Independent Prescribing

1
Independent Prescribing

• Jane Haywood
• Shared Care Coordinator Islington PCT
• RGN, Dip Drug Dependence, MSc Addiction,
  Independent and Supplementary Nurse Prescriber

2
Independent Prescribing

• Doctors and Dentists
• Pharmacists (2 years post-reg experience)
• Nurses (3 years post-reg experience)
• Profession Training and Registration (NMC, RPSGP)

3
Medicines Matters (DoH) July, 2006

• Front-line patient-centred service
• Better use of practitioners skills
• Faster access to medicines

4
Independent Prescribing

• May 2006, Nurse Prescribing Extended Formulary
  discontinued
• Now can prescribe for any condition within scope
  of practice
• Drugs must be licensed
• Some CDs excluded (but not for Supplementary
  Prescribing with a CMP)

5
Training Issues

• Generic HEI training programmes-funded by SHAs
• 6 month course (26 days training and 12 days
  clinical practice)
• Medical supervisor

6
Controlled Drugs

• Nurses 13 CDs for specific conditions
  (palliative care, post-op and cardiac pain) and
  lower schedule drugs (containing codeine)
• Problems not for substance misuse!
• Pharmacists none at present

7
Independent Working

• Assessment, diagnosis and treatment decisions
• Competence and accountability
• Remote/independent working
• DANOS not enough
• Not suitable for complex conditions

8
Where it can go wrong

• Practice Nurse seconded to homeless service
• Prescribing DF118s to drug users (in huge
  quantities) for pain management
• Unaware of addiction-related issues

9
Where it can go well

• Working with hard to reach patient populations
• One-stop shop
• Clinic for female sex workers
• Addiction medication, family planning,
  antibiotics

10
Beyond CDs

• ALCOHOL vitamins, acute detox
• Withdrawal symptomatic prescribing
• Related conditions (wound care)
• Managing specific long-term conditions (asthma,
  depression), although not in isolation
• Vulnerable groups (sexworkers, homeless)

11
Clinical Governance and CPD

• Suitable medical mentor
• Enhanced training issues (therapeutic
  relationship, boundaries, safety)
• Nationally agreed guidelines
• Local support and supervision