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Prescribing in pregnancy
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moggy1

8 Posts

Posted:  12-Apr-2012 09:01
Whilst doing the NMP course I contacted the NMC for advice regarding prescribing in pregnancy. The answer came on 28th March.

nmc-uk.org

So to clarify we are not allowed to prescribe for pregnant women unless it is for a minor injury.

We are altering our behaviour as a result. I am surprised and disappointed in equal measure!
wendiesmith

48 Posts

Posted:  18-Apr-2012 07:52
Can I have a copy of the reply, I think this needs to widely published as the advice in the site doesn't match the reply
Regards
Wendie smith
wendiesmith

48 Posts

Posted:  18-Apr-2012 07:57
Sorry clicked link, how about thrush, uncomplicated UTI's and other minor illnesses? I am shocked that this advice has been taken literally. My stance would be that if all pregnancy related issues have been excluded then prescribing should be per BNF advice.
Any thoughts on this?
moggy1

8 Posts

Posted:  18-Apr-2012 08:05
I phoned them up and discussed at length. I asked about all the above and was told categorically not to prescribe. I have been nursing 31 years and been looking after pregnant women in Primary Care since 1990. I am quite aggrieved myself because I believe I am competent to deal with the above. I am not a midwife or a doctor so am by dint NOT allowed. Disappointed and dissatisfied too.
kangaroo

15 Posts

Posted:  18-Apr-2012 08:15
I too have read this guidance and find it disappointing and unhelpful. It seems to me that it could potentially deny pregnant women timely treatment for minor infections, or access to expert care in chronic disease. It is so like the NMC to say, on the one hand, you can prescribe within your competence and scope of practice, and then with the other to feel compelled to make a "rule" because they don't really trust us to do so! I did follow the link in the guidance to the link on maternal deaths, which is very interesting, and should be brought to the attention of all prescribers (medical and non-medical, but in many ways it seemed to reinforce the notion that delaying treatment could be harmful - so surely the answer is better education, not a blanket ban?
n/a

3 Posts

Posted:  18-Apr-2012 13:46
This is yet another barrier to nurses becoming independent practitioners. How can a Nurse Prascriber then cover nurse run services; e.g. walk in clinics? If we turn around and say we can see everyone but...that will put a lot of people off wanting to let nurses cover such services.
n/a

2 Posts

Posted:  18-Apr-2012 14:44
Our pregnant ladies are seen by the midwife or doctor and have no problems being seen. I deal with minor illness but do not see or prescribe for ladies who are pregnant - I AM a Midwife (not practicing as one) so am competent with pregnancy. I believe in holistic care, uncomplicated uti's can still have issues with the pregnancy. Our patients do not get denies any timely treatment.
kangaroo

15 Posts

Posted:  18-Apr-2012 16:16 Log in to like this post
what about asthma reviews for pregnant women? Many GPs are, on their own admission, deskilled in asthma and other chronic diseases. Am I now no longer allowed to prescribe a flu jab for a pregnant woman? I could go on, but is seems to me that this has been badly thought out.
J.R.H

3 Posts

Posted:  20-Apr-2012 14:42
I agree-this needs further clarification and if it is the case that we are not allowed to prescribe anything for pregnant women then we need to change things. Surely, it makes sense to have the most experienced person dealing with pregnant women and if the expert happens to be a nurse then the nurse should be the prescriber imo. Asthma is a very good example and my GPs have certainly become skilled in this area.
n/a

2 Posts

Posted:  25-Apr-2012 08:31
Giving flu jabs in pregnancy is covered under PGD!!. I am shocked at some of the comments on this issue. How can you be competent in prescribing in pregnancy if not midwifery trained? Did you cover pregnancy in your training? As for asthma reviews, any necessary alteration of medication can still be prescribed by gp, and should be, even if seen by nurse.
kangaroo

15 Posts

Posted:  25-Apr-2012 22:29 Log in to like this post
but surely if we get the GP to prescribe when we have seen and assessed the woman, we are going back to the subversive methods we had to employ before we became prescribers...and not taking responsibility for our own decisions.
mermaid

4 Posts

Posted:  26-Apr-2012 11:47 Log in to like this post
Prescribing for pregnant/breastfeeding women is heavily covered in the NMP course, it had to be included in my prescribing formulary which I submitted for the drugs which I prescribe and am fully aware of the effects and whether they can/cannot be taken during pregnancy. I would never prescribe anything I hadn't covered and I don't think you need to be a midwife to prescribe for these patients if you know what you are doing.
J.R.H

3 Posts

Posted:  29-Apr-2012 13:16
Lyn-the choice is usually between
a) midwife without asthma diploma
b) GP-becoming increasingly deskilled in asthma-that's why they refer to me
c) PN with asthma diploma who has studied pharmacology in pregancy.

It would obviously be perfect if the midwife has been trained in the management of asthma but are there enough of them and are they always willing and able to squeeze in pts exacerbating at a moments notice etc?
kangaroo

15 Posts

Posted:  04-May-2012 22:07
A couple of scenarios from this week....

I saw a pregnant woman who basically had a cold. I didn't prescribe anything for her, though did advise her that she was Ok to take paracetamol in pregnancy (she had been concerned about doing so). Should I have referred her to the doctor or midwife?

I also saw a young woman for confirmation of a planned pregnancy and referral to the midwife. While she was with me, I gave her a flu jab (I haven't signed the PGDs so did this as an independent prescriber) and some cream for her eczema. I also advised her to buy folic acid. I can't imagine it would have gone down too well if I had asked the duty dr to see her for these things! (though they would have done so as they are aware of the guidance). In fact I only remembered half way through that maybe I shouldn't be doing this!

I am interested in how others of you, both those who agree with the guidance and those who don't would have handled these two examples.
wendiesmith

48 Posts

Posted:  09-May-2012 08:16
Hi Kangaroo, my only concern is that if something went wrong (anaphylaxis, minor reaction, complaint) how would your employers react? If the NMC then heard the case how would you justify stepping outside guidance? The issue of prescribing in pregnancy has changed my practice in that I am no longer seeing pregnant ladies, which in my view makes their accessibility to appropriate care reduced. This is choice as my nursing practice is my livelihood and would be homeless without it.
As long as your employers would support you and you feel confident you would be able to justify your actions then I fully support you.
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