Matt Griffiths

Independent and Supplementary Prescribing: Non-medical prescribing: an overview

In 1986, recommendations were made for nurses to take on the role of prescribing. The Cumberlege report, Neighbourhood nursing: a focus for care (Department of Health and Social Security (DHSS) 1986), examined the care given to clients in their homes by district nurses (DNs) and health visitors (HVs). It was identified that some very complicated procedures had arisen around prescribing in the community and that nurses were wasting their time requesting prescriptions from the general practitioner (GP) for such items as wound dressings and ointments. The report suggested that patient care could be improved and resources used more effectively if community nurses were able to prescribe as part of their everyday nursing practice, from a limited list of items and simple agents agreed by the DHSS. Following the publication of this report, the recommendations for prescribing and its implications were examined. An advisory group was set up by the Department of Health (DoH) to examine nurse prescribing (DoH 1989). Dr June Crown was the Chair of this group. The following is taken from the Crown report: Nurses in the community take a central role in caring for patients in their homes. Nurses are not, however, able to write prescriptions for the products that are needed for patient care, even when the nurse is effectively taking professional responsibility for some aspects of the management of the patient. However experienced or highly skilled in their own areas of practice, nurses must ask a doctor to write a prescription. It is well known that in practice a doctor often rubber stamps a prescribing decision taken by a nurse. […]

Medication Safety: Introduction to medication errors and medication safety

A medication safety incident is defined by the National Patient Safety Agency (NPSA) as: ‘any unintended or unexpected incident which could have or did lead to harm for one or more patients’ (NPSA, 2007:9). These incidents can occur at each stage of the process involved in the delivery of medicines to patients, i.e. prescribing (including transcribing or physician ordering), dispensing, preparation, administering and monitoring (NPSA, 2007). Medication incidents have been reported as accounting for 10%–20% of all Adverse Events (AE) (Department of Health (DoH), 2004), i.e. an event that causes an unintended injury to a patient that either prolongs hospitalization or produces disability (Karson & Bates, 1999). The impact of medication safety incidents on patient outcomes includes increased length of stay, disability and mortality (Vincent et al., 2001). Across the UK, about two and a half million medicines are prescribed across hospitals and the community every day (DoH, 2004) and an indicator of quality, adopted to demonstrate medication safety, is the incidence of medication errors (DoH, 2004). The Government has committed to reducing the incidents of medication errors in prescribed drugs by 40% (DoH, 2004). Between January 2005 and June 2006, 60 000 medication incidents were reported to the NPSA via the National Reporting and Learning System (NRLS) (NPSA, 2007). Although most medicine-related activity is carried out in the community, over 80% of the incidents reported to the NPSA were from the hospital setting. The majority of these incidents (over 80%) did not result in harm. Wrong dose, strength or frequency of medicine, omitted medicine and wrong medicine were errors that occurred most frequently and accounted for nearly 60% of all incidents reported. Ninety-two out of the 60 000 medication incidents reported to the NPSA resulted in severe harm or death and arose from errors involving the administration and prescribing of medicines. Medicines most frequently associated with these incidents included opioids, anticoagulants, anaesthetics, insulin, antibiotics, chemotherapy, anti-psychotics and infusion fluids. The two groups of patients associated with medication errors, and highlighted in the NPSA report, included patients with known allergies being given medicines to which they were allergic (notably antibiotics), and errors involving specific medicines and dose calculations in children up to 4 years old. Other important areas highlighted by the report included the high number of injectable medicines resulting in death and severe harm; risks associated with care transfer and the importance of accurate documentation; the availability and supply of certain medicines at the point they are required; medicines given outside a medicines ward round, or to those patients with specific needs. Chapter

Sharing our knowledge: Are there any plans to allow nurse prescribers to mentor trainees in the process?

There are more than 70,000 nurse prescribers in the UK, many of whom have years of experience that should be shared with trainee prescribers. In November, the General Pharmaceutical Council launched a consultation on whether pharmacist independent prescribers (PIPs) should be able to mentor trainee PIPs. This discussion, which closes on 1 February, should be expanded to our own and other professional groups, because we could all gain so much from each other.

Standards help to keep nurses and patients safe: The NMC is consulting on plans to withdraw its standards for medicines management

The proposed withdrawal of the standards for medicines management is potentially detrimental to nurses and patients. Medicines legislation is extremely complicated. The standards help practitioners understand what is legal and what is illegal, as well as legislation on licenced, off-licence and unlicensed medicines and the impact this could have on them.

Boarding school rules: I am considering working in a boarding school. Do you have any advice regarding medicines manangement?

Ofsted inspects and regulates services that care for children and young people, including boarding facilities. Medication management is an integral part of caring for children in boarding schools, and robust systems must be in place to pass inspection. These systems must cover how medicines are dispensed, administered and stored at the facility, risk assessments, identifying which pupils can manage their own medicines and the individual health needs of boarders, so that care plans can be put in place for children with specific needs.

Ruling out antibiotics: Overuse of antibiotics can lead to resistance. This is becoming a major problem worldwide, and we urgently need to change the way we prescribe and use them

Most upper respiratory tract infections are viral. As antibiotics are only effective if the infection is caused by bacteria, they are not recommended in most cases. However, prescribing for respiratory tract infections in primary care is not an exact science, and deciding whether an infection is viral or bacterial is often down to individual clinicians.

Should patients complete the course?: Update yourself on the recent debate on taking antibiotics

In a recent article in the British Medical Journal (BMJ), a group of experts including infectious disease specialists and microbiologists discussed whether patients should stop taking antibiotics when they feel better.

Beware of ‘lookalikes’: What can I do to ensure the safety of patients when administering medicines with similar packaging?

In 2014, health staff who were vaccinating children in rebel-held northern Syria accidentally administered a muscle relaxant, atracurium, to up to 75 children, killing 15 of them. An investigation found that the drug was given to the children instead of a solution used to mix measles vaccines because the packaging was similar.

Changing the drug rules: Allowing newly qualified nurses to prescribe from a limited formulary could offer safer access to medicines

As part of its overhaul of education, the Nursing and Midwifery Council is considering allowing newly qualified nurses to prescribe from a limited formulary. When I first heard this, I was concerned. I have pushed for nurse prescribing to be developed over the years, and was fearful of opening the floodgates to many more junior staff becoming prescribers.

Fair blame, not no blame: How can we improve medication error reporting?

All nurses have a professional responsibility to report medication errors, and patients must be made aware of any incident involving them. I have been involved in investigating medication errors, and emotions often run high for the patients and staff involved, but you should never try to hide an error. Not only is this dangerous for patients, it can have serious consequences for your career, as you may be reported to the Nursing and Midwifery Council and face a disciplinary panel.