Child leaves specialist clinic without treatment due to prescribing restrictions
A specialist dietitian assessed a child with complex gastrointestinal problems and identified the treatment they needed, but prescribing restrictions meant they left clinic without medication.
Assessing the patient
Emma is an Advanced Clinical Practitioner working in a paediatric hospital within the speciality of gastroenterology. As part of this role, she runs a paediatric gastroenterology clinic.
A new patient was referred for assessment due to ongoing constipation. Multiple medical treatments had failed to improve their condition, and they had undergone several surgeries as a result. This eventually included surgery to create an opening in their abdomen so waste could leave the body into an external stoma bag. Despite this the patient continued to have problems.
A treatment plan without a prescription
Emma examined the patient and made an assessment of his needs. Using her clinical expertise, she decided on a course of treatment, which would include the reintroduction of laxatives.
“I took a complete history, performed a top to toe examination and developed a treatment plan.”
However, as Emma is a supplementary prescriber she was unable to prescribe medication to help him that day.
Supplementary prescribers need to have a clinical management plan set up for every patient they work with, listing exactly what medication they are allowed to be prescribed and signed off by an independent prescriber. As this was a new patient, a clinical management plan would now have to be created – and until it was, Emma could not prescribe for this patient.
Why treatment was delayed
“I was frustrated and the patient was very annoyed as they were unable to leave the appointment with appropriate medication.”
The patient would now have to continue to suffer discomfort while they waited for Emma to set up the appropriate paperwork – a process which can often take several days – or refer him back to his GP. In either case, the clinician signing off on his prescription would be relying on Emma’s assessment.
Impact on patients and clinicians
Despite leading the patient’s assessment and care planning, Emma was unable to provide the medication herself, and the patient left the appointment without treatment and disappointed.
How independent prescribing would have changed this case
Independent prescribing would have enabled Emma to provide timely treatment and complete the patient's care during the same appointment.
✅ The patient could have received treatment immediately
✅ No delay while a clinical management plan was created
✅ Reduced frustration for the patient and family
✅ Fewer administrative tasks for clinicians
✅ The same practitioner who assessed the patient could have completed their care
