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Nurse and pharmacist independent prescribing changes announced

Changes to Misuse of Drugs Regulations mean that appropriately qualified nurses and pharmacists will now be able to prescribe controlled drugs…

Changes to Misuse of Drugs Regulations mean that appropriately qualified nurses and pharmacists will now be able to prescribe controlled drugs like morphine, diamorphine and prescription strength co-codamol. The changes relating to prescribing and mixing of controlled drugs by nurse and pharmacist independent prescribers also apply to midwives who are registered as nurse independent prescribers.

The agreed changes to the Misuse of Drugs Regulations 2001 relating to nurse and pharmacist independent prescribing of controlled drugs (Misuse of Drugs (Amendment No.2) (England, Wales and Scotland) Regulations 2012 (Statutory Instrument 2012/973)) came into force on 23 April 2012 and are summarised below.

Nurse independent prescribing

Current restrictions are removed to enable nurse independent prescribers to prescribe any controlled drug listed in schedules 2-5 for any medical condition within their competence, except diamorphine, cocaine and dipipanone for the treatment of addiction (nurse independent prescribers are able to prescribe other controlled drugs for the treatment of addiction). Nurse independent prescribers are able to requisition controlled drugs and are authorised to possess, supply, offer to supply and administer the drugs they are able to prescribe. Persons acting in accordance with the directions of a nurse independent prescriber are authorised to administer any schedule 2-5 drugs that the nurse can prescribe.

Pharmacist independent prescribing

Pharmacist independent prescribers are able to prescribe any controlled drug listed in schedules 2-5 for any medical condition within their competence, except diamorphine, cocaine and dipipanone for the treatment of addiction (pharmacist independent prescribers are able to prescribe other controlled drugs for the treatment of addiction). Pharmacist independent prescribers are able to requisition controlled drugs and are authorised to supply or administer the drugs they are able to prescribe. The existing authorities for pharmacists to possess, supply  and offer to supply schedule 2-5 controlled drugs remain. Persons acting in accordance with the directions of a pharmacist independent prescriber are authorised to administer any schedule 2-5 drugs that the pharmacist can prescribe.

Mixing of medicines that include controlled drugs

Pharmacists already have authority to mix any drugs in schedules 2-5. Nurse and pharmacist independent prescribers, as well as supplementary prescribers acting in accordance with the terms of a clinical management plan for an individual patient, are authorised to mix any drugs listed in schedules 2-5 prior to administration. Persons acting in accordance with the written directions of a nurse or pharmacist independent prescriber or, a supplementary prescriber when acting in accordance with the terms of a clinical management plan, are authorised to mix drugs listed in schedules 2-5.

Patient Group Directions

Patient Group Directions (PGD) are not a form of prescribing, but these amendments to the Misuse of Drugs Regulations also make changes to the authorities that nurses and pharmacists possess when acting in accordance with a PGD. Nurses and pharmacists working under a PGD are now authorised to supply, or offer to supply, diamorphine and morphine where administration of such drugs is required for the immediate and necessary treatment of sick or injured persons (excluding the treatment of addiction). This removes the restrictions whereby a nurse could only supply diamorphine under a PGD for the treatment of cardiac pain in patients admitted to a coronary care unit or an accident and emergency department of a hospital. The existing authorities for registered health professionals working in accordance with a PGD to supply and/or administer all drugs in schedules 4 and 5 of the 2001 regulations remain.

Note: The changes relating to prescribing and mixing of controlled drugs by nurse and pharmacist independent prescribers also apply to midwives who are registered as nurse independent prescribers. The amendments relating to PGDs also apply to midwives who are registered nurses.

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