Non medical prescribing in Scotland: implementation guide

Good Practice, and Ethical issues for all Nurse Independent Prescribers

Informing patients

78. Nurse independent prescribers must ensure that patients are aware that they are being treated by a non-medical practitioner and of the scope and limits of their prescribing. So there may be circumstances where the patient has to be referred on to another healthcare professional to access other aspects of their care.

79. Nurse independent prescribers must observe the NMC (2006) Practice Standard on 'consent'. ²⁴ See Practice Standard 5.

Responsibility for prescribing decisions

80. A nurse independent prescriber can only order a medicine for a patient whom s/he has assessed for care. In primary care, a nurse should only write prescriptions on a prescription pad bearing her/his own unique Prescribing Code and NMC registration number.

81. In the absence of the patient's original nurse prescriber, another nurse prescriber may issue a repeat prescription or order repeat doses following an assessment of need, and taking into consideration continuity of care. Accountability for the prescription rests with the nurse who has issued the prescription or orders the drugs, on each occasion.

82. The NMC (2006) ²⁵ provides useful guidance on repeat prescribing (see Practice Standard 19), and on remote prescribing via telephone, email, fax, video link or a website (see Practice Standard 20).

83. Nurse prescribers are professionally accountable for prescribing decisions including actions and omissions and cannot delegate this accountability to any other person ( NMC) 2006. ²⁶ See Practice Standard 2. If a nurse prescriber moves to another area of practice s/he must consider requirements of the new role and only ever prescribe within her/his level of experience and competence.

Prescribing for self, family and friends

84. Nurse independent prescribers must not prescribe any medicine for themselves. Neither should they prescribe a drug for anyone with whom they have a close personal or emotional relationship, other than in an exceptional circumstance. See NMC (2006) ²⁷ Practice Standard 11, and NMC²⁸ (2002), Clause 2.3.

Stock items

85. In primary care settings, prescriptions should not be written when an item has been administered to a patient using GP surgery or clinic stock items, because the cost of these items is already covered through the indirect reimbursement of practice expenses (see also paragraph 117).

Gifts and benefits

86. The advertising and promotion of medicines is strictly regulated under the Medicines (Advertising) Regulations 1994, and it is important that nurse independent prescribers, and indeed all health professionals, make their choice of medicinal product for their patients on the basis of evidence, clinical suitability and cost effectiveness alone.

87. Nurse independent prescribers must maintain a 'register of interests' within their personal portfolio and produce this on request if required for audit purposes. Local policies on maintaining a register of interests should also be adhered to.

88. As part of the promotion of a medicine or medicines, suppliers may provide inexpensive gifts and benefits, for example pens, diaries or mouse mats. Personal gifts are prohibited, and it is an offence to solicit or accept a prohibited gift or inducement. Companies may also offer hospitality at a professional or scientific meeting or at meetings held to promote medicines, but such hospitality should be reasonable in level and subordinate to the main purpose of the meeting. NHS organisations should have local policies for working with the pharmaceutical industry which cover gifts and benefits, as well as, for example, access to prescribers and sponsorship. Prescribers should familiarise themselves with these policies and are expected to abide by them.

89. The Medicines and Healthcare products Regulatory Agency ( MHRA) is responsible for enforcing the legislation on advertising and promotion of medicines. Any complaints about promotional practices should be referred to the MHRA or to the industry self-regulatory body, the Prescription Medicines Code of Practice Authority.

Guidance on Controlled Drugs

90. For guidelines on the prescription of Controlled Drugs, nurse independent prescribers should see Appendix 9 and refer to:

• NMC (2006) ²⁹ published guidance on prescribing controlled drugs. See Practice Standard 16
• 'A guide to good practice in the management of controlled drugs in primary care' - published by the National Prescribing Centre. See: www.npc.co.uk
• Department of Health guidance available at: www.dh.gov.uk
• The legal requirements for prescriptions for Schedule 2 and 3 Controlled Drugs summarised in the British National Formulary
• Scottish Executive Health Department Guidance HDL (2006) 27 available at: www.show.scot.nhs.uk