The announcement this week by the MHRA about mixing medicines is good news for the professionals involved and for patients, and follows months of uncertainty about the legal situation around what has become common clinical practice in many areas, not just palliative care.
The planned changes to the law, due by the end of the year, will mean that:
- Doctors and dentists – who can already mix medicines themselves – will be able to direct others to mix (other than a pharmacist under existing legislative provisions, or by a person holding a manufacturer’s licence).
- Non-medical prescribers will also be able to mix medicines themselves – or direct others to mix, as above.
- The changes will apply to “all clinical areas where the mixing of medicines is accepted practice”.
- Nurse and pharmacist independent prescribers will be able to prescribe unlicensed medicines for their patients, on the same basis as doctors and supplementary prescribers.
The MHRA also says that its previous advice – that it will “not consider taking enforcement action against those prescribing and administering mixtures of licensed medicines in palliative care unless it would be in the public interest to do so”, with each case being considered individually – is now extended to cover other areas of clinical practice, to reflect the legal changes planned.
The ANP has said that there are many other areas of clinical practice where mixing medicines occurs and supported this approach (see here).
One example, says Matt Griffiths of the ANP and the Senior Nurse for Medicines Management at The University Hospitals of Leicester NHS Trust, is the mixing of nebuliser solutions: guidelines for asthma recommend mixing salbutamol with ipratropium bromide in some circumstances.
He added that, “This is great news for non-medical prescribers: they can now follow best practice and provide excellent care, without confusion over what is legal and what is not.” David Pruce, Director of Policy at the Royal Pharmaceutical Society of
Great Britain, said “We are pleased that ministers have accepted the recommendation of the Commission on Human Medicines. This will legalise the established clinical practice of mixing medicines in clinical areas and will allow nurse and pharmacist independent prescribers to prescribe unlicensed medicines. We believe that this settles a long standing anomaly that was never intended when nurse and pharmacist independent prescribing was introduced.”