P16 Pharmacist prescribing in neonatal intensive care units in the uk: an update
Authors: Peter Mulholland 
Published: January 2018

Aim

Following the amendment of the Misuse of Drugs Act in 2012,1 pharmacists have the same prescribing rights as medical prescribers. A survey in 20122 looked at how far this had been implemented in Neonatal Intensive Care Units (NICU) in the UK. This follow up survey looked at how much progress has been made in the past five years.

Method

Neonatal and Paediatric Pharmacist Group (NPPG) members working in NICU were invited to complete an electronic survey to determine the extent of prescribing being undertaken and what, if any, barriers were encountered for this service development.

Results

40 responses were received, with the majority (23) working in Level 3 units. Just over half (56%) were prescribers, with 53% being independent prescribers. This compares with 47% and 40% in 2012. Of those not currently qualified only 8% had no plans to undertake the course (27% in 2012).

The areas where pharmacists were prescribing were similar to 2012 with 70% prescribing in NICU or Special Care Baby Units (SCBU). As in 2012, 19% of those qualified were not prescribing.

The majority of respondents were sole pharmacists on their units (54%), with 34% having two pharmacists and one unit had 4 pharmacists (all prescribers)

Main medicines being prescribed were nutritional supplements (86%), Parenteral Nutrition (76%), antibiotics (76%), caffeine (67%) and reflux medication (62%). More pharmacists were prescribing controlled drugs (50%) and clinical trials medicines (12%), up from 5% and 2.5% respectively in 2012.

Improvement in safety was seen as a benefit of pharmacist prescribing, with quicker access to medicines for patients. Freeing up medical staff time, allowing teams to focus on diagnosis and stabilising sick babies, was also seen as a benefit. Pharmacist prescribers can demonstrate good prescribing practices and set an example for other prescribers, particularly junior medical staff and trainee Advanced Neonatal Nurse Practitioners (ANNP)

Pharmacists were generally seen as the most consistent presence on the unit and so are more aware of medication histories of patients, facilitating better discharge planning and communication with families regarding items such as unlicensed specials and prescribable feeds. Pharmacist’s knowledge of medicine formulations meant that they were more likely to consider if doses are measurable when prescribing

It was also felt that being a prescriber helped the pharmacist to integrate more into the multidisciplinary team.

Few barriers were reported, with medical and nursing staff supporting the process. The main barriers were pharmacy related: funding being prioritised to adult services and the need for a second pharmacist to clinically check the prescribing were reported.

Conclusion

Pharmacist prescribing has developed since the previous survey in 2012 with the process now embedded as routine practice in many units. Further support is required from pharmacy management to support this development.

References

The Misuse of Drugs (Amendment No.2) (England, Wales and Scotland) Regulations2012 SI No 973.

Mulholland P. Pharmacist prescribing in neonatal intensive care units in the UK. Arch Dis Child2013;98:e1. http://adc.bmj.com/cgi/content/abstract/98/6/e1-an?etoc