Barriers to treatment for patient with life-threatening condition
A dietitian caring for a critically unwell surgical patient had to seek approval from clinicians who openly acknowledged that she was the expert making the prescribing decisions.
A critically unwell patient
Sarah is a Senior Dietitian in the Intestinal Failure Nutrition Team in a large cross-site teaching hospital trust.
She was working at their hepatobiliary surgical site, the department that performs surgery involving the liver and biliary system. One of her patients had recently undergone pancreatic surgery, but complications following the operation had prolonged their stay in hospital.
The patient had developed sepsis, a life-threatening reaction to infection, and oedema, a build-up of excess fluid in the body's tissues, alongside high losses from abdominal drains.
Knowing what treatment was needed
They needed immediate treatment to ensure they had the appropriate nutrition to support their recovery.
Waiting for another clinician's approval
As a supplementary prescriber, Sarah was not able to issue this prescription alone.
“As the gastroenterologist was working at a different site within the hospital I was not able to have a clinical management plan signed for this patient. I therefore had to discuss the patient with the team that was present and ask them to sign the prescription.”
When expertise isn't enough
In this scenario, Sarah was the medical professional who was best placed to determine the patient’s nutritional needs and decide on a course of treatment. The medical team relied on her expertise.
“They told me ‘I don't know why you are asking me to do this (sign the clinical management plan), I will never disagree with what you are prescribing as you know more about it than I do’.”
Sarah is used to having to explain why she needs a clinical management plan signed off when she’s writing prescriptions for patients. But given that the prescription relies on her assessment of the patient, and the independent prescriber relies entirely on her judgement to approve the script, she feels it’s a poor use of time and “a paper exercise with little meaning.”
Independent prescribing rights would support dietitians to work with vulnerable patients who are in need of time sensitive treatment.
How independent prescribing would have changed this case
Sarah had the expertise to assess the patient and identify the treatment required. Independent prescribing would have enabled her to act on that expertise without waiting for approval from another clinician.
✅ Faster access to time-sensitive treatment
✅ Clearer lines of clinical accountability
✅ Reduced delays caused by administrative processes
✅ Less reliance on clinicians who were not directly involved in assessing the patient
✅ More efficient care for patients with complex conditions
