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Non Medical Prescribing – Making a Difference
Karen Selwood
Advanced Nurse Practitioner
ANP’s in paediatric oncology
• 2 ANP’s in the late 1990’s
• Role development over the last 10 years
• Moved to a new unit
• 2 more ANP’s – wider service
Prescribing before the V300
• Group protocols– Written instruction for the supply and/ or
administration of medicines in an identified clinical situation.
PATIENT GROUP DIRECTION FOR NURSE PRESCRIBING OF ANTIBIOTICS IN ONCOLOGY11.2.1 AIMS OF TREATMENTTo treat neutropenic pyrexia following chemotherapy11.2.2 POLICY & PROCEDURE STATEMENTThe policy and procedures on the nurse or HCP administration of drugs according to prescribing exemptions are followed.11.2.3 ADDITIONAL CRITERIA FOR ROLE EXPANSIONOncology ANP or clinician11.2.4 DRUGSPiperacillin, Netilmicin, Ceftazidime, Amikacin, Teicoplanin.11.2.5 EXCEPTIONSSee guidelines relating to infection control in oncology. Patients allergic to one of the drugs or who have shown a previous ADR.11.2.6 CONTRAINDICATIONS, PRECAUTIONS OR SPECIAL CONSIDERATIONSConsider previous anti-infective therapy, renal function adverse reactions, and aminoglycoside levels.11.2.7 ASSESSMENT & ADMINISTRATION PROCEDURESRefer to guidelines on the use of anti-infectives in oncology. Document administration on the patient's nursing and medical notes.11.2.8 FOLLOW UPAll children will be assessed within 24 hours by a doctor.11.2.9 DRUG DETAILSAdministration and side effects - see guidelines.11.2.10 REFERENCESGuidelines on the use of anti-infectives in oncology
Prescribing before the V300
• Group protocols– Written instruction for the supply and/ or
administration of medicines in an identified clinical situation.
• Transcription on admission/ discharge
V300
• Issues– Adult orientated – Practical aspects from paediatric perspective
• A means to an end!
Prescribing in paediatrics
• Within scope of practice– Licensed medicines– Off label use
• Limitations of an Independent prescriber– The use of unlicensed medicines– Controlled drugs
Now in practice
• Independent Prescriber
• Clinical management plans– Partnership between independent/
supplementary prescriber– Can prescribe all medicines– Written care plan– Needs a diagnosis– Shared records
Name of Patient: Patient medication sensitivities/allergies:
Patient identification AH No: Date of birth:
Independent Prescriber(s):Dr. M. Caswell, Dr. R. Keenan, Dr. H. McDowell, Dr. B. Pizer, Dr L Howell
Supplementary Prescriber(s)Monica Hopkins, Michelle WrightKaren Selwood, Caroline Langford
Condition(s) to be treated: Leukaemia
Aim of treatmentTreatment of malignancy and relief of potential and actual side effects
Medicines that may be prescribed by SP:
IndicationTreatment of malignancy
PreparationChemotherapy/ steroids
Dose scheduleAs per current protocol
Specific indications for referral back to the IPIntolerance of treatment
Prevention and treatment of nausea and/ or vomiting
Antiemetics As per antiemetic guidelines/ medicines for children/ BNF
Uncontrolled nausea/ vomiting
Prevention and treatment of infections
Antibiotics/ antifungals/ antivirals, antiseptic products.
As per infective guidelines/ chemotherapy protocol
Septic shock, unremitting fever or infectious signs
Dehydration, fluid overload, abnormal electrolyte results, administration of drugs and fluid resuscitation
Fluid and electrolytes As per medicines for children / guidelines
Severe dehydration, unresponsive blood chemistry, unremitting hypovolaemia
GIT problems Laxatives, drugs for mouthcare, diarrhoea, gastritis.
As per guidelines Unresponsive to initial treatments
The relief of pain and discomfort
Analgesia including controlled drugs where appropriate
As per pain pathway/ medicines for children
Uncontrolled or increasing pain
Prevention and treatment of malnutrition
Nutritional supplements/ TPN
As per nutritional guidance and patient notes
Persistent weight loss
Maintenance of central venous line patency
Heparin flushes, urokinase As per CVL guidelines Persistent CVL blockage
Treatment and prevention of thrombus
Anticoagulation therapy As per warfarin/heparin guidelines
Persistent coagulopathy
Prevention and treatment of allergic reactions.
Antihistamines, corticosteroids
As per anaphylaxis guidelines/ antihistamine guidelines
Unresponsive to initial treatment
The prevention and treatment of skin breakdown or trauma. Promotion of wound healing.
Emollients, bacteriocidals, antiseptic and wound care dressings
As per skin care guidelines – wound management, dermatological and radiotherapy
Poor wound healing, deteriorating skin integrity
Now in practice
• Cover all areas of oncology unit
• Nurse led day care
• Leukaemia clinics
• Advantages for families– Holistic approach to care– Seen in more timely manner– See small team who know the child and their
history
Issues for the future
• Controlled drugs– Awaiting changes in legislation
• Unlicensed medicines
