Unlike many other independent prescribers, I do not have a ward or clinic that I cover routinely but work in various locations in intermediate and secondary care. Recently, I provided cover for our off-site intermediate care unit for older people, which provides step-up and step-down beds for prevention of hospital admission and early hospital discharge, respectively. There is no doctor on site and the nurse prescriber who leads the unit is available for limited hours.
I found myself reflecting on the value I offer as an independent prescriber. On that particular week I reviewed a patient who was recovering from a fractured elbow and was complaining of pain. He was prescribed paracetamol “as required” and it was being administered infrequently. I prescribed it regularly and he reported a substantial improvement in 24 hours.
Another patient reported that the calcium supplement she was prescribed made her feel nauseous. She agreed to try a soluble formulation, which I prescribed, and she tolerated it well. Another patient was also complaining of nausea with no apparent cause — the nurses asked me to prescribe domperidone but I suggested that, since the doctor was visiting the unit that morning, the patient be examined to determine the cause of her nausea before I prescribed symptomatic treatment.
Finally, I was told by the night staff that a patient was given a dose of tramadol in the night for pain, which she did not tolerate. I requested that no more tramadol be given until review by the doctor and prescribed regular paracetamol in the meantime.
My prescribing activity is, by my own admission, modest, infrequent and uncomplicated. So does it live up to the aims of non-medical prescribing? Did it improve skill mix? Yes: prescribing allowed me to provide care to patients that would have had to wait for another healthcare professional. Did it improve access to care? Yes: patients received a timely service because I could prescribe. Did it improve access to services? Yes: I provided a service that was not available in the past.
On reflection, I don’t believe that my prescribing is groundbreaking, but I’m comfortable with my limitations and am satisfied that it benefits patients. Does my prescribing provide good value for money? I think indeed it does.
