Select Committee on Science and Technology Written Evidence

Memorandum by Matt Griffiths Senior Lecturer—Nurse Prescribing, School of Health Studies, Homerton College, Cambridge

  1.  The treatment of infectious disease has recently entered the role of prescribing nurses, with the extended formulary being implemented in April 2002. Further details of the Nurse Prescribers' Extended formulary may be found on the Department of health website.[75]

  2.  Oral antibacterials included and their indications considered suitable for nurse prescribing are as follows. Amoxicillin trihydrate (Lower Urinary Tract Infection—women), Nitrofurantoin (Lower Urinary Tract Infection—women), Trimethoprim (Lower Urinary Tract Infection—women), Flucloxacillin sodium (impetigo), Metronidazole (fungating malodorous tumours; Bacterial vaginosis), Doxycycline (acne), Minocycline (acne), Oxytetracycline dehydrate (acne), Tetracycline hydrochloride (acne).[76]

  3.  This formulary is extremely limiting especially with the associated indications.

  4.  Other specialities in Nursing were targeted for initial training in Prescribing from the Extended Nurses' Formulary, and would benefit from an extension of the indications for use of antibiotics.

  5.  Accident and Emergency is one such speciality, with many units now having Emergency Nurse practitioners, looking after patients presenting with minor injuries. Antibiotics are currently prescribed to patients by these nurses under a system called "Patient Group Directions". This means that nurses are able to "prescribe" and administer medications to certain groups of patients who fit stated criteria in the individual policy, which is drawn up locally within a trust.

  6.  These policies vary widely from hospital to hospital, and so does the education preparation behind them. Thus different nurses, with different educational preparation are able or unable to give different drugs to the same type of patient, dependant on which hospital the patient attends. Treatment is variable in a National Health Service—getting back to the old argument about a postcode lottery.

  7.  The educational preparation for Nurses to prescribe from the Extended formulary (a national qualification) includes education about the over use of antibacterials. I believe that we offer a safe educational preparation to nurses to prescribe, which is taught at level three (degree level) by senior pharmacists.

  8.  Nurses are thoroughly assessed to ensure their safety, by way of an exam—short answers and essay, OSCEs (Objective Structured Clinical Examinations), and students are required to keep a prescription log in a portfolio (which they develop to prove competency and progression). In line with the ENB guidelines.[77]

  9.  Another issue which I have come across, has been the fact that even with a Microbiology report (stating the type of infection and the sensitivity to antibacterials) surely the best type of evidence based practice. The Nurses' who have carried out the educational preparation and have a registered qualification in prescribing with the Nursing and Midwifery Council, are unable to write out a script for the appropriate antibiotic.

  10.  Nurses are very often the practitioners who instigate this type of investigation, by way of wound swab or other microbiology investigation. They are therefore the choice of practitioner to follow up the investigation, and see the patient through to the conclusion of the episode.

  11.  This provides the patient with a sense of continuity of care. An ideal which is well documented in the field of health, and also reduces the workload of the patients Doctor.

  12.  The Preface of the Nurse Prescribers Formulary[78], states that "the list of preparations from which nurse prescribers (with District nurse or health Visitor qualifications) may prescribe is reviewed constantly in light of comments from Nurse Prescribers and applications from Manufacturers. The Department of Health (DoH) and the MCA are putting in place separate arrangements for the Nurse prescribers' Extended Formulary".

  13.  These separate arrangements are not clear, and therefore need clarification from the DoH and the MCA.

October 2002

75 Back

76   Nurse Prescribing Formulary (NPF) 2002-03 British Medical Association, Royal Pharmaceutical Society of Great Britain in association with Community Practitioners' and Health Visitors Association and the Royal College of Nursing. Page N10. British Medical Association, London. Back

77   English National Board-for Nursing Midwifery and Health Visiting, Education Policy Letter 2001/01/TL September 2001. ( This organisation has now ceased to be, and has been amalgamated into the Nursing and Midwifery Council. Back

78   Nurse Prescribing Formulary (NPF) 2002-03 British Medical Association, Royal Pharmaceutical Society of Great Britain in association with Community Practitioners' and Health Visitors Association and The Royal College of Nursing. Preface, Page iv. British Medical Association, London. Back

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