Nurse prescribers lack access to computer systems

Lack of access to computer-generated prescriptions is holding back nurse prescribing according to a report published this week.

An evaluation of extended formulary nurse prescribing by Southampton University found that the two factors that made nurse prescribing difficult were the limitations of the formulary and lack of computer-generated prescriptions.

The report, commissioned by the Department of Health, includes a survey of almost 250 nurse prescribers of which only 5% said they were able to prescribe using computer generated prescriptions. More than half of those surveyed considered that access to computerised prescriptions would improve their prescribing practice.

Barbara Stuttle, chair of the Association of Nurse Prescribers and community nursing adviser to Connecting for Health, said the issue was frustrating community nurses.

She told EHI Primary Care: “Nurse prescribing first starting in 1996/97 and this lack of access to computer-generated prescriptions is an insult to professional nurses. In my opinion this is what has stopped people from taking it on and running with it.”

Stuttle said she had been asked by Connecting for Health to undertake a project to investigate how many community nurses such as district nurses and health visitors were using handheld computers of which kind and then to look at how prescription software can be placed on these computers. Practice nurse prescribers have so far been held back by lack of action by the GP computer suppliers, she claimed.

She added: “There is some urgency to get this done and I think some of the problem has been that the companies have not been dealing with it quickly enough.”

However nurse prescribers working in EMIS practices should have access to computer-generated prescriptions soon according to the company which covers more than 50 per cent of practices in England. Rob Murgatroyd, development project manager for nurse prescribing software at

EMIS, said the software will be rolled out from next week for EMIS LV users. Practices with EMIS PCS already have the software. He added: "All EMIS LV users should begin to get it in the next week or so and it will then become a standard feature of the system.”

Dr Mike Robinson, medical director of InPracticeSystems, told EHI Primary Care that Vision has supported the recording of prescription items by nurse and supplementary prescribers for some time, but the functionality to support the printing of these prescriptions is currently in development and testing and is planned for release in the next few months.

”When released it will include support for the English, Welsh and Scottish requirements, “ he added.

The other leading GP supplier, iSOFT, did not offer a comment.

In Scotland nurse prescribers using GPASS already have access to computer-generated prescriptions according to the company.

A spokesman for GPASS, the system used by more than 80 per cent of practices in Scotland, said release 5.5 supports district nurse and health visitor prescribing and extended nurse prescribing which allows nurses to prescribe from a limited, nurse formulary of drugs. He said 5.5 has been released to all practices, although some have yet to carry out the upgrade.

He added that release 5.6, which have so far been sent to 500 practices with the rest to go in the next two weeks, supports full supplementary nurse prescribing, so that licensed nurse prescribers can prescribe onto appropriate prescribing stationery from the full drug dictionary. It also prints the nurse prescriber number.

However, Jane Macpherson, a nurse partner at a practice using GPASS 5.5 in Lanarkshire, said she had to log in as a clinician, use nurse computer prescription paper, score out the GP details on the bottom of the prescription and replace it with a stamp with her own details.

“It’s a nuisance because I am issuing about 200 prescriptions a day but there is no way I could go back to handwriting.” Macpherson said she believed the lack of access to computer generated prescriptions was holding back nurse prescribing.

She added: “I know a lot of nurses who have completed the course but haven’t bothered to do nurse prescribing because they can’t use the computer. A lot of them print off a prescription and then still have to stand outside the doctor’s room waiting to get it signed.”

The Nursing and Midwifery Council (NMC), the profession’s regulatory body had queried the legality of Macpherson’s method of using computer prescriptions but have now agreed that it is lawful. Guidance for nurses on nurse prescribing is being prepared by the NMC.