Non medical prescribing in Scotland: implementation guide

Dispensing

Dispensing means: to label from stock and supply a clinically appropriate medicine to a patient/client/carer, usually against a written prescription, for self-administration or administration by another professional, and to advise on safe and effective use. ³⁸

Supply is defined above. There is no legal distinction between 'dispense' and 'supply' although there are considerable differences in practice. The act of dispensing includes supply and also encompasses a number of other functions (e.g. checking the validity of the prescription, the appropriateness of the medicine for an individual patient, assembly of the product). In common usage 'dispense' is usually reserved to the activity of pharmacists and dispensing doctors. ³⁹

Nurses required to dispense in primary care

112. As stated within the NMC (2004) ⁴⁰ Guidelines for the Administration of Medicines, a nurse may be required to dispense 'under exceptional circumstances'. Where this is likely to occur, the nurse's employer should be aware of this practice.

The NMC (2006) ⁴¹ also provides guidance on dispensing. It states that 'dispensing is part of the remit of the pharmacy profession who undertake a clinical screen of prescriptions prior to the dispensing process by trained technicians and a final accuracy check either by a pharmacist or higher level pharmacy technician'.

113. Whilst there is no legal bar to nurse/midwife dispensing there must be in place a local policy agreed to endorse the registrant's actions. ⁴² The recipient of the medication will expect the same level of practice from a nurse or midwife as they would from a pharmacist.

114. As a registrant the nurse is accountable for her/his actions and should understand the medication s/he is dispensing, its therapeutic effect, correct dosage, side effects and contra-indications. The registrant should be able to inform the patient what they should expect when taking the medication and to whom any adverse reaction should be reported. Nurses should only dispense medication if they feel competent to do so, and in the knowledge that they are accountable for their actions. A record should be kept of the dispensing practice and, to comply with clinical governance, an audit trail should be present and visible. The same principles apply for all drugs whether they are prescription only medicines or pharmacy-level medicines.

115. The NMC recommends that nurses ensure they are covered for vicarious liability and seek appropriate indemnity insurance for this practice.

Prescribing and Dispensing

116. Nurse prescribers must ensure separation of prescribing and dispensing whenever possible, including within dispensing practices (see below). In exceptional circumstances, where nurses are involved in both prescribing and dispensing a patient/client's medication, a second suitably competent person should be involved in checking the accuracy of the medication provided. See Practice Standard 10. ⁴³

117. Where a stock supply of medication has been labelled and dispensed by a pharmacist and is then supplied by a nurse/midwife in an 'out-of-hours' or family planning situation this is not dispensing, but supplying.

Nurse prescribing in dispensing practices in primary care

118. Where a GP practice is a dispensing practice, prescriptions from nurse independent prescribers can be dispensed by the practice but only for the dispensing patients of that practice. Dispensing doctors cannot dispense prescriptions written by nurse and pharmacist independent prescribers for patients of other practices.

119. When submitting prescriptions to the PSD, dispensing practices should include them with their GP10 form count on their GP34 declaration and sort them as per existing instructions.

120. Reimbursement for nurse and midwife prescriptions can be claimed by dispensing doctors and payment for the prescriptions submitted will be made to the practice partnership.

121. Pharmacists are a useful source of help and advice to any prescriber, and the dispensing pharmacist will need to be sure that the prescriber has qualified as a nurse independent prescriber (see Appendix 6).

Dispensing by appliance contractors

122. When a nurse becomes aware that the patient intends to have a prescription dispensed by an appliance contractor, s/he must ensure that the prescription form does not also include medicinal preparations (appliance contractors cannot dispense medicinal preparations). Appliance contractors should follow the instructions on the Prescription Invoice - Form GP34B - when sorting prescription forms prior to sending them to the Practitioner Services for pricing. N.B. appliances should be on a separate prescription form to other medications.

Urgent dispensing

123. Occasionally a nurse prescription may need to be dispensed out of normal pharmacy opening hours. NHS Boards hold lists of pharmacies able to dispense in an emergency. Alternatively, information could be obtained through the NHS Board out-of-hours Centre or NHS 24. Also see paras 81 - 82.

Dispensing of items in England, Wales and Northern Ireland

124. Prescriptions written by nurse independent prescribers in Scotland will only be dispensable by pharmacists in England, Wales and Northern Ireland when the Administrations amend their pharmaceutical regulations, to permit them to be dispensed at NHS expense.

Dispensing items against nurse independent prescriber's prescription in hospital pharmacies

125. An up-to-date list of all hospital employed qualified nurse independent prescribers will need to be kept in the hospital pharmacy for staff to check the prescriber against the list. The same process will apply for in-patient, outpatient and discharge prescriptions.