Non medical prescribing in Scotland: implementation guide

Medicines Prescribable under Nurse Independent Prescribing

Prescribing within competence (See also Appendices 4-8)

62. All nurse independent prescribers must work only within their own level of professional competence and expertise, and must seek advice and make appropriate referrals to other professionals with different expertise. Nurses are accountable for their own actions, and must be aware of the limits of their skills, knowledge and competence.

63. Nurses must act within Clause 6 of the NMC (2002) ²⁰ Code of Professional Conduct. All prescribing nurses should be aware of and follow the NMC (2006) Standards of Proficiency for nurse prescribers. ²¹

Controlled Drugs

64. Suitably qualified nurse independent prescribers can prescribe any licensed medicine (i.e. products with a UK marketing authorisation) for any medical condition, including some controlled drugs. Nurse independent prescribers are able to prescribe the list of controlled drugs at Appendix 9, solely for the medical conditions indicated. Local clinical governance systems need to be put in place to monitor and support prescribing generally, and specifically for controlled drugs (see paragraphs 66 - 73). Medicines management teams and pharmacy guidance are required to advise on national and local policies.

Prescribing medicines used outside the terms of their licence (off-label)

65. Nurse independent prescribers can prescribe medicines independently for use outside their licensed indications/ UK marketing authorisation (so called 'off-licence' or 'off-label'). See NMC (2006) ²² Practice Standard 18.

66. Nurse independent prescribers must however, accept clinical/legal responsibility for that prescribing, and should only prescribe off-licence/off-label where it is accepted clinical practice. A local policy for the use of off-licence medicines should be approved through mechanisms such as Drug and Therapeutic Committees. The prescriber should explain the situation to the patient/guardian, where possible, but where a patient is unable to agree to such treatment, the prescriber should act in accordance with best practice in the given situation and within the policy of the employing organisation.

Unlicensed medicines (products without a UK marketing authorisation)

67. You must not prescribe an unlicensed medicine as a nurse independent prescriber. See NMC (2006) ²³ Practice Standard 17 and Appendix 11.

Borderline Substances

68. All NHS prescribers will need to abide by any NHS terms of service under which they operate. For example, if operating under the new GMS, borderline substances may be prescribed but the prescription will need to be marked ' ACBS'. A list of ACBS (Advisory Committee on Borderline Substances) approved products and the circumstances under which they can be prescribed, can be found in the British National Formulary. Although this is a non-mandatory list, nurse independent prescribers should normally restrict their prescribing of borderline substances to items on the ACBS approved list. They should also work within the guidance of their employing organisation.

Appliances and dressings in the Scottish Drug Tariff

69. Nurse independent prescribers, in primary care, can also prescribe any appliances/dressings that are listed in the Scottish Drug Tariff. Nurses prescribing in secondary care are not restricted to prescribing appliances/dressings from the Tariff.