Prescribing of CDs? Not soon enough (Christine Dixon)

I work in an elective orthopaedic centre that admits 100 patients a week; these patients usually stay for no more than five days. A rota of consultants provides postoperative care.

Unusually for the NHS there are no junior doctors on the wards. There is an obvious role for the pharmacist prescriber to fill the “house officer” gap.

In February 2008 the Government began steps to add pharmacist independent prescribers to the list of those who can prescribe Controlled Drugs.

It was expected that the Home Office would enable this to come into force in the April of that year. On that basis, I started the prescribing course but, some three years later, that change has not materialised.

In February 2009 I wrote to the Home Office about this. I was assured that they would use their “best endeavours to complete the legislative process through Parliament in April” (2009). Their best endeavours have still produced nothing.

What is the impact of this? Most pharmacists on my course were working in hospitals, for instance in oncology and intensive care. Our choices of analgesia, sedation, etc, to prescribe are constrained severely.

Example 1

A new patient was on 10 medicines at home but none had been prescribed so I did this, including his digoxin and a warfarin reload. The item I could not legally prescribe was temazepam, which he had taken regularly for 20 years.

This was clinically the safest drug he was on, but can quickly cause withdrawal symptoms if not taken. I had to find a doctor, or nurse prescriber, for this one item.

 

Example 2

A patient on my ward had left the operating theatre in the morning with epidural analgesia. The catheter for this had fallen out and she was crying with pain. Clearly patient-controlled analgesia with IV morphine was needed — a regimen easy to prescribe using a pre-printed form. There were no nurse prescribers available (they are allowed to prescribe this).

A nurse had to take the charts upstairs to the high dependency unit and interrupt the doctor who was dealing with a sick patient.

 

I only undertook the personal commitment to train as an independent prescriber on the understanding that the law would permit me to prescribe the full range of drugs, on equal standing with nurse prescribers, by the time I qualified. In post-op orthopaedics it is important to maintain pre-op drug regimens, and to achieve good pain control — and I cannot do this fully until the law is changed.

Even if this change occurs fortuitously between my writing this piece and it being published, this will not remove the resentment and insult of having been left by the authorities with fewer prescribing rights than nurse prescribers for all this time.

If the change has still not occurred, then why not, and when?

Christine Dixon is principal pharmacist at the South West London Elective Orthopaedic Centre, Epsom and St Helier University Hospitals NHS Trust