Ensuring safe prescribing - Carnegie Conference centre, Dunfermline, 30th April 2009
May 26, 2009 by admin
Workforce planning, medico-legal aspects of prescribing, medication errors, and the impact of prescribing on service delivery in chronic disease management were all highlighted at the recent ‘Ensuring safe prescribing practice’ ANP conference, held Scotland in April. Some of the more complex prescribing issues specific to different therapy areas (palliative care, COPD, minor illnesses and sexual health) were explored in a number of workshops.
The importance of safe prescribing practice was the theme emphasised throughout the day. The strategic framework ‘A safe prescription’, designed to provide NHS Boards with a framework from which they can develop and support Nursing Midwifery and Allied health Professions (NMAHPs) prescribing services that are right for the patients, the public, NMAHPs and fellow health professionals, was highlighted by Sheena Williamson ( Project Officer, NMAHP Prescribing).
Later in the morning, Omar Ali (Formulary Development Pharmacist, Surrey and Sussex NHS Trust) and Alison MacRobbie (Palliative and Community Care Pharmacist, NHS Highland) went on to look at the medico-legal aspects of prescribing and polypharmacy. Omar described the size of the medico-legal bill - the majority of medical mistakes being medication errors. Delegates were provided with the chance to play ‘judge and jury’ throughout the presentation, and asked to comment on a number of actual cases. The Bolam Principles were explained, ensuring delegates were aware of the issues surrounding legal investigations. How to make practice, prescribing and patient follow-up safe, were issues touched on throughout. Alison explored polypharmacy. What counts as polypharmacy, the cost drivers, over-prescribing versus under-prescribing, pharmacokinetics, concordance were issues covered. Alison also described a new scheme ‘Supporting medicines management in the community - NHS Highland’, designed to help maintain individuals in their own home through the safe use of medicines.
After lunch, prescribing errors - rates, impact on patients and the NHS, and Government targets, were examined by Ross Lynton (Associate Lecturer, Edge Hill University, Pharmacy Consultant-bpas, Lead Pharmacist, Fylde Coast medical Services). Cases were presented to explore the application of bad rules and systems failures. The need to reduce the frequency and severity of errors in order to improve the quality of patient care and the role of the NPSA were also covered.
Later in the day, Alison MacRobbie, in the palliative care workshop provided an overview of the medicines commonly administered to palliative care patients at the end of life. Unlicensed medicines, drug combinations, and potentially irritant drugs were some of the issues explored. Jane Jones (Senior Practice Nurse/Midwife Inverness) used a number of case studies to explore treatments in COPD. Scenario’s and case studies were used by William Craig-Macleman (Night Nurse Practitioner, Raigmore Hospital, Inverness), Lucy Store (Nurse Practitioner, Nurse Practitioner Unscheduled Care Services, Raigmore Hospital) and Steve Baguley (Consultant Genitourinary Physician, Aberdeen) to examine prescribing issues in minor illnesses, unscheduled care and sexual health. Changing antibiotics, blood results, maintaining competencies, PGDs, mixing medicines, PSDs, Chlamydia and HIV were some of the topics covered.
The benefits of nurse prescribing on service delivery - specifically continuity of care, efficiency and access, communication and safety were some of the advantages described by Molly Courtenay (Reading University), from her research exploring independent and supplementary prescribing in diabetes.
The conference was well attended by practitioners from both community and acute sectors, with many nursing specialities. Plenty of opportunity was provided for debate and discussion and there was plenty of networking.
New & updated CKS topics for May
May 26, 2009 by admin
New or updated Clinical Knowledge Summaries (CKS; see here) published in May include: chlamydia - uncomplicated genital; deep vein thrombosis prevention for travellers; fungal nail infection; fungal skin infection - body and groin; fungal skin infection - foot; fungal skin infection - scalp; giant cell arteritis; and polymyalgia rheumatica.
Honorary Doctorate for Lady Cumberlege
May 26, 2009 by admin
Lady Julia Cumberlege, patron of the ANP, member of the House of Lords and a former health minister, has been awarded an honorary doctorate by the University of Northampton.
V150 prescribing - more than a “taster”?
May 26, 2009 by admin
Will the V150 be a waste of resources, in providing nurses who then progress quickly to V300 prescribing with a “taster” programme? This author argues that the V150 can contribute to fulfilling the demand from many organisations for nurses to prescribe and highlights data suggesting that rapid conversions were not a widespread trend with V100 to V300.
The article also discussed the future of community practitioner nurse prescribing and its success so far, but points out that in some areas the prescribing of wound care products is reverting back to GPs but the delivery of wound care is not. This may suggest some instances of nurses not completing episodes of care and GPs writing prescriptions again for patients they have not seen.Â
The V150 prepares nurses without a specialist practitioner qualification to prescribe from the community practitioner formulary.
Hogg D and Schelowok C. The need for V150 prescribing. Nurse Prescribing 2009; 7(3): 122-125.
Prescribing works well for specialist dermatology nurses
May 26, 2009 by admin
Nurse prescribing enhances the care of patients with dermatological conditions, with the benefits being most pronounced for patients of dermatology specialist nurses rather than general practice nurses, according to this case study of consultations between nurse prescribers and patients. The authors also highlight the need for nurses to give patients more information about their medicines if they are to be more involved in the decision-making process.
Interviews, questionnaires and videotaping were used in 10 practice settings across England where nurses prescribe for patients with dermatological conditions. The nurses believed that their prescribing decisions were improved by their holistic assessment approach and better prescribing knowledge. Patients rated their listening and treatment explanation skills, and the assessors who watched the tapes also rated the nurses’ ability to listen and deal sensitively with emotions.
The authors conclude that prescribing allows specialist dermatology nurses to contribute more effectively to dermatology services and that more research is needed to establish whether this is the case for other specialist areas.
Courtenay M, Carey N and Stenner K. Nurse prescriber-patient consultations: a case study in dermatology. J Adv Nursing 2009; 65(6): 1207-1217.
How to prescribe for anxiety
May 26, 2009 by admin
This useful review discusses the characteristics of anxiety and panic and explains that in primary care, anxiety can be broadly seen as being one of three types: generalised anxiety disorder (GAD), panic disorder and phobia. NICE guidance from 2004 covers the management of GAD and panic disorder and the article discusses treatment options highlighting the mainstay of drug treatment for anxiety, paroxetine.
Warren E. Prescribing for anxiety. Practice Nurse 2009; 37(8): 34-38.
Independent Nurse: Practical Prescribing
May 18, 2009 by admin
Q: I am in the process of setting up a “new entrants” community based service which aims to support new arrivals into the country by offering a health access service. One of the objectives of this scheme is to decrease the incidence of TB. Can a nurse independent prescriber (NIP) write a Patient Specific Direction for the Mantoux test, which uses a tuberculin that is unlicensed in the UK?
To read the response to this question, click here.
Guidance on use of unlicensed medicines for children
May 11, 2009 by admin
New guidelines aimed at minimising the ‘potential pitfalls’ linked with the unlicensed prescribing of medicines for children and improve understanding of the clinical, ethical and legal issues has been written by a group of academics and practitioners, and sponsored by Rosemont Pharmaceuticals Ltd. (See Making medicines safer for children- guidance for the use of unlicensed medicines in paediatric patients). It includes advice on issues such as the primary/secondary care interface, considerations for different classes of unlicensed medicines, and the importance of complete information.
Public awareness of non-medical prescribing
May 11, 2009 by admin
The Scottish public seem to be reasonably well aware of non-medical prescribing, with more than half the respondents to a survey saying they knew that trained health professionals could write prescriptions for medicines previously prescribed only by doctors. They were most comfortable with pharmacist prescribing, closely followed by nurse prescribing.
The postal questionnaire was sent to 5000 members of the public in November 2006, and generated a response rate of 37.1%.
Stewart DC et al. Cross Sectional Survey of the Scottish General Public’s Awareness of, Views on, and Attitudes Toward Nonmedical Prescribing. Ann Pharmacother 2009; 43(9): published online 5 May.
Independent Nurse: Practical Prescribing
May 9, 2009 by admin
Q: Further to your advice (IN, 6 Apr) about the issue of “vicarious indemnity” through NHS employers, I would appreciate further clarification. I have been asked to pay my own insurance cover by my GP following advice from the MDU.
To read the reponse to this question, click here.
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