Nurse prescribing in the UK has grown significantly over the last decade. Legislative and policy reforms have encouraged and supported nurses to take on prescribing roles in both acute and community settings. Nurse prescribing in the UK is well established as a mainstream qualification with over 54,000 nurse and midwife prescribers across the UK. Prescribing for palliative care patients has resulted in faster access to symptom control medication and improved care.
From April 2012 non-medical prescribers (NMP) were able to prescribe controlled drugs within their competence and regularise the practice of mixing medicines that include controlled drugs.
Clinical Nurse Specialists are often working autonomously and are better positioned to respond quickly to patient’s needs, however it was obvious to our team that there was a lack of national standards and audit tools relating to non-medical prescribing in palliative care.
In our NMP group, we devised NMP prescribing standards with reference to existing, NMC guidelines. Twelve Standards were introduced which included areas such as holistic examination of patients symptoms, consideration of polypharmacy, patient concordance, competency of NMP to prescribe relevant drug, and communication with GP. This allowed the team to audit not only the process of prescribing but also the clinical relevance to ensure practice was safe but also effective.
One of the main challenges was the collection of data with eleven NMPs in the team covering a wide geographical area. The team devised a methodology to randomly select 96 prescriptions throughout the team to audit to the agreed standards. The conclusion from the audit highlighted despite some areas to improve upon, there was good evidence that the team prescribed safely, and the items prescribed were clinically relevant to the particular symptom to be controlled.
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