Council (NMC).
January 20, 2010 by admin
The National Prescribing Centre (NPC) has published an updated guide to Patient Group Directions (PGDs). It includes case studies and discussion of when to use PGDs and when prescribing is preferable.
July 6, 2009 by admin
Can medicines be supplied under patient group directions (PGDs) when the patient is absent? Yes, in exceptional circumstances, says the answer to a new frequently asked question on the PGD website here.
The legal framework and associated guidance does not say that the patient must be present, so they do not have to be, but the requirements for PGDs mean that an adequate assessment is needed. Only when the circumstances are exceptional, and the use of a PGD in the absence of the patient unavoidable, should this be done, and assessment could then include a telephone conversation with the patient or a discussion with a close relative.
A recent editorial in Practice Nursing (volume 20, issue 6, p267) highlights the inconsistent and complex system for developing PGDs for general practices, with many Primary Care Trusts (PCTs) no longer willing to undertake this role. The author argues that a simpler system is needed: the RCN has asked for PGDs to be addressed in the review of medicines legislation but what should practice nurses do in the meantime? As non-medical prescribing leads in Strategic Health Authorities (SHAs) have apparently been made aware of the situation, practice nurses could contact their non-medical prescribing lead if they are having trouble getting PGDs authorised.