Nurse Prescribing: whats the rush

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Nurse Prescribing whats the rush?

• Ian Hulatt
• Mental Health Advisor

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Well actually!!

• Cumberledge report on Community Nursing 1986
  envisioned a nurse with access to the full
  formulary
• So why the delay?

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A vision realised

• 1996 District Nurses/Health Visitors (6 POMs)
  (32K)
• 2002 Independent Expert Nurse Prescriber (250
  POMs)(6,100)
• 2003 Supplementary Prescriber (Entire Formulary
  subject to a Care Management Plan)(5,600)

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Progress has been achieved by a series of
incremental changes.

• Under the auspices of the Medicines Act 1968
• Amendments to Prescription Only
• Medicines
• 2003/4/5/6 Formulary Extensions

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Culminating in

• May 2006 saw nurses able to prescribe all
  licensed medicines (except controlled Drugs) for
  any condition in Eng/Scotland

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Why now?

• The Choice Agenda
• A nursing workforce moving beyond
• traditional boundaries
• New Ways of Working
• New roles

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Legal and ethical issues for nurses Regulation

• Nurse prescribers are regulated by the Nursing
  and Midwifery Council
• Their scheme of preparation is subject to a
  checklist of regulatory requirements for
  Approval/Re-approval and Monitoring (V300)
• Their practice is subject to the NMC code of
  professional conduct
• The NMC has existing guidelines for the
  administration of medicines

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Legal issues for nurses

• Accountability
• Liability for negligent advice
• Failure to follow a reasonable standard of care
  (Bolam test)
• Vicarious liability of employer

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Ethical issues for nurses

• Beneficence
• Non maleficence
• Exercise of professional autonomy
• Acknowledge the limits of competence (veracity)

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If 99.9 were good enough or Why governance
matters

• 2700 pieces of mail would be lost by the Royal
  Mail every hour
• 6200 ATM errors every hour
• 14 unsafe airplane landings every day
• One major plane crash every 18 days
• 2 babies given to the wrong parents every day

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Issues to consider

• Creative usage of nurse prescribing can be much
  more than a bolt on
• Lessons can be learned from PSI
• If prescription becomes normalised should it be
  followed by diagnosis?

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Scottish Nurse Prescribing Audit 2006 concluded
that

• Extending nurse prescribing responsibilities will
  mean
• Improved quality of services to patients without
  compromising safety
• It is easier for patients to get the medicines
  they need
• Patients will have increased choice in accessing
  medicines
• Better use of the skills of all health
  professionals
• More flexible team working in the NHS.

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Care to discuss?

• Ian Hulatt
• Mental Health Advisor
• Professional Nursing Department
• Room 401
• 20 Cavendish Square
• London W1G ORN
• ian.hulatt_at_rcn.org.uk