The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [520]
Box 13.4 Patient group directions
The legal definition of a patient group direction is ‘a written instruction for the supply and/or administration of a licensed medicine (or medicines) in an identified clinical situation signed by a doctor or dentist and a pharmacist’ (NPC 2009). It is drawn up locally by doctors, pharmacists and other appropriate professionals and must be approved by the employer, advised by the relevant professional advisory committee. It applies to groups of patients or other service users who may not be individually identified before presentation for treatment (DH 2004). The Health and Safety Commission (HSC) advised that the majority of medication ‘should be prescribed and administered on an individual patient specific basis’, but that it is appropriate to use PGDs for the supply and administration of medicines in situations where this offers an advantage for patient care (DH 2000). Shepherd suggests that this means ‘where medical staff are either inaccessible or unavailable’ (Shepherd 2002b, p. 44). The flowchart in Figure 13.1 aims to assist practitioners in deciding the appropriate system for the prescription, supply or administration of medicines. Using a PGD is not a form of prescribing.
Figure 13.1 Patient group directions (PGDs) flowchart. The diagram takes the practitioner through a logical process that aims to assist decision making. The majority of clinical care should still be provided on an individual, patient-specific basis.
The second report looked at the existing arrangements for prescribing, supply and administration of medicines and suggested the introduction of a new form of prescribing to be undertaken by non-medical health professionals (DH 2003a). Independent nurse prescribing was initially allowed from an extremely limited formulary (Shuttleworth 2005). It was then extended a number of times until finally, appropriately qualified nurses were allowed to prescribe from the whole British National Formulary.
Independent prescribing: this allows nurses who are registered as independent prescribers to prescribe any licensed medicine (and now unlicensed; DH 2009) for any medical condition (this also includes some controlled drugs) but only within their own level of experience and competence, and acting in accordance with the NMC Code (DH 2006, NMC 2008b). Only those who have undergone appropriate training and are registered with the NMC as an independent prescriber can prescribe (NMC 2006a). It must also be considered to be part of that nurse’s role.
Supplementary prescribing has been defined as: ‘A voluntary prescribing partnership between an independent prescriber and a supplementary prescriber to implement an agreed patient specific clinical management plan with the patient’s agreement’ (DH 2003a). Amendments to the Prescription Only Medicines Order and the NHS regulations allowed supplementary prescribing by suitably trained nurses from April 2003. Supplementary prescribers prescribe in partnership with a doctor or dentist (the independent prescriber) and are able to prescribe any medicine, including controlled drugs and unlicensed medicines that are listed in an agreed clinical management plan. The plan is drawn up with the patient’s agreement, following diagnosis of the patient by an independent prescriber and following consultation and agreement between the independent and supplementary prescribers.
(DH 2003a, pp. 6, 7)
The key principles that underpin supplementary prescribing are:
the importance of communication between prescribing partners
the need for access to shared patient records
the patient is treated as a partner in their care and is involved at all stages in decision making, including whether part of their care is delivered via supplementary prescribing (NPC 2003a).
Preparation for both independent nurse prescribing and supplementary prescribing is at least 26 days in length and must follow the standards set out in the