Extending Independent Nurse Prescribing within NHSScotland
ROLE OF THE PHARMACIST - ADVICE ON MEDICINES
Pharmacists are a useful source of help and advice to any prescriber, particularly on matters of pharmacology, drug usage and product selection. They will also know the costs, availability and pack sizes of prescribed items.
To enable pharmacists to check whether a nurse prescription handed in for dispensing is bona fide, all NHSScotland employers should keep a list of all nurse prescribers employed by them and the items that the nurse can prescribe. It is also recommended that a copy of the nurse's or midwife's signature is held by the employing authority and individuals should be prepared to provide specimen signatures to pharmacists, should that be required.
Community pharmacists will expect to see primary care nurse prescriptions on a GP10N; hospital-based nurse prescriptions on an HBPN. Nurses must not use other types of prescription form.
Nurse or midwife prescribers should be aware that pharmacists have legal and ethical obligations which mean they may need to contact prescribers - sometimes urgently - to confirm an aspect of the prescription, return it for amendment or even to refrain from dispensing it (for example if the prescription appears unsafe, inappropriate, or contains items which a nurse is not permitted to prescribe).
An up-to-date contact telephone number should be included (in the address box) on all prescriptions. See sample contained in Annex D.
SECURITY AND SAFE HANDLING OF PRESCRIPTION FORMS: GOOD PRACTICE
The security of nurse prescription forms is the responsibility of both the employing organisation and the nurse prescriber. It is advisable to hold only minimal stocks of the prescription forms. This reduces the number lost if there is a theft or break-in, and also helps keep prescription forms up to date.
The nurse employer should record the serial numbers of prescriptions received and subsequently issued to individual prescribers, surgeries, clinics, etc. For this type of 'stock control' record, there is no need to record every number in each pad - just the first and last numbers of each pad. Note that the prescription serial number is the first 10 numbers (these run in sequence), the final digit is a check digit (and does not run in sequence).
Local policy should be established regarding monitoring the use of prescription forms to deter the creation of fraudulent prescriptions (see paras 105 and 106 re monitoring prescribing). For example, if practicable, a Practice or Prescribing Manager may undertake, from time to time, a reconciliation between the number of prescriptions written during a session with the number of forms used by individual prescribers. Or more detailed records, such as a log of each patient prescribed for and the serial number of the prescription issued to them may be required.
The nurse prescriber should also keep records of the serial numbers of prescriptions issued to them. The first and last serial numbers of pads should be recorded. It is also good practice to record the number of the first remaining prescription form of an in-use pad at the end of the working day. Such steps will help to identify any prescriptions that are either lost or stolen overnight.
Blank prescription forms should not be pre-signed, to reduce the risk of misuse should they fall into the wrong hands. In addition, prescription forms should only be produced when needed, and never left unattended. Prescription forms should not be left on the desk but placed in a locked drawer. When out visiting, it is advisable for nurses to keep prescription pads in their bags - they should never be left in the car.
Best practice recommends that where possible, nurses (especially those working on a sessional or part-time basis) should return all unused forms to stock at the end of the session or day. Prescriptions are less likely to be stolen from (locked) secure stationery cupboards than from desks, bags or cars.
Loss of prescription forms
Practitioner Services Division (PSD) should be contacted about prescriptions ordered, but not delivered, at the address in para 47: ie Moira Gardner, Room D091, Trinity Park House, South Trinity Road, Edinburgh EH5 3SE.
Practice, community and PMS pilot nurse prescribers should report the loss or theft to the Primary Care Manager at the PCT/NHS Board as soon as possible after the theft/loss is confirmed, giving details of the approximate number of scripts stolen, their identification numbers, and where and when they were lost or stolen. The nurse should inform the GP (where appropriate) as soon as he/she is aware of missing scripts.
The GP should ensure that the nurse prescriber has informed the Primary Care Trust by telephone, as soon as he/she is aware that any prescription forms have been stolen from the nurse in his/her team.
The Primary Care Manager should notify the Fraud Liaison Officer (FLO) at the PCT who should notify the local pharmacists and decide upon any necessary action to minimise the abuse of the forms. The FLO should notify the Practitioner Services Fraud Investigation Unit who will maintain a database of lost/stolen prescription forms.
Following the reported loss of a prescription form the PCT/NHS Board will normally tell the prescriber to write and sign all scripts in a particular colour (usually green) for a period of 2 months. The PCT/NHS Board will inform all pharmacies in their area and adjacent PCTs/NHS Boards of the name and address of the prescriber concerned, the approximate number of scripts stolen and the period within which the prescriber will write in a specific colour. This will normally be put in writing within 24 hours with the exception of weekends.
In the event of a loss or suspected theft from any nurse, an Acute Trust-employed nurse should report this immediately to whoever issued the prescription forms (normally the hospital pharmacy) and the local fraud specialist at the Trust.
The nurse should give details of the number of scripts stolen, their serial numbers, and where and when they were stolen. Thereafter hospital-based prescribers should follow local instructions following the loss of theft of prescription forms - this may include writing and signing all scripts in a particular colour (usually green) for a period of 2 months.
It is the responsibility of the employer to ensure that prescription pads are retrieved from nurses or midwives who leave their employment for whatever reason. Prescription pads should be securely destroyed e.g. by shredding and treated as confidential waste. It is advisable to record first and last serial numbers of the pads destroyed. Failure to recover prescription forms may potentially incur a cost, as any item prescribed on forms after nurses have left employment would still be charged to the appropriate budget.