Non-medical prescribing in secondary care: more is needed

“When are the other night sisters going to do their prescribing course?” was the question asked of this orthopaedic night sister with a non-medical prescribing qualification working in a centre for elective orthopaedic surgery, by nursing colleagues who felt they were able to provide better care for their patients as a result of her prescribing. This interesting article describes an audit of the author’s prescribing practice and some of her experiences as a prescriber.

The plan for this prescriber had been that she would start by prescribing for patients on the close observation unit within the centre and then after three months to start prescribing for the rest of the centre, but in fact her skills were needed sooner than that by other wards.

An audit was conducted after four months using her prescribing diary, a list of drugs she was allowed to prescribe, annotated to indicate the number of times they were prescribed, and the Trust audit tool. This showed that her prescribing was readable, clear, correct and in line with local policy and guidelines. She was prescribing a mean of 5.4 times a night, with the most common items being analgesia and intravenous fluid The author comments that one issue was that she sometimes had to prescribe and administer medicines to a patient, so would ask another trained nurse to check and co-sign the prescription before administration. She points out also that it is appropriate not to prescribe in situations where the prescriber does not feel confident (an example was requests for night sedation from patients who had already had large amounts of morphine).

It is still unusual to find nurses prescribing in wards, although specialist nurses and nurse consultants are prescribing in hospitals: the author explains the rationale and benefits for introducing nurse prescribing in her particular setting, concluding that more non-medical prescribers are needed in secondary care.

Crew S. Non-medical prescribing in secondary care: an audit. Nurse Prescribing 2010; 8(10): 498-502.