As supplementary prescribing devlops and more and more experienced nurses and pharmacists are working in teams and prescribing under CMP, this situation was bound to arise one day. How do you manage CMPs when more than one supplementary prescriber might prescribe for a patient?

At present we have tended to prescribe to those on a caseload but increasingly, there are times in order to ensure continuity of care is maintained, people are seen outside of this arrangement. They have CMPs of course but, if you have two or more potential supplementary precribers for a patient do you need two or more CMPs OR have relevant names of all concerned on ONE CMP?

I am sure some of you out there have crossed this bridge before and I'd appreciate your advice.

Lou

We get them agreed in the first instance in the patients electronic record by the GP. The protocols relate to any opiate substitute within BNF limits.
The Nurses part is agreed when we see the patient, doesn't matter which Nurse really.
You do have to have seen the patient and assessed them to be legally able to prescribe for them.

Agree with Simon. It is important that the supplementary prescriber sees the patient

This link:-

http://www.cmponline.info/Documents/A/asthma.pdf

is to an example for Asthma where it has 'Nurse 1' 'Nurse 2' 'Nurse 3' on the CMP. I am sure it will be the same for CDs.

The cmponline site has a lot of examples and, as it is run by the DoH, they are probably all legal.

Anyway, not long now before we will be able to prescribe independently.........

......................................

Legally, a CMP can have multiple independent prescribers and multiple supplementary prescribers, and sometimes that produces best care for the patient - for example, domiciliary outreach teams need a method of covering holidays and the patient suffers if no substitute can prescribe.

The key is that each SP must have assessed the patient themselves. Legally, this doesn't need to be face to face, but as a professional standard, it's hard to know how you could have the necessary assurance if you hadn't seen the patient.

It's also important that the patient knows all those involved in his care, so the practice of adding names after the patient signs is to be deprecated. If you add names, you should start again.

One reason for having multiple signatures rather than multiple CMPs is to ensure that all the prescribers are working to the same instructions; if A,B and C have CMPs saying X can have up to 16mg Subutex but D's CMP only says 12mg, that could pose problems.

Thanks everyone for your responses to my question. Things are much more clear.

Graham your point about different parameters for prescribing in relation to supplementary prescribers is something to think about, especially if one person is fairly newly qualified for example and less experienced perhaps. Thankfully the prescribers concerned are experienced practitioners and there need be no difference between them re prescribing.