Expanding Authority to Prescribe Medications

The manufacture, quality, licensing, possession, sale, dispensing, prescribing and administration of drugs is regulated by a number of Federal, State and Territory laws.

The right to prescribe Schedule 4 and Schedule 8 drugs is governed by specific rules within State and Territory legislation and has traditionally been assigned to doctors, vestiary surgeons and dentists.

However, there is an increasing trend for other health practitioners to be authorised to prescribe albeit in limited circumstances to improve client access to healthcare.

Registered Nurses who meet the Nursing and Midwifery Board of Australia (NMBA) standard for Endorsement as a Nurse Practitioners have been authorised to prescribe under s 95 of the National Health Practitioner Regulation National Law in each jurisdiction (The National Law).

The scope of authority for prescribing is governed by state and territory legislation and varies between jurisdictions with respect to the nurse practitioners’ scope and context of practice, formulary’s and protocols and any hospital/health agency prescribing arrangements.

An endorsed nurse practitioner is also eligible to apply to the Pharmaceutical Benefits Scheme for a prescriber number and where granted must comply with the requirements for collaboration as stated in ss 5-7 of the Australian Government National Health (Collaborative arrangements for nurse practitioners) Determination, 201 (NMBA 2016).

The nurse practitioner may enter a collaborative arrangement with a health service team or a medical practitioner.

Registered nurses have also been able to obtain, supply and administer scheduled 2,3,4 and 8 medicines appropriate to their scope of practice in rural and isolated practice area since the 1st of July, 2010.

To be endorsed the RN must satisfactorily complete an approved program of study and must comply with all guidelines around accessing, supplying and administering scheduled medications as published by the NMBA.

The scope of this authority is defined through the poisons standard under s 52D of the Therapeutic Goods Act 1989 (Cth) as necessary for their practice in their area and as described and under the relevant drug therapy protocols, standing orders or local protocols that are compliant with State and Territory legislation (NMBA 2010).

Similarly, midwives who meet the NMBA registration standard for endorsement for scheduled medicines under s 94 of the National Law in each jurisdiction, have been able to prescribe schedule 2, 3, 4 and 8 medicines since the 30th October 2015.

An eligible midwife applying for endorsement to prescribe scheduled medicines can do so ether across the continuum of care or in a nominated context of practice approved by the NMBA - antenatal, postnatal, ante and post-natal.

The Nursing and Midwifery Board of Australia (NMBA) has developed draft guidelines to develop a new registration standard that will enable employed register nurses (not those in private practice) who have undertaken relevant education to make diagnostic and treatment decisions to prescribe within their scope of practice and level of competence and after a period of supervised practice.

The Endorsement for scheduled medicines standard will enable registered nurses to prescribe in partnership with a medical officer or nurse practitioner in accordance with a clinical governance framework for the quality use of medicines.

What is Prescribing in Partnership?

A prescribing in partnership model will see a registered nurse endorsed to prescribe scheduled 2,3,4 and 8 medicines in alignment with their competence level and scope of practice.

An endorsed registered nurse would have authority to obtain, possess, prescribe and supply scheduled in partnership with one or more authorised prescribers such as a medical officer or a nurse practitioner (NMBA 2018).

It is anticipated that an endorsed RN would prescribe medicines in line with legislation in their jurisdiction, standards and guidelines produced by the NMBA (including additional 10 hours of CPD in relation to prescribing, recency of practice) and local health provider policies and protocols.

References

• Nursing and Midwifery Board of Australia 2010, Registration Standard for Endorsement for Scheduled Medicines Registered Nurses (Rural and Isolated Practice),NMBA, viewed 18 December 2019, https://www.nursingmidwiferyboard.gov.au/Registration-Standards/Endorsement-for-scheduled-medicines.aspx
• Nursing and Midwifery Board of Australia 2016, Safety and Quality Guidelines for Nurse Practitioners, NMBA, viewed 18 December 2019, https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Codes-Guidelines/Safety-and-quality-guidelines-for-nurse-practitioners.aspx
• Nursing and Midwifery Board of Australia 2017, Registration Standard for Endorsement for Scheduled Medicines for Midwives, NMBA, viewed 18 December 2019, https://www.nursingmidwiferyboard.gov.au/Registration-Standards/Endorsement-for-scheduled-medicines.aspx
• Nursing and Midwifery Board of Australia 2018, Proposal For Registered Nurses Applying For and With the Endorsement for Scheduled Medicines – Prescribing in Partnership, NMBA (online).