Independent prescribing of controlled drugs: the current state of play
Since RCN members began raising issues around the independent prescribing of all controlled drugs (CDs) and also the use of patient group directions (PGDs) to administer CDs by those who are not qualified to prescribe, the RCN Professional Nursing Department has been lobbying the relevant organisations to demonstrate the worth of nurse prescribing.
For some 18 months Mike Hayward, Molly Courtenay and I have been stressing the benefits for patients that would come of allowing further independent prescribing of CDs and using PGDs for administering them in different scenarios.
So what have we achieved?
Currently, qualified extended independent nurse prescribers can independently prescribe certain Schedule 2 CDs only for certain condition such as cardiac pain, trauma, post-operative pain and palliative care. They can also prescribe other Schedule 4 and 5 CDs for other conditions. This must always be only within a nurse’s area of practice and, of course, within their competence.
The Department of Health has acknowledged the problems with restricting certain CDs from nurse prescribers and has publicly recognised nurse prescribing as a great success.
Nurses have rolled out this initiative responsibly and last year in England alone, around 760,000 items of CDs were prescribed by nurses as either independent or supplementary prescribers. The highest number of items included co-codamol (prescribed independently) and methadone (currently prescribed as a supplementary prescriber).
The DH, Home Office and Commission on Human Medicines were all supportive of a public consultation and the results of this consultation have also been extremely favourable to the new developments.
The legal foundation
To allow these changes to take place, two pieces of legislation need to change. The first is the Medicines Act, and the DH has set out their legislation in Parliament to amend the act, allowing nurses to prescribe all CDs.
Second is the Misuse of Drugs Act and we hope the Home Office will lay their legislation in Parliament within the next month or so. Again this needs to be amended to allow nurses to prescribe these extra CDs and for the nurses who use PGDs to be able to use the proposed changes.
Within the next four-to-six weeks we hope to hear the news that we have lobbied long and hard for – that qualified extended independent nurse prescribers will be able to prescribe, within their own competence, all controlled drugs that are currently prescribed by most doctors.
More changes in the pipeline
The other proposed changes to the legislation will affect PGDs and staff who use this method of supplying/administering CDs.
At present nurses and certain other registered health care professionals can only administer diamorphine to a patient with cardiac pain in an A&E or CCU. We hope this will be extended to allow morphine as well as diamorphine – also that the new legislation will remove the stated geographical location of A&E or CCU to allow for other areas such as pre-hospital care, and consider other scenarios where such opiates would benefit patient care, such as for trauma patients.
Will we get critics for these developments?
Of course we will, but we must remember that the changes that have allowed nurse prescribing to open up to the entire British National Formulary (BNF) have not developed overnight. As a profession, it has taken us over 20 years to get this far.
We have trained around 55,000 nurse prescribers, some 13,000 of them as independent and supplementary prescribers. Around 90 per cent of prescribers have been qualified for over 15 years.
Independent and supplementary prescribers nearly all have first degrees, masters or PhDs, alongside their own specialist qualifications within their speciality.
Nurse prescribing has been very well evaluated, with a positive response from most clinicians, nurses and patients.
And doctors do support us
For the minority of medical staff who have opposed nurse prescribing, we can always remind ourselves that over 13,000 nurses who have qualified with the independent/supplementary prescribing qualification have all been supported and passed by a medical mentor. The course itself is rigorous and the standards from the NMC are among the most demanding of any profession.
We too believe that patient safety is of the utmost importance.
And finally, for people who are just concerned about nurses prescribing CDs, we can of course demonstrate that we are already prescribing them safely - we are just changing the mechanism to improve on patient care.
- Professor Matt Griffiths: www.matt-griffiths.com