Hi All,

I currently work as a nurse prescriber for a CDT. I prescriber a range of medication from methadone and subutex to antidepressants, antipsychotics, hypnotics and Anxiolytics.I currently prescribe everything at present Supplementary and according to the CMP. However I am looking to start prescribing some of the medication inderpendantly and have become concerned regarding what medications outside of controled drugs a nurse can prescribe. I was under the impression that this included most antidepressants, antipsychotics and hynotics however from recent conversations with fellow prescribers from other trusts I believe this may not be the case. One Nurse stated that they were only allowed to prescribe from the choice of 2 antidepressants.
Any advice on this would be much appreciated.
Catherine

Hi Catherine,
I think what you are mentioning what some PCT's are doing and only allowing some Nurses to prescribe a limited number of drugs. It's nothing to do with the legalities, more an employment and maybe insurance issue.
http://www.dh.gov.uk/en/Healthcare/Medicinespharmacyand...rescribing/index.htm
The above link may be of use.
best wishes

Simon

Hi Catherine
I am actually undergoing the Prescribing course at this moment in time.. yes I should be going through my notes at this minute, but hey, real life gets in the way..
Unfortunately I am a Pharmacist,so that bit really stuck..
But Nurses can prescribe, independently, most anti physcotics etc, there are some controls on CDs, as we all know. But you can prescribe chlordiazepoxide and diazepams for alcohol withdrawal(I wont be able to(YET!!)
Its as Simon says.. to do with insurance, formulary etc.. CHALLENGE it...
I will be!!
You do need to be competent in that area, as I am sure you are aware
Good Luck
Claire

Simon is right, if you are an independent prescriber and recorded as such by the NMC the only restriction on your prescribing (apart from CDs for addiction) is your competency to diagnose the need and understand the medication you prescribe, including interactions, contra-indications and so on. The 'competency' is not set down, it is up to you to determine and account for when required, and I think this is the key area to be absolutely sure of. The 'opening up' of the BNF that took place in 2006 has not led to a rush of nurses prescribing a wide range of medications because they have limited themselves to their area of competence and gradually and carefully expanded it.

Your accountability is also to your employer as part of your contract, which may have tighter restrictions. This should be part of clinical governance and subject to review. Remember the purpose of non-medical prescribing is to allow the timely access to prescribed medication for those who need it. If something is stopping this access due to poor management of doctors time for example, this should be addressed before wheeling out the non-medics.

If there is a problem with patients getting medication, and you are competent in the area of practice, then this should be fed into your local clinical governance system to change contractual conditions.

Good luck and be careful out there!

I prescribe all the antidepressants and other medication for substance misuse independantly; I only use CMPs for methadone / subutex due to the legal framework which we hope will be changed!!

Whilst this can be seen as a bad thing, if you are a good and responsible prescriber, it need not be that bad. What some trusts do, which i endorse, is ask you list the drugs/groups of drugs that you will prescribe ie your own formulary. The list can be amended as necessary. This prevents the scenario where NMPs will add an item that someone has run out of that they really have no idea about. To give you an example I have come across a mental health NMP who wants to do 'repeat prescribing' to include medicines for a patient's physical health needs eg asthma. Then what happens is they have to take responsibility for ensuring if the same dose is needed and that all the appropriate monitoring is done. What happens if that patient, after receiving their prescription, has an asthma atttack and dies ? Can the NMP demonstrate clinical competence in that area - i think they would be on really dodgy ground.
This is what the trusts are trying to prevent happening.