Appendix 1: The Nurse Prescribers' Formulary - Springer LINK

Appendix 1: The Nurse Prescribers' Formulary

The Nurse Prescribers) Fonnulary (NPF) forms an appendix to the British National Fonnulary (BNF). The products that nurses may prescribe are taken from 12 chapters of the ENE The types of preparations that are included in the NPF are:

laxatives analgesics

• local anaesthetics • drugs for the mouth • drugs for the removal of earwax

drugs for threadworms drugs for scabies and head lice

e skin preparations • agents for disinfection and cleansing e wound management products

elastic hosiery urinary catheters and appliances

• stoma care products • appliances and reagents for diabetes • fertility and gynaecological products.

126

Appendix 2: Circumstances in which a nurse may prescribe

The NHS Executive HQ Nurse Prescribing Guidance April 1997 very clearly states, in Section 7, the circumstances in which nurses may prescribe. These are as follows:

Issues common to all nurse prescribers

7.1 Nurses qualified to prescribe cannot issue prescriptions on behalf of a practice nurse who is not a prescriber.

Prescriptions generated by a non-prescribing nurse must be presented to a GP to sign

7.2 Nurses can only write prescriptions on a prescription pad bearing their own unique identifier number.

7.3 A nurse prescription should generally provide treatment for no more than one calendar month. However, nurses will need to ensure that the prescription is cost effective and meets the clinical needs of the patient.

Patients requiring long term treatments will have their needs continually assessed and prescriptions issued should reflect assessed need. Only sufficient supplies should be prescribed to enable the fulfilment of the care plan) normally up to the reevaluation date.

7. 4 Nurse prescriptions must not be written when an item has been administered to a patient using surgery stock; the cost of these

127

128 NURSE PRESCRIBING

items is already covered through the indirect reimbursement of practice expenses/frost contracts respectively.

7.5 Nurses are not entitled to prescribe items which are not listed in the Secretary of State's list for nurse prescribing. This is published as Part XVIIB of the Drug Tariff and as an Appendix to the British National Formulary. Nurses may only prescribe in the manner in which they are set out in the prescribable list.

7.6 When a nurse becomes aware that the patient intends having a prescription dispensed by approaching an appliance contractor the nurse must ensure that the prescription does not contain medicinal preparations. Appliance contractors cannot dispense medicinal preparations.

7.7 Nurse prescribers may only issue prescriptions for the patients of the GP practices covered by the health authority or GP contracts with the Trust. Nurses should not prescribe for others such as visiting relatives unless temporary registration with such a doctor has been arranged.

7.8 Nurse prescribers must ensure that patients and clients are fully informed of the change in nursing responsibilities. Items available on nurse and GP prescription should be fully explained to ensure that there is no delay in obtaining supplies.

7.9 Practice Nurse with District Nurse or Health Visitor Qualifications

The practice nurse may prescribe in the GP surgery or in the home for the patients of the practice. The nurse should be mindful of any practice prescribing protocols and should only initiate a course of prescriptions after appropriately assessing the patient's needs.

7.10 The Department strongly advises that no more than six repeat prescriptions should be made, or six months elapse, whichever is the less, without reassessing the patient's needs.

7.11 The nurse may issue a repeat prescription on behalf of another nurse, provided that the other nurse is also registered as a nurse prescriber but the nurse must be sure

APPENDIX 2: CIRCUMSTANCES IN WHICH A NURSE MAY PRESCRIBE 129

that this is acceptable clinical practice because the clinical responsibility rests with the prescriber.

7.12 Items for dispensing on the practice nurse lilac form must only be those from the Secretary of State's list for nurse prescribers.

7.13 Items that are not in the Nurse Prescriber's List should not be entered on form FP10PN even if they are countersigned by a GP.

7.14 District Nurses and Health Visitors

District nurses and health visitors may prescribe m the surgery, the community clinic or in the home.

A district nurse who is qualified to prescribe may sign prescriptions for members of the district nursing team for patients on the caseload whom the district nurse has seen and whose treatment the nurse has initially assessed.

A prescribing district nurse may also sign a prescription when providing 'cover' for another prescribing district nurse who has originally seen the patient and assessed the treatment needed. It is important to note however, that whoever signs the prescription assumes responsibility and the clinical liability for it. In all cases, nurses must put themselves in a position to assess the necessity for, and appropriate choice of, drug, dressing or appliance before prescribing.

The nurse should be mindful of any prescribing protocols agreed within the GP practice relevant to the patient.

7.15 When a district nurse or health visitor who is qualified to prescribe is providing 'cover' for an absent colleague, who is also qualified to prescribe, the nurse providing cover may prescribe in their own right following a patient assessment and they may write a repeat prescription. Most community units have standards for reassessment periods and these may need to be reviewed in the light of nurse prescribing.

7.16 When a community district nurse or health visitor who works in a health clinic as cover for a practice nurse on


behalf of the GP, the prescriptions written by the community district nurse or health visitor cannot be charged to the practice budget. This is because the nurse is not directly employed by the GP. Arrangements must be made within the contract to ensure that the contract for these services covers such occasions and that the resources required to reflect these arrangements are built into the Trust's notional budget. This will ensure that the community nurse can prescribe and the expenditure is reflected against the Trust budget.

7.17 Items for dispensing on the DNjHV green form must only be those from the Secretary of State's list for nurse prescribers.

7.18 Items that require a GP signature should not be entered on this form even if they are countersigned by the GP. (NHS Executive HQ 1997, pp. 13-16)

It is the responsibility of all nurse prescribers to familiarise themselves with and to observe the above regulations regarding nurse prescribing at all times. This is in the interest of good patient/client care and of safe and effective clinical practice.

Index A accountability l()-30, 34

and autonomy 17, 18 a dynamic process 17-18 ethical perspectives 20--4 extension of 92, 96-7 individual 16, 17, 20 in law 24 nurse prescribing 18-19

addiction fear 83 adherence, see compliance advocacy 16-17 Afro-Caribbean health belief

system 84--6 age, and non-compliance 82-3 allergies

to medicinal additives 52-3 records of 53

aqueous cream emollient 60-1 assessment

diagnosis 33, 34 of medication/treatment 37 nursing knowledge and skills in

33--6 of patients and clients 31-2, 37

Association of the British Pharmaceutical Industry 59

asthma care 12 audit 42-3 Australia, quality use of medicines

43 Austria, financial incentives for

compliance with antenatal sessions 87

autonomy 21 and accountability 17, 18 increase in 104

B beneficence 21 BNF, see British National

Formulary Bolam v. Friern Hospital

Management Committee 25 Bolton, pilot sites in 4, 90, 105 British Association of Behavioural

Psychotherapy 109

131

British National Formulary (BNF) 53--4

bulletins, see drug information bulletins

c care

holistic approach 103 models of 32-3

case law 24 case studies 93-5, 95--6, 97-103 catheters, see urinary

catheterisation; urinary catheters and appliances

Children Act 1989 28 children, non-compliance 81-2 chlorpromazine 82 clinical audit 42-3 clinical decision-making 36-8 clinical nurse specialists 118-19 clinical supervision 43--4 Code of Professional Conduct

(UKCC) 17, 18, 19, 21, 29, 122

codes, professional 17, 18, 21 coercion (forced medication)

86-7 Committee on Safety of

Medicines (CSM) 59, 60 communication

inter-professional 11, 96, 97 nurse-patient, prescribing as

barrier to 113 community health care, current

nursing developments 118 community nurses 14

care framework 33 see also district nurses; practice

nurses community profiling 35 Community Psychiatric Nurses

Association 110 compliance

and cost of medication 82 and counselling 80, 86 dosing systems 64 ethnicity and 84--6, 88 evaluating 80


financial incentives for 87 improvement in 94--5 life-threatening disease and 83 overcompliance 78, 88 pharmacological markers 80 side-effects and 82 strategies for 86-7 see also non-compliance

confidence, and experience 34--5, 45

consent 27-9 informed 27 parental 28-9

constipation, case studies 94--5, 100-1

constraints, on nurse prescribing 11-12, 14

consultation styles 78-9 authoritarian 78 participatory 79 permissive 78-9 psychotherapeutic 79

Consumer Protection Act 1987 29

continuity of care 95-6 contract law 24 contracts, with patients 86 costs

awareness of 95 drug pricing 68-9 prescribed drugs 67-8 prescription charges 69 savings from generic prescribing

75 counselling, effect on compliance

80,86 criminal law 24 Crown Report 2, 9, 13, 14, 26,

93 Crown review 117, 119 Cumberlege Report 1-2

D Data Sheet Compendium, see

Summary of Product Characteristics

decision-making 36-8 demonstration sites, see pilot sites

deontology 23-4 diagnosis 33, 34 dialysis patients, non-compliance

83 Disposal of Unwanted Medicines

(DUMP) 74 district nurses 10

case studies 93-5, 95-6 circumstances in which they

may prescribe 129-30 experience at a pilot site 91-2,

93-6 products covered in NPF 91-2

Dobson, Frank 117, 120 doctors' assistants, role of

113-14 documentation

in clinical audit 46 see also records

dosing systems, individual 64 Drug and Therapeutics Bulletin 55 DrugData 55 drug information bulletins 54--5 drug pricing 68-9 drugs

addiction fears 83 administration standards 19 cautions 58 contraindications 58 costs 67-8 increasing numbers of 67 interactions 59 records 19 reference sources 53-6 reporting adverse reactions

59-60 selected list 69-70 side-effects 58-9 side-effects, and non-compliance

82 waste 74 see also medication; medicinal

products Drug Tariff 54, 61 drug testing, in prisons 80 DUMP (Disposal of Unwanted

Medicines) 7 4 duty to care, definition 25

E education and training 4--8,

120-2, 122-3 assessment strategies 7-8 health education 33-4, 37 learning outcomes 6 Open Learning Pack 4, 6-7,

11,22,121 postgraduate 7 4 practice nurses 12-13 qualifications necessary for

nurse prescribing 108 Steering Group 5 taught course 4, 6-7 Working Group 5-6

employers, vicarious liability 26 English National Board for

Nursing, Midwifery and Health Visiting (ENB) 4, 5 Open Learning Pack 4, 6-7,

11, 22, 121 ethics 20-4

deontology v. utilitarianism 23-4

ethical dilemmas 21, 22-3 ethical problems 21, 22-3 patients' interests 22

ethnicity, and compliance 84--6, 88

evaluation, see nursing evaluation evidence-based medicine 72-3 experience, and confidence 34--5,

45

F family law 24 financial incentives

for compliance 87 in prescribing 70-1

formularies 72-3 see also British National

Formulary; Nurse Prescribers' Formulary

France, attendance payments 87 the future 117-25

INDEX 133

G general practice, see primary

health care generic prescribing 51-2, 74--5

financial savings 75 of wound care products 104

Gillick competence test 28 group protocols 2, 118, 119-20 guidelines 72-3 Guidelines for Professional Practice

(UKCC), on consent 28

H head lice, case study 101-2 health belief systems, internalising

v. externalising 84--6 health education 33-4, 37 health maintenance, practice

nurses' role 115 health promotion 35, 96

role of nurses 9 health visitors 10

case studies 97-103 circumstances in which they

may prescribe 129-30 experience at a pilot site 91-2,

96-7, 103-4 redundancies 112 role, and prescribing 110-11

helpline, nurse-staffed 34

I immunisation, case study 97-9 indicative prescribing amounts

(IPAs) 70 information

for patients 40, 62-3 patients' forgetfulness 81

informed consent 27 insulin, human v. pig-derived 81 itching, case study 99-100

J job satisfaction 105, 106 justice 21, 24


K knowledge, see nursing knowledge

L labelling, medicines 63-4 law, see legislation legal implications 92 legislation

framework 1-3 and group protocols 119-20 responsibility and accountability

in law 24 liability

nurses' 26-7 product liability 29 vicarious 26

litigation, growth in 18 Luker, Professor Karen 122

M medication

assessing patient's 37 cost of, and non-compliance 82 disposal of 66, 7 4 fixed ratio combinations 86 forced 86-7 labelling 63-4 overmedication 78 self-regulation 87-8 Standards for the Administration

of Medicines (UKCC) 19 see also drugs; medicinal

products medicinal products

additives and excipients 52-3 generic v. branded 51-2 74-5 parallel imports 52 ' product selection 62 quantities to prescribe 60-1 see also drugs; medication

Medicinal Products: Prescription by Nurses Act 1992 3

medicines, see drugs; medication· medicinal products '

Medicines Control Agency 52 59 '

metabolite level measurement 80

models of care 32-3 definition 32

N National Health Service (Primary

Care) Act 1997 118 negligence 25--6 non-compliance 77-89

and age 82-3 children 81-2 dialysis patients 83 electronic monitoring devices

80 evidence of 79-80 fear of addiction 83 features of 81-3 medical perspective of 77 metabolite levels 80 non-presentation of

prescriptions 62 74 patient's rationale for 87-8 pill counting/dumping 79 self-regulation 87-8 strategies to overcome 86-7 waste 74 see also compliance

non-maleficence 21 non-steroidal anti-inflammatory

drugs, topical 70 NPF, see Nurse Prescribers'

Formulary nurse anaesthetists 112 nurse-patient communication

prescribing as barrier to 113 nurse practitioners 118-19 Nurse Prescribers' Formulary (NPF)

2,5,54 alternatives in 37-8 limitations 10 types of preparations included

m 126 use at a pilot site 91-2

Nurse Prescribing Guidance 7 8 10,65 ' ' circumstances in which nurses

may prescribe 127-30

nurses all qualified nurses to prescribe?

Ill, 113, 114 categories 107 grading scheme 110 health promotion role 9 individual responsibility for safe

practice 19-20 teaching role 9 training needs 13 see also community nurses;

district nurses; practice nurses; specialist practitioners

nursing evaluation 38-46 clinical audit 42-3 clinical supervision 43-4 a cyclical activity 38 documentation 46 outcome 40-l patienqclientsatisfaction 41-2 personal development 44-5 process 40 structure 39

nursing intervention 33-4 nursing knowledge

in assessment of patients and clients 33-6

needs for nurse prescribing 37 and nursing theory 36

nursing practice, changes in 16--17

0 Open Learning Pack 4, 6--7, ll,

22, 121 study areas 6

oral syringes 64 outcome evaluation 40-l overcompliance 78, 88 overmedication 78

p 'parking lot' phenomenon 79 patientadvocacy 16--17 patient/client satisfaction 41-2 Patient Package Inserts (PPis) 86 patients

contracts with 86

INDEX 135

information for 40, 62-3, 81 patients' interests 22

Patient's Charter 21 peer review 92-3 personal development profile

44-5 pharmaceutical companies 53,

68, 75 Pharmaceutical Price Regulation

Scheme (PPRS) 68-9 pharmacological markers 80 pill counting 79 'pill dumping' 79 pilot (demonstration) sites 3-4

Dr Saul and Partners 90 extension to 4, 105 media attention 90-l, 105 selection criteria 3

Post Graduate Education Allowance scheme 7 4

PPRS, see Pharmaceutical Price Regulation Scheme

practice nurses 10 health maintenance role 115 not all allowed to prescribe

108, 109, 115 training needs 12-13

practice profiling 35 prescribers

individual responsibilities 49 personallimitations 58 reference sources for 53-6

prescribing by all qualified nurses? Ill,

113, 114 external influences on 53, 75 financial incentives in 70-l generic 51-2, 74--5 good prescribing, aims of and

factors in 56--7 indicative prescribing amounts

(IPAs) 70 information and feedback 71-2 management of 67-76 practical difficulties in 104 as a practitioner skill lll-12 to prescribe or not? 56--8 product selection 62 queries about items 55-6


reservations about 123-4 suboptimal 56 as unifying or divisive force for

nursing? Ill, 114, 115 see also drugs

prescribing incidents 31-2 prescription analysis and cost

(PAc;f)reports 35,71-2 Prescription Pricing Authority

(PPA) 68, 7l prescriptions

charges for 69 contents 50-l costs 67-8 duplicate 65 legal requirements 50-l lost 65 non-presentation 62, 74 processing 68 quantities, specification of 51 quantities to prescribe 60-l recommendations 50-l repeat prescriptions 64-5, 73 security of 49-50 see also drugs

Primary Care: Delivering the Future (White Paper) 4

primary care groups 7l primary care prescribing bulletins

55 primary health care 8-ll

asthma care clinics 12 benefits of nurse prescribing in

9-10,14,93-6 current nursing developments

118 National Health Service

(Primary Care) Act 1997 118 process evaluation 40 product liability 29 professional development profile

44-5 professionalism, criteria for 17 professional standards practice

25-6 profiling, community and practice

35 protocols 2, 118, 119-20

Psychiatric Nurses Association 110

psychiatric nursing, solidarity issue l 09-l 0

Q qualifications necessary for nurse

prescribing 108

R records

of allergies 53 clinical audit documentation 46 difficulties with record-keeping

104 Standards for Records and Record

Keeping (UKCC) 19 reference sources 5 3-6 referral 36 reflection in practice 97 responsibilities 49-66

extension of 92 financial 49 in law 24 legal 49 personal 49 to prescribe or not? 56-8 prescription-writing 50-l see also prescribing; prescriptions

rights, of patients 21 Royal College ofNursing (RCN)

14

s Scope of Proftssional Practice

(UKCC) 19,26,29,45,122 self-regulation, and medication

87-8 sick role, after Parsons 77-8 side-effects 58-9

and non-compliance 82 Simms, Roger 2 specialist practitioners 107,

lll-12, 113-14, 115, 121 standards

professional standards practice 25-6

standard-setting 42 Standards for Records and Record

Keeping (UKCC) 19 Standards for the Administration

of Medicines (UKCC) 19 stockpiling, by patients 61, 94 stoma care products 54, 61 structure evaluation 39 Summary of Product Characteristics

(formerly Data Sheet Compendium) 58-9

supervised discharge 86-7 supervision, clinical 43-4 syringes, oral 64

T taught course 4, 6-7 teaching role of nurses 9 teamwork ll, 14 thrush, case study 102-3 time-saving 9, 10-ll, 93-4 tort 24 training, see education and

training treatment, assessing patient's 37

u United Kingdom Central Council

for Nursing, Midwifery and Health Visiting (UKCC) Code of Professional Conduct 17,

18, 19,21,29,122 educational standards 4-5 Guidelines for Professional Practice

28 learning outcomes 6 mandatory profile on personal

development 44

INDEX 137

Scope of Professional Practice 19, 26,29,45,122

Standards for Records and Record Keeping 19

Standards for the Administration of Medicines 19

statutory obligations 17 United States of America

financial incentives for patient compliance 87

savings on overheads 43 University of Liverpool 3-4 University of York 4 urinary catheterisation, case study

95-6 urinary catheters and appliances

54,61 utilitarianism 23-4

v vicarious liability 26 victim-blaming, in failure to

improve 81 A Vtsion for the Future, on clinical

supervision 43

w wound care dressings, generic

prescribing 104 wound management products

54,61

y 'yellow card scheme' 59-60

Appendix 1: The Nurse Prescribers' Formulary - Springer LINK

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