Adverse Drug Effects: A Nursing Concern

Nurse administration and prescribing 237approach with independent prescribers who would diagnose andprescribe and dependent prescribers who would meet the needs ofpatients with a known diagnosis. The government is presentlyreviewing these recommendations.There is no provision at the moment in the nurse prescribinglegislation that allows RGNs without a district nurse, midwife orhealth visitor qualification to prescribe, nor does the legislation allowhospital nurses to do so. This has resulted in ‘the emplacement ofimaginative, interpretative and potentially unlawful practices withinhospitals, typified by the increased use of protocols – developed as ameans of circumventing the clear legal rules regulating who is anappropriate practitioner to prescribe’ (Elliott Pennels, 1997b). Theuse of protocols is based on an imaginative interpretation of section58 of the 1968 Medicines Act (Elliott Pennels, 1997c), which isendorsed in paragraphs 35 and 36 of Standards for the Administrationof Medicines (UKCC, 1992c). The Crown report on groupprotocols (DoH, 1998) recommended that the law be clarified, andset a new high standard for protocols.In order to comply as closely as possible with the current law, adrug protocol should be a detailed written document, as oral protocolsare not safe and should not be used. The protocol is a substitutefor a prescription, and so it must comply with all the details expectedof a prescription, i.e. it should identify all the drugs that can beconsidered for each patient, together with a clear description of thedosage, frequency of administration and route. It should also provideclinically relevant information on indications for use, contra-indicationsand side-effects, together with an indication of when to give tothe drug, when to withhold it, and when to refer to a doctor. Theprotocol should be designed for a specific clinical environment, itshould ideally be specific to an individual named nurse and usedonly by her, and it should be reviewed and updated at least yearly.The protocol should be formalized by being signed by all thoseinvolved including the doctor, nurse and hospital management.Finally, it must be remembered that a protocol must be under thecontrol of a doctor who has overall accountability for the protocol,whilst the nurse administering the drug should be suitably qualifiedand competent and has complete accountability for all actions sheundertakes while using the protocol.