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Patient safety in the hands of new prescribers

In November 2005, it was reported that nurses and pharmacists in England and Scotland are likely to be given increased powers to prescribe medicines. From Spring 2006, it is anticipated that nurses and pharmacists with special training will, in principle, be able to prescribe any licensed medicine with the exception of controlled drugs such as diamorphine.

Extended Formulary Nurse Prescribers have been trained since 2002 to prescribe from a restricted range of ‘prescription only’ medicines to treat, for example, certain infections and skin conditions. Experience so far has been encouraging but the new proposal represents a substantial expansion of scope.

The initial reaction from doctors' leaders, reported by the BBC, said they were “extremely concerned” at the move which raised “safety issues”. The British Medical Association commented that the “announcement raises patient safety issues and we are extremely concerned that the training provided is not to the five or six years training every doctor has undertaken”.

Robust clinical decision support systems

Whilst this raises some important questions, it also highlights opportunities for existing resources to be used more effectively. One aspect of this new move, which First DataBank Europe (FDBE) believes will contribute to its success, is the need for robust clinical decision support mechanisms. The more information available to all prescribing parties about the patient’s active and inactive problems, and the properties of their medications, the more realistic the proposal becomes.

The expansion of the pharmacological armamentarium, coupled with exponential growth of knowledge about drug actions and interactions has long outstripped the ability of any single professional to keep fully up to date and be sure of avoiding known problems.

Highly-trained professionals

One of the aims of expanding traditional prescribing roles is to enable GPs to focus on more complex cases, allowing both doctors and patients the luxury of more time together. This will be made easier, for example, by nurses with the ability to run diabetes and coronary heart disease clinics, and pharmacists with the capacity to prescribe for the local community, for example, controlling high blood pressure and diabetes. Patients will therefore have easier access to the medicines they need.

Consider the possible scenario for a patient who has a urinary tract infection. She wants to book an appointment at the local GP surgery to request some treatment. The GP’s appointments are booked up for the day. However, the patient is offered an appointment with the surgery nurse. The patient visits the nurse who confirms an infection and prescribes an antibiotic.

The prescription is checked against the patient’s record for other current medication and any ongoing health issues or allergies and sent ahead to the pharmacy to be dispensed to the patient the same day. The patient has received safe, prompt and appropriate care.

Information is the key

The sharing and standardisation of information will support all prescribers and of course, this is a key element of the NHS Connecting for Health’s National Programme for IT (NPfIT).

NPfIT promises a new era for NHS information management with the NHS National Care Records Service (NCRS) at its core. Upon the successful implementation of NCRS, summary patient records will be held in a centralised information repository and messaging system - the Spine. Electronic prescribing, already common in GP surgeries, combined with electronic transfer of prescriptions will both feed information to and interact with the NCRS.

NCRS accessed via the Spine will supply information to prescribers, such as test results, medication records, treatment history and details of which care providers have been involved in treating a patient. Access to a summary of patient records and the ability to communicate with other health professionals will enable clinicians in a variety of roles, including new prescribers, to ensure that patients get the best from their medicines.

Joined up healthcare system

Hugh McGavock, visiting professor of prescribing science at the University of Ulster, voiced his opinions on the role of the new prescribers in the September 2005 Pharmacy Journal's Prescribing & Medicines Management feature; “Nobody, whether doctor, pharmacist, or nurse, should be permitted to prescribe solo… my opinion… is that supplementary prescribing by pharmacists fulfils the requirements of diagnostic and pharmacological knowledge, provided there is sufficiently accurate and up-to-date record-keeping and regular exchange of opinions between the doctor and pharmacist.” He concluded: “Partnership is the way ahead, and is an important way of improving the safety and efficacy of medication.”

FDBE supports this concept of a ‘regular exchange’ of information between clinicians involved in the prescribing process. By sharing information, the value of clinical decision support can only increase, bringing benefits to all prescribers.

While debate continues about training issues and which medication will be prescribed by whom, focus should be given to the improved resources we can offer all prescribers. A joined up healthcare system and more extensive use of clinical decision support systems should be welcomed by physicians as well as nurses and pharmacists in their expanding roles.