BACCN position statement on non-medical prescribing in critical care

Background: The British Association of Critical Care Nurses (BACCN) published its first position statement on non-medical prescribing (NMP) in critical care in 2009 (Bray et al., Nurs Crit Care. 2009;14:224-234). Over the years, more nurses and other health care professionals have become non-medical prescribers, and the BACCN have thus revisited and updated the statement. Aim: To update the 2009 position statement on NMP in critical care to reflect contemporary guidance and practice. Study design: A working group was established following an expression of interest to BACCN members, and the original BACCN position statement and literature review were updated using key databases. An electronic questionnaire was developed by the working group to describe current NMP practises and the authorization and prescribing of blood and blood components. It was distributed via email to 1861 BACCN members and on BACCN social media in October and November 2021. Results: Two hundred and fifty nine health care professionals from the four countries of the United Kingdom completed the survey, and of these 136 (52.5%) respondents were BACCN members. One hundred and five (40.4%) of the respondents described themselves as non-medical prescribers, and of these, 57 (54.8%) were independent prescribers and 47 (45.2%) were supplementary and independent prescribers, with one respondent not revealing. The remaining 154 (59.4%) respondents were not registered as non-medical prescribers. Ninety-one (86.7%) of the respondents who were non-medical prescribers reported making prescribing decisions on every clinical shift, and 67 (64.4%) of these audited their prescribing practises. Of the 105 who described themselves as non-medical prescribers, 71 (67.6%) had been in their area of practice for more than 5 years before they became non-medical prescribers, with 3 (2.8%) being in the practise area for less than 1 year. All seven statements from Bray et al's (2009) position statement were revised and updated following the survey results and review of the literature search. Conclusions: The updated position statement is based upon new policy documents from a range of sources, including the Nursing and Midwifery Council, the Faculty of Intensive Care Medicine, the Royal College of Emergency Medicine and the Royal Pharmaceutical Society. It takes account of the adult critical care patient pathway before, during and after an admission to critical care. Updated Statements: 1. Non-medical prescribing (NMP) should only be implemented to improve the safety and quality of care for the critically ill or deteriorating patient. 2. The requirement for NMP needs to be determined locally by organizations, ensuring that the care of the critically ill and deteriorating patient is the main reason. 3. NMP must not be used as a substitute for unsafe medical practice or poor medical prescribing practice. 4. Non-medical prescribers must adhere to the current Royal Pharmaceutical Society's Prescribing Competency Framework and must be registered with their professional regulatory body. 5. Non-medical prescribers must audit and evaluate their practice as well as ensuring continuing professional development. 6. Non-medical prescribers in critical care must consider how their own professional codes of conduct, scope of practice, standards and guidelines impact their prescribing decisions 7. Non-medical prescribers must work collaboratively to ensure that continuity and transfer of care between care settings consider deprescribing and medicines reconciliation.