MHRA warns against Bonjela for use in under-16s
April 25, 2009 by admin
Bonjela and Bonjela Cool Mint Gel should not be used by people under 16 years of age, according to a new recommendation from the MHRA issued on 21 April. Other Bonjela products are not affected.
The new advice is that “topical oral pain relief products containing salicylate salts should be contraindicated in children and young people under the age of 16 years”. New packaging and patient information is expected to be available in May.
The MHRA says that this is a precautionary measure because of the theoretical risk of Reye’s syndrome, and brings these products into line with others containing oral salicylates. MHRA advice is that those under 16 should not take aspirin unless recommended by a doctor.
By April 2009, the MHRA had received a total of three suspected serious Adverse Drug Reactions (ADR) reports associated with the use of topical oral gels containing choline salicylate in children: Reye’s syndrome was suspected in all three but confirmed in none.
One other product is also affected: Pyralvex is a pharmacy-only product, an oral paint containing salicylic acid for denture and mouth ulcer pain for people over 12 years old; the new advice is it should only be used in those over 16.
The MHRA suggests alternatives to these products. For infant teething pain, it says gentle pressure with something cool may be helpful; a number of products containing a local anaesthetic/mild antiseptic that do not contain a salicylate can be used for teething pain or mouth ulcers; salt water mouthwashes are recommended for pain associated with orthodontic devices; and paracetamol is suggested for discomfort linked with tooth movement.
Mixing medicines: Option D wins support
April 10, 2009 by admin
Responses to the MHRA consultation on mixing medicines in palliative care seem to be supporting Option D: that the law be changed to allow nurse and pharmacist independent prescribers to “specially prepare products for their individual patients and direct nurses and pharmacists who are not prescribers to mix drugs prior to administration� and to enable doctors to direct nurses and pharmacists to mix on a similar basis
ANP “Bugs and Drugs” conference: from hand washing to komodo dragons
April 10, 2009 by admin
Preventive strategies, good nursing care, appropriate antibiotic prescribing, hospital cleanliness and hand hygiene, fundamental organisational change, and new therapies, were all highlighted at the recent “Bugs and Drugs” ANP conference, held in London in February. Everything from what crocodiles can do for human medicine to how to support organizational change was covered in the talks and a workshop explored some of the trickier issues surrounding antibiotic and other prescribing.
Nurse prescribing: what do other professionals think?
April 10, 2009 by admin
What are the views of other healthcare professionals - doctors and non-prescribing nurses - on nurse prescribing? This is an important question because, if nurse prescribing is to reach its potential, the support and cooperation of other professionals is crucial. Two recent studies have sought to address this and related issues.
In one [1], 12 doctors (seven dermatology specialists and five GPs) and six non-prescribing nurses, all of whom worked with nurses prescribing for patients with dermatological conditions, were interviewed about their views on nurse prescribing in the light of this experience. They were positive about the prescribing practice of the nurses with whom they themselves worked and about the benefits, but they continued to have reservations about nurse prescribing in general and particularly about the importance of extensive experience before nurses start prescribing and about prescribing within limits of competence.
The authors point out that the parameters within which nurses prescribe are not always understood and some of the participants expected negative opinions about nurse prescribing to shift as more healthcare professionals gain direct experience of how it works in practice. The authors then recommend that the standards for nurse prescribing are promoted widely and adhered to.
In the other study [2], a questionnaire survey of all 200 qualified psychiatrists working in two UK mental health trusts, the results from the 149 that were returned suggested that senior doctors had fewer concerns about new nursing roles than their junior colleagues.
Although just over half the consultants felt that mental health nurses should be able to prescribe independently, 80% of junior doctors thought that they should not, although many thought they had a role in out-of-hours prescribing. The junior doctors suggested consistent supervision and limited access to mental health drugs. The senior doctors also had strong ideas about which drugs nurses should be prescribing.
The authors discuss these interesting results in terms of role change and implications for the future. It is possible that the consultants know the senior nurses who are prescribing better than their junior colleagues do, and therefore have had more chance to gain confidence in their abilities. It is also possible that the junior doctors are concerned about their roles in future. The concerns of junior doctors about nurse prescribing need addressing, to avoid conflict and to safeguard the quality of care that patients receive; more research is also needed in this area. Links between nurse prescribers and pharmacists could be a valuable means of support and development, given the importance participants attached to regular practice review for nurse prescribers, but the authors point out that there are few specialised mental health pharmacists in England and that not all mental health trusts have dedicated pharmacy support.
[1] Stenner K, Carey N and Courtenay M. Nurse prescribing in dermatology: doctors’ and non-prescribing nurses’ views. J Adv Nursing 2009; 65(4): 851-859.
http://dx.doi.org/10.1111/j.1365-2648.2008.04944.x
[2] Rana T, Bradley E and Nolan P. Survey of psychiatrists’ views of nurse prescribing. J Psychiatr Men Health Nursing 2009; 16(257-262).
http://dx.doi.org/10.1111/j.1365-2850.2008.01351.x
US nurse practitioners widely involved in pharma marketing
April 10, 2009 by admin
A study of US family nurse practitioners found that they were widely involved in pharmaceutical marketing, with more than 75% of the survey respondents saying they accepted gifts. The authors found that that they viewed pharmaceutical company marketing “uncritically as educational and beneficial” and did not see themselves as influenced by this practice, although they thought others would be.
Commenting on the study, Professor Molly Courtenay said she would be surprised if the prescribing practices of UK nurses were influenced by gifts from pharmaceutical companies, as this is a topic addressed within the non-medical prescribing programme. She also pointed out that a number of pharmaceutical companies have developed university-accredited CPD for nurse prescribers� - vital for nurses if they are to maintain their prescribing competencies.
Crigger N et al. Nurse practitioners’ perceptions and participation in pharmaceutical marketing. J Adv Nursing 2009; 65(3): 525-533.
http://dx.doi.org/10.1111/j.1365-2648.2008.04911.x
MHRA warning about cough and cold medicines in under-sixes
April 10, 2009 by admin
The MHRA has said that a number of over-the-counter (OTC) cough and cold medicines should no longer be used in children under the age of six (see here for the detailed advice and the list of products affected). The MHRA says that there is no robust evidence that they work and they can cause side effects, such as allergic reactions, effects on sleep or hallucinations. Parents and carers should follow the Department of Health 2007 “Birth to Five” guidance .
For older children, aged six to 12, these medicines will continue to be available, but only through pharmacies, and with clearer advice on the packaging and from pharmacists. Older children should not be given these medicines as first-line treatments and not for more than five days, and the medicines will have stronger warnings on the packaging and labelling.
Nurses to comment on Clinical Knowledge Summaries
April 10, 2009 by admin
Nurses are being asked to comment and provide feedback on draft NHS Clinical Knowledge Summaries (CKS). The team that develops CKS says it greatly values the input provided by nurses, as it ensures the topics are accurate and practical for use in the community (including general practice and walk-in centres).
More information about providing feedback on CKS draft topics can be found here:
What are the legal implications of care pathways?
April 10, 2009 by admin
What are the legal implications of care pathways, increasingly used by nurse prescribers to manage sometimes complex chronic conditions? Could they be used as legal swords for patients seeking compensation, or will they provide shields for nurse prescribers, by providing courts with evidence that the interventions were evidence-based best practice? The latter, is the reassuring conclusion of this article. Richard Griffith, a lecturer in health law, looks at whether care pathways make nurse prescribers more liable to face litigation. He explains how the Bolam test works in practice: if the actions of a nurse prescriber accord with practice accepted by a respected body of professional opinion, the standard of care will not have been breached. However, this standard of care must stand up to logical analysis and a nurse prescriber “will not be exonerated because others are negligent or common professional practice is slack”. He argues that is unlikely that care pathways will promote litigation, given their purpose and evidence-based nature. They are likely to be considered by a court as another form of evidence of practice, not as inflexible rules of conduct: deviation from them will not be automatically assumed to be negligent but is likely to be subject to the test of whether it is a logical, evidence-based response to patient needs. Nor, however, will blindly following a care pathway protect a prescriber from successful negligence suits. The author advises that if a nurse prescriber deviates from a care pathway, this should be well documented and reviewed. Care pathways, properly considered and evidence-based, will therefore act as shield to protect nurse prescribers.
Griffith R. Nurse prescribers, care pathways and the law. Nurse Prescribing 2008; 6(10): 456-459.
Non-medical prescribing in an acute cardiac ward
April 10, 2009 by admin
Non-medical prescribing in an acute cardiac ward can provide timely and safe access to medication, suggests the experiences of two nurse prescribers on their ward. These nurses have found that they are in a position to correct prescribing errors immediately, support prompt discharge by being able to prescribe discharge medication, increase patient involvement in treatment through their greater knowledge of medicines management, and that once they had got used to identifying appropriate situations, prescribing became second nature to them. Prescribing only really started once the formulary was opened up and its successful growth in this setting was through multidisciplinary collaboration, as suggested by the literature. These nurses have found that prescribing is never done in isolation, but tends to be discussed either before or afterwards. The authors found they could progress only with the support of other clinical prescribers in their specialty; the CPD group they attend cannot meet individual needs although it addresses wider prescribing issues.
Do you prescribe in an acute ward setting? If so, do share your experiences with others on the forum.
Goswell N and Siefers R. Experiences of ward-based prescribers in an acute ward setting. Br J Nursing 2009; 18(1): 34-37
Administration of injectable cosmetic treatments
April 10, 2009 by admin
The NMC has updated its advice (January 2009) on the administration of injectable cosmetic treatments. It says that the administration of, for example, a botulinum toxin injection, by a patient group direction or patient specific direction that has been signed remotely by someone who has not seen the patient is contrary to its ‘Standards for Medicines Management’ Any injectable cosmetic treatment should only be administered after a registered prescriber has made a comprehensive assessment and written and signed the prescription. Remote prescribing should not be used routinely to administer such injections.
NB: The NMC has now removed this advice sheet from its website because it says some of the information was “potentially misleading” and it will be updated as soon as possible.
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