Nurses’ views about unlicensed and off-license medicines in forensic mental health
| Date | 05 August 2014 |
| Published date | 05 August 2014 |
| DOI | https://doi.org/10.1108/JFP-10-2013-0045 |
| Pages | 194-202 |
| Author | Camilla M. Haw,Jean H. Stubbs,Geoffrey L. Dickens |
| Subject Matter | Health & social care,Criminology & forensic psychology,Forensic practice |
Nurses’ views about unlicensed and
off-license medicines in forensic
mental health
Camilla M. Haw, Jean H. Stubbs and Geoffrey L. Dickens
Camilla M. Haw is a Professor
in Mental Health Care and
Consultant Psychiatrist and
Geoffrey L. Dickens is the Head
of Nursing Research and
Professor of Psychiatric
Nursing, both are based at
St Andrew’s Academic
Department, St Andrew’s
Healthcare, and School of
Health, University of
Northampton, Northampton,
UK. Jean H. Stubbs is a
Research Associate, based
at St Andrew’s Academic
Department Northampton, UK.
Abstract
Purpose – Use of off-license medicines in forensic mental health settings is common and unlicensed drugs
are sometimes prescribed. Despite their responsibility for administering medicines little is known about how
mental health nurses view these practices. The paper aims to discuss these issues.
Design/methodology/approach – In total, 50 mental health nurses working in low and medium secure
adolescent and adult mental health wards were presented with a clinical vignette about administration of
unlicensed and off-license medicines. Semi-structured interviews about their likely clinical response to, and
feelings about, this practice were conducted. Interview data were subject to a thematic analysis.
Findings – Analysis revealed six themes: status of unlicensed/off-label medicines; legality of administering
unlicensed medicines; professional standards around administering unlicensed medicines; finding out more
about unlicensed medicines; trusting medical colleagues; and decision making in uncertain cases.
Practical implications – Forensic mental health nurses take a pragmatic approach to the practice of
administering unlicensed medicines and most are aware of their professional responsibilities.
Originality/value – This study provides the first evidence to inform the development of training for forensic
mental health nurses about an issue that is common in forensic mental health practice.
Keywords Thematic analysis, Adults, Adolescents, Forensic mental health nursing,
Medicines management, Unlicensed drugs
Paper type Research paper
Introduction
In inpatient psychiatric settings psychotropic medicines are very frequently prescribed and as a
result medicines management forms a central part of the mental health nursing role (Gray et al.,
2010). One under-explored area in the medicines management literature is the involvement
of mental health nurses in the administration of unlicensed or off-license medicines. Given the
widespread use of medicines in psychiatry outside of the licensed dose range or for conditions
other than that for which a medicine is licensed (Lowe-Ponsford and Baldwin, 2000) this is
surprising. This paper describes a study conducted to explore mental health nurses knowledge
and perceptions of the use of unlicensed and off-label medicines.
Unlicensed and off-license medicines: definitions
In the UK a medicine that is unlicensed does not have a marketing authorisation issued by
the regulator (in the UK the Medicines and Healthcare products Regulatory Agency (MHRA))
and therefore does not feature in the British National Formulary (BNF; BMJ Group and
Pharmaceutical Press, 2013). Parallel arrangements exist in the USA, where the process is
controlled by the Food and Drug Administration (FDA; Long and Watts, 2013), and Australia,
where it is the responsibility of the Therapeutic Goods Agency (Turner, 2000). One example in
The study was funded by
St Andrew’s, Billing Road,
Northampton, NN1 5DG, UK.
PAGE 194
j
JOURNAL OF FORENSIC PRACTICE
j
VOL. 16 NO. 3 2014, pp. 194-202, CEmerald Group Publishing Limited, ISSN 2050-8794 DOI 10.1108/JFP-10-2013-0045
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