The Home Office, the NMC and the NPC have all now provided further information about the legal changes affecting prescribing of controlled drugs by nurse and pharmacist independent prescribers, and about mixing medicines containing controlled drugs, which took effect on 23 April.
The Home Office has issued a circular, setting out the background and explaining the amendments, and the NPC has also issued a Controlled Drugs Alert (dated April 2012) and will be updating its FAQs soon. Briefly, they cover:
- new regulations that allow nurse and pharmacist independent prescribers to prescribe schedule 2-5 controlled drugs for any medical condition (but not to prescribe cocaine, diamorphine and dipipanone for the treatment of addiction), provided they prescribe within their clinical competence. This is the key change that nurse prescribers have been waiting for. Some of the other changes relate to this, for example about, requisitioning, possession and directing others to administer controlled drugs.
- nurse independent prescribers who work in substance misuse can now supply articles for administering or preparing controlled drugs.
- nurses and pharmacists may now supply, or offer to supply, diamorphine and morphine under a patient group direction (PGD) for, “the immediate, necessary treatment of sick or injured persons (excluding the treatment of addiction)”.
- mixing medicines: nurse and pharmacist independent prescribers can mix schedule 2-5 controlled drugs for administering to a patient and provide written directions for others to do so; supplementary prescribers may also do this under the terms of a clinical management plan.
The NPC stresses that nurse and pharmacist independent prescribers should ensure that they always prescribe only within their clinical competence, and “that they have up to date knowledge of the doses, side-effects, interactions, cautions and contraindications of the controlled drugs they intend to prescribe”, and says that organisational governance arrangements should be followed. This, of course, also applies to supplying and administering any medicine under PGDs, where nurses and pharmacists must also work within their clinical competence, ensure their knowledge is up to date and follow organisational and governance arrangements.
The NMC says that, “Nurses and midwives should in the first instance refer to local organisational governance arrangements, and standard operating procedures” and reminds nurses and midwives of the importance of practitioners working “within their own competence, in line with robust education, training and governance arrangements.” It also points out that Northern Ireland has yet to make these changes. The NMC has recently said that, in future, its primary focus will be core regulatory activities.