News

Nurses could be struck off for mixing drugs in syringe drivers

07-Jul-08

Nurses could be struck off for unwittingly breaching prescribing rules after an NHS watchdog said they were not qualified to mix drugs in syringe drivers, a practice that is common in palliative care.

Independent Nurse has learned that a West Midlands PCT sought advice from the Medicines Healthcare Regulatory Authority (MHRA) after becoming concerned that nurses may be breaking the law.

Mixing licensed drugs in a syringe driver creates a new, unlicensed product, the MHRA warned.

Although doctors are allowed to prescribe unlicensed drugs, this sits outside the current legal framework for non-medical prescribing.

An advanced nurse practitioner from the West Midlands who did not wish to be named said many district nurses were unaware of the restriction. Her PCT told community matrons, Macmillan nurses and nurse practitioners to seek consent from GPs before giving patients a combination of drugs with syringe drivers after the MHRA advice.

But she said: 'Macmillan nurses are supposed to be experts in palliative and terminal care, so making them go to the GP to get permission to prescribe is a backward step.'

Asked to clarify the legal position on mixing drugs in syringe drivers, the RCN did not respond. But a spokesman confirmed the union had not issued guidance on the matter.

Professor Matt Griffiths, former prescribing adviser for the RCN, said: 'Nurses cannot prescribe an unlicensed medicine to patients. If they do so, they are breaking the law and could face legal and professional action. There is certainly confusion out there over unlicensed drugs.'

To use syringe drivers in this way, nurses will have to use supplementary prescribing and develop a clinical management plan (CMP) that will need to be signed off by a GP, said Professor Griffiths.

CMPs can be developed up to one year in advance so it should not lead to any patients suffering delays in care, he added

Comment below and tell us what you think

Comments

Angela McGuinness

08/07/2008

The whole world has finally gone mad. No patient will be able to stay at home for terminal care as many times there is no easy access to a GP especially out of hours. It is unacceptable that patients might be left suffering all for the want of a signature.

Pippa Johannsen

09/07/2008

My understanding was nurse independent prescriber's could prescribe 'off label' or 'off licence' taking full clinical and professional responsibility for their prescribing if it was deemed to be best practice.

graeme catto

12/07/2008

This is going to prevent patient getting timely pain relief. This is just mad! Mad ! Mad!

Lee Jenkins

14/07/2008

It is common Knowledge that independant nurse prescribers cannot prescribe unliscenced medications. They CAN however prescribe liscenced medicines for an unliscenced use that is 'off label'. All of the drugs used in palliative care, especially the liverpool care pathway drugs, are liscensed drugs. It is accepted practice that many drugs used in palliative care are prescribed in an 'off label' fashion. If a nurse prescriber has decided that they are happy to prescribe drugs for off lable use in this way, then the question to ask is 1) are these drugs compatable in the syringe, or 2) are there likely interactions of these drugs. Once everything is taken into account, a risk/benefit assessment is done and the nurse should then be able to prescribe if they feel able to do so having full responsibility and taking full accountability for the prescribing decisions that they make. So, it would be useful to get some guidence quickly from both the NMC and RCN in order to inform us what the actual situation is. This kind of article in Independant Nurse is not particularly useful because it is scare mongering and leads to alterrations in practice that are to the detreiment of patients.

Gill Naylor

14/07/2008

How can you possibly be struck off for using the education skills and knowledge, and working within limitations as stated in Nursing Code of Conduct?

It's time to stop threatening these highly skilled nurses working in specialist areas. If they aren't qualified to make this decision a GP without a particular knowledge base won't be either

tim southwood

16/07/2008

[quote user="HCR"]

[/quote] Is this a devious ploy by dignity in dying to make terminal care in the community almost impossible ????

Christopher Malone

17/07/2008

I am currently undertaking the non-medical prescribing course.

I work in Out of Hours in Lincolnshire. Many of our patients are palliative and need syringe drivers either commencing or changing in the out of hours period. This is certainly very worrying.

1. Granted once qualified as a non-medical prescriber I could prescribe the individual drugs and administer one off doses. However, this is far from ideal for patients, particularly over a long bank holiday weekend as we cover a large rural area and might not be able to respond in a timely manner, to the palliative cases if we are on other visits, when the next stat dose is due.

2. It would be almost impossible to sort out CMPs for each and every palliative patient covered by our service due to the sheer numbers of patients, number of GP practices we cover, the number of non-medical prescribers that work in our service and would therefore need to sign a CMP for each patient, the distances we cover and the fact that we work when everyone else is not. Although we have good links with the surgeries and are informed when patients reach the palliative stage patients would, I fear, slip through the net and not have a CMP in place when needed.

3. Finally how are we affected if a GP (either the patient's own or one of on duty in the Out of Hours Service) prescribes the drug(s) and we or our community nursing colleagues add the drugs to the syringe driver?

I agree with the above comments that the world has gone mad and that palliative patients will not be able to be cared for effectively at home.

How does this fit in with the Governments plans mentioned this week in the news that palliative patients can choose where they want to die?

david price

21/07/2008

The GP in community cases prescribes the drugs and fills in The 'blue card'. The GP takes the ultimate responsibility and hence cases should always be discussed in this situation

Caryll Coats

22/07/2008

I do think the heading is very misleading and has in my experience already caused unnecessary patient suffering, because on more than one occasion district nurses refused to set up a syringe driver containing more than one drug, despite the fact that it was prescribed by a doctor.

It is also extremely inappropriate that patients will not receive the medications they need to relieve suffering at the end of life, when in fact there is adequate information and guidance in palliative care literature as to which drugs can be mixed in a syringe driver.

Nurse prescribers act within their field of competence and are always covered by a doctor's advice, and by best practice guidelines of their particular specialty- in this case, palliative care.

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