NON-MEDICAL PRESCRIBING IN A NEONATAL INTENSIVE CARE UNIT - 4 YEARS EXPERIENCE Mulholland P.J.1, Cochran D.2 1 Neonatal Pharmacist, 2 Neonatal Consultant, Southern General Hospital, Glasgow, UK
Supplementary prescribing (SP) allows nurses and pharmacists to
prescribe ongoing treatments following diagnosis by medical staff.
It is "a voluntary partnership between an independent
prescriber (IP) and a supplementary prescriber to implement an
agreed patient-specific clinical management plan (CMP) with the
patient's agreement". In the case of neonates this is with the
mother's consent. The hospital service needs pharmacists who can
utilise their prescribing skills within their current service to do
so, and demonstrate the patient care benefits.
Methods: SP was implemented in the NICU at the Southern General Hospital, Glasgow in March 2005. The legislation makes provision for the CMP to be electronic and we hold an electronic copy of a generic clinical management plan on the unit, with consent recorded in the patient notes.
The CMP covers parenteral nutrition, antibiotics, apnoea, chronic lung disease and reflux. Each treatment is backed with protocols. Unlicensed medicines can be, and are, included in the CMP.
Results: The pharmaceutical care of patients has improved, with more pharmacist involvement in producing medication plans for patients to allow for consistency of treatment during medical staff rotations.
Within SP the supplementary prescriber is responsible for working at all times within their clinical competence, consulting the independent prescriber as necessary. In line with this we have reviewed and amended the CMP on an annual basis.
The introduction of Non-Medical Independent Prescribing in 2006 has enabled the process to run more smoothly, although the large usage of unlicensed medicines in NICU1 has meant that a hybrid of SP and IP has had to be introduced.
Conclusion: Non-medical prescribing is intended to encourage a team approach to the care and management of patients and to make the best use of the skills of trained healthcare professionals. This team approach mirrors how we work in practice in the NICU and pharmacist prescribing is an important addition to the healthcare of premature infants.
Prescribing further integrates the pharmacist into the multidisciplinary team and helps to enhance the teaching role with junior medical staff. Medical and nursing staff have fully supported the development of the new role as it frees up time for the doctors to work elsewhere and enhances pharmacist patient contact.
The introduction of legislation to allow non-medical independent prescribers to prescribe unlicensed medicines in late 20092 will enable non-medical prescribers to prescribe without the delay required to set up a CMP. The hospital service needs pharmacists who can utilise their prescribing skills within their current service to do so, and demonstrate the patient care benefits.
References 1. Conroy, S., McIntyre J., Choonara, I. (1999) 'Unlicensed and off label drug use in neonates', Arch Dis Child Fetal Neonatal Ed; 80: F142-145. 2. MHRA Public consultation (MLX 356): Proposal for amendments to medicines legislation to allow mixing of medicines in palliative care outcome July 2009.