This section features a regularly updated list of recently published articles relevant to nurse prescribing.

Abstracts of the papers are included and users are encouraged to submit their views about published papers through the feedback section.

Please note: In this section of the website we aim to cover articles on areas where nurses do prescribe. However, not all the treatments or appliances mentioned are prescribable by nurses. For that reason, nurses should check the up-to-date versions of the Nurse Prescribers’ Formulary for District Nurses and Health Visitors (NPF) and the Nurse Prescribers’ Extended Formulary (NPEF) and Drug tariff if they are in any doubt. Alternatively contact your Regional Nurse Prescribing Lead for clarification.

Click here to visit the 2001 archive of PGDs

Patient Group Directions (PGDs)
Click on the article title below to read the summaries. 

• Doubts over PGD necessity
• PGDs and the law
• Practice nurses may be prescribing outside the law

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• PGDs and the law

Spyropoulos A. Nursing Times Plus 2002; 98(9): 48.

This article explains the legal basis of patient group directions and points out the potential they offer.

The introduction of a new statutory instrument in August 2000 allowed the supply or administration of medicines under protocols to patients who may not have been individually identified before presenting for treatment. The author says that PGDs will allow the right treatment to be instigated by the right professional at the right time. If practitioners work within PGDs and their professional code, there is little likelihood of legal action, and nurses should seize the opportunity to improve their practice in this way.

The legislation sets out explicitly the information that must be included in a PGD. It should be drawn up by a group including a doctor, a pharmacist, and someone representing any professional group that will be expected to use it. Various professions including nurses are covered by the statutory instrument but anyone supplying or administering a medicine under a PGD must be specifically authorized to do so.

Website: Nursing Times

• Practice nurses may be prescribing outside the law

Jones RCM et al. The role of the practice nurse in the management of asthma. Primary Care Respiratory Journal 2001; 10(4): 109-111.

Practice nurses diagnosing and managing asthma are performing many duties previously undertaken by GPs, according to a survey of 179 respiratory nurses in Cornwall and Devon. Some may be undertaking prescribing that would be impossible to defend legally and professionally.

The nurses had all been identified as the practice nurse with prime responsibility for asthma management. They were initiating a range of treatments without consulting a doctor and displayed high levels of confidence in these activities. More than half were initiating treatment, without consulting a doctor, with inhaled bronchodilators, long-acting bronchodilators, and inhaled steroids. A small minority were initiating treatment with theophyllines and anti-leukotrienes and 15% were initiating treatment with oral steroids. About 80% of those performing asthma duties had received formal training but, surprisingly, there seemed to be no association between training and initiating treatment.

Many of the practice nurses were arranging for prescriptions to be signed without discussion with the GP. The authors point out that in the case of the 20% without formal training, and those who have not updated their training recently, they and their delegating GP could be vulnerable to criticism both from the professional bodies and from a court of law. The present NPF does not include any asthma medication. Nurse-initiated prescribing should only occur under clear and agreed shared care protocols. [back]

Website: www.gpiag-asthma.org
 

• Doubts over PGD necessity

Richards S. Editorial. Are you practising legally? Practice Nurse 2002; 24(9): 17

The question of whether PGDs are always necessary if a formal protocol is in place is raised in this article by the chair of the Practice Nurse Association. The advice given to the BMA’s General Practitioner Committee is apparently that for independent contractor GPs and their practice nurse colleagues, patients are individually identified before presentation, in that they are registered with the GP: there is therefore no requirement to sign up to a PGD. The view of RCN lawyers is also that a formal protocol will suffice.

Lawyers for the Department of Health are also looking at the situation. Until it is clarified, the author suggests that practice nurses who are totally accountable for their practice should ensure that either a PGD or a robust protocol that meets patient safety needs is available before any drugs are supplied or administered without a written prescription or note.