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Extending Independent Nurse Prescribing within NHSScotland
THE PRESCRIPTION FORM
Obtaining prescription forms for nurse prescribers
NHS Board, PCT, practice or PMS pilot nurses must be registered with PCIG/ISD before prescription forms can be issued. Early notification of such details is very important in order that qualified nurses can begin utilising their new skills. Prescription pads of GP10N forms will be printed and sent out to Trusts after notification of a new nurse prescriber or newly qualified nurse prescriber. Subsequent supplies of GP10N forms will not automatically be sent out and should be re-ordered from the address below by the Trust.
Managers of hospital-based nurses should order HBPN forms, which will be supplied ready for hand stamping with nurse and hospital details. See para 52 for details of stamps required.
GP10N or HBPN prescription forms can be ordered from Practitioner Services Division (PSD) at the following address: Moira Gardner, Room D091, Trinity Park House, South Trinity Road, Edinburgh EH5 3SE. Prescriptions are normally sent to the address of the person who orders them (an alternative address can be specified for invoicing purposes). Checks are made to ensure that prescriptions are only supplied to bona-fide NHS organisations.
Non-NHS nurses
Non-NHS nurses cannot issue a NHS prescription i.e. one written on a form GP10N or HBPN for dispensing in an NHS community pharmacy, unless the organisation they work for has an arrangement or contract with an NHS provider (e.g. PCT) which allows the non-NHS organisation to use NHS community pharmacy dispensing services. The NHS provider should organise the supply of GP10N or HBPN prescription forms and obtain prescribers codes via PCIG in the usual way.
Prescription forms for nurses and midwives in primary care
Existing nurse prescribers will already have supplies of GP10N forms. These will be retained for existing 'limited formulary' nurse prescribers but will gradually be updated and replaced, so that by January 2003 limited formulary nurse prescribers will be using prescription forms pre-printed with the nurse's name and NMC number. The forms will also be annotated DISTRICT NURSE/HEALTH VISITOR PRESCRIBER.
When a nurse qualifies to prescribe from the extended formulary the employer will be provided with a GP10N prescription pad which will also be pre-printed, and annotated EXTENDED FORMULARY NURSE PRESCRIBER.
GP10N prescription forms will also be pre-printed with the nurse prescriber code. Nurses directly employed by Primary Care Trusts working across more than one GP practice and using multiple prescriber codes will be issued with a prescription pad pre-printed with the prescriber code for the practice within which the nurse issues the majority of their prescriptions. For the additional practices they will be issued with a pad without a pre-printed prescriber code and will be required to manually enter the relevant prescriber code as necessary.
Prescribing forms for hospital-based nurses and midwives
Nurse prescribers prescribing for hospital in- or out-patients may use three methods to prescribe:
Ward order - to be used for inpatients and discharge supplies only.
A prescription charge is not levied on in-patients.
Internal hospital prescription form - to be used for out-patients but only
in cases where the hospital pharmacy will dispense the prescription.
A prescription charge may be payable, unless the patient is exempt from prescription charges. For this reason, these types of form often resemble a GP10N prescription form
(NB internal hospital forms cannot be accepted for dispensing by community pharmacies).
HBPN prescription form,
where the prescription will be dispensed by a community pharmacist. (Note: nurse employers should establish a local policy on the use of HBPN prescription forms.)
HBPN prescription forms for hospital based nurses will not be pre-printed with nurse details. Each form should be stamped with the following items:
How to complete the prescription form
Detailed advice on prescription writing is contained in the Nurse Prescribers' Formulary and the British National Formulary (BNF).
Nurse and midwife prescribers who have taken the appropriate additional training, may prescribe items listed in the NPEF as published in Part 8C of the Scottish Drug Tariff and in the BNF. A dispensing contractor cannot legally dispense any other item prescribed by a nurse prescriber, and will not be reimbursed for any prescription containing such items.
The NPEF also contains information on the medical conditions or indications for which the items listed may be prescribed. Nurse and midwife prescribers are expected to prescribe in accordance with this information, which forms the basis for their educational preparation, and is the basis on which their employers have agreed to include prescribing in the responsibilities of the post.
The nurse prescriber should complete all the details on the front of the prescription form by writing clearly and legibly using an indelible pen (preferably black). The details required are:
the patient's title, forename, surname and address (including postcode)
age - NB it is a legal requirement to write the patient's age on the prescription when prescribing Prescription Only Medicines for a child under 12 years of age
CHI number, if known
nurse prescribers should use the product description as listed in the NPF/NPEF
for prescribing in primary care, the prescription should contain the name of the prescribed item, formulation, strength (if any) dosage and frequency, and quantity to be dispensed. The quantity prescribed should be appropriate to the patient's treatment needs, bearing in mind the need to avoid waste. Some medicines are only available in patient packs (or multiples thereof)
5, 6 and special containers
7 and the quantity contained should be prescribed, provided this is clinically and economically appropriate. The quantity should be specified for solid preparations as number of dose-units (number of tablets, capsules, lozenges, patches, etc.), for liquid measures in millilitres (mL or ml), for topical preparations by mass (grams, g) or volume (millilitres, ml). Terms such as '1 Pack' or '1 OP' should
not be used. Alternatively, for preparations to be given at a fixed dose and interval, the duration(s) of treatment can be given in place of quantity to be dispensed. Current best practice requires quantity to be clear on the prescription form.
in hospitals, prescriptions for in-patients should contain the name of the prescribed item, formulation, strength (if any), dosage and frequency. Where a defined length of treatment is required this should be stated. For outpatients and discharge prescriptions, the requirements are the same as those for primary/ community care, whilst recognising local policies for example on the length of treatment provided for outpatients and patients who were being discharged.
the names of medicines should be written clearly using approved generic titles (where available) as specified throughout the NPF and NPEF, and should not be abbreviated.
The only exception to this rule is for the prescribing of some dressings and appliances, and of compound or modified release medicines which have no approved non-proprietary name.
directions, if for use or application by the patient or carer, which should be in English and not abbreviated
where there is more than one item on a form, a line should be inserted between each item for clarity
unused space in the prescription area of the form should be blocked out with, for example, a diagonal line (to prevent subsequent fraudulent addition of extra items)
prescribers' signature and date
nurses should ensure the appropriate prescriber code is entered on the prescription form if this has not been pre-printed.
Nurses will need to ensure that the prescription is cost-effective and meets the Clinical needs of the patient. Patients requiring long-term treatments should have their clinical management and medical product needs regularly assessed and prescriptions issued should reflect assessed need. For patients with enduring conditions that require continuing medication, dressings or appliances, nurses will need to balance patient convenience with the need to avoid waste of NHS resources and of excessive quantities of medicines in the patients' home. Only sufficient supplies should be prescribed to enable the fulfilment of the care plan, normally up to the re-evaluation date. Current best practice indicates that regular prescriptions should be issued for up to 28 days.
Items that require a doctor's signature should not be entered on a nurse prescription even if the doctor countersigns them. A GP prescription must be used at all times when the GP's signature is required.
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