Independent Nurse: Practical Prescribing
June 23, 2009 by admin
Q: Some of the vaccines that we administer in our practice, such as yellow fever and meningitis, are licensed for use in this country. However, others, including Japanese encephalits and tick-born encephalitis, are not licensed in the UK. Can a patient group direction (PGD) be used to administer private vavccines? As yellow fever and meningitis are licensed, can a patient specific direction (PSD) be authorised by a nurse prescriber for private patients?
To read the reponse to this question, click here.
Nurse prescribing: therapy areas and CPD needs
June 21, 2009 by admin
Three-quarters of nurses replying to a recent survey about prescribing said that they had CPD needs specifically related to pharmacology, more than 50% to assessment and diagnosis and 44% to knowledge of conditions. Their preferred method for undertaking CPD was e-learning.
The survey took the form of an online questionnaire e-mailed to members of the Association for Nurse Prescribing (ANP), and 62% replied (546 in total). The authors point out that members of the ANP may be particularly likely to be actively prescribing and to be keen to access prescribing support and education.
Nurses reported prescribing for a broad range of conditions, with large numbers of nurses saying that they are now prescribing for pain, respiratory conditions and sexual health - Â in addition to areas identified in previous work such as dermatology - and these areas were among those with most respondents reporting that they had CPD needs.
The authors comment that these results provide useful pointers for those developing and delivering CPD for nurse prescribers and involved in undergraduate training.
Courtenay M and Gordon J. A survey of therapy areas in which nurses prescribe and CPD needs. Nurse Prescribing 2009; 7(6): 255-262.
DH updates non-medical prescribing leads list
June 21, 2009 by admin
The Department of Health (DH) has published an updated list of non-medical prescribing leads in Strategic Health Authorities, which can be found here.
Information leaflets about children’s medicines launched
June 21, 2009 by admin
A series of leaflets aimed at parents and carers about children’s medicines - including ibuprofen for pain and inflammation and medicines to prevent seizures - has been launched and can be found here.
The leaflets contain clear information specifically about the use of medicines in children, which may differ from that provided by the manufacturer, and answer common questions about side-effects, dosages and administration.
The leaflets have been develop jointly by the Royal College of Paediatrics and Child Health (RCPCH), the Neonatal and Paediatric Pharmacists Group (NPPG) and children’s charity WellChild.
Nurses and swine flu: prescribing, NMC statement, and DH tools
June 21, 2009 by admin
Up-to-date information on prescribing Tamiflu and Relenza for nurse prescribers can be found here.
The NMC has made clear that all nurses and midwives must practice within their competency levels and should seek advice or supervision from a “competent practitioner” if faced with an aspect of practice outside their competency or registration area: they remain answerable at all times for their actions and omissions. The full NMC position statement on the role of registered nurses and midwives during an influenza pandemic can be found here - it also states that nurses and midwives will not be professionally compromised “provided they are competent (and have been assessed as such) to carry out duties being requested by the employer”.
The Department of Health has issued a swine flu clinical package containing a set of tools that can be used by frontline healthcare professionals in a pandemic.
Independent Nurse: Practical Prescribing
June 8, 2009 by admin
Q: I work in rural Scotland and qualified as a nurse independent prescriber / supplementary prescriber just under a year ago. There are are couple of patients, for whom I am responsible, that I can’t always see for face-to-face consultations. Instead, I provide them with a telephone consultation and then prescribe their medicines on the basis of this. I am unsure if this practice is acceptable.
To read the response to this question, click here.
Mental health nurse prescribing: psychiatrists’ concerns
June 6, 2009 by admin
How is mental health nurse prescribing viewed by psychiatrists and nurses, given the slower than expected uptake of nurse prescribing by mental health nurses, and the suggestion that psychiatrists’ behaviour is a barrier for implementation? It seems that a majority of both groups are now in favour of mental health nurse prescribing but with more psychiatrists expressing concerns, according to a recent study.
This study, the first large in-depth attempt to explore and compare these attitudes and perspectives of mental health nurses and psychiatrists, used a specially created questionnaire returned by 82 psychiatrists and 119 mental health nurses, after random selection of recipients from staff lists in two large metal health trusts. So, importantly, it was not a sample of those undertaking nurse prescribing or involved with it necessarily, although a rather low response rate may be explained by the suggestion that many recipients had no knowledge of, or interest in, nurse prescribing, perhaps leading to some bias in respondents.
Although psychiatrists and mental health nurses were overall in favour of mental health nurse prescribing, psychiatrists had particular concerns about aspects of clinical and legal responsibility, and the appropriate setting for use, with nurses being much more positive about the notions of mental health nurses prescribing in acute inpatient wards and of nurses prescribing medication (including intravenous medication in emergency situations) for rapid tranquilisation. Interestingly, about half the participants from both groups thought mental health nurse prescribing would cause conflict in clinical teams, 61% of psychiatrists thought it would make services more complex, and nearly half of the psychiatrists disagreed with the assertion that it has an increasingly favourable evidence base.
The authors argue that some of the findings may be explained by a perceived change in power balance.
Patel MX et al. Attitudes regarding mental health nurse prescribing among psychiatrists and nurses: A cross-sectional questionnaire study. Int J Nurs Stud 2009;Â 46(11): 1467-1474
Diverse views on nurse prescribing in a children’s hospital
June 6, 2009 by admin
How is nurse prescribing being implemented in a specialist children’s hospital? Healthcare professionals had a range of views on this in a series of interviews in this small study in a highly specialist setting. The nurses had differing views on autonomy - how much they have at present and how much they aspired to - and the authors conclude that this is reflected in the way prescribing was used in practice. Some nurses primarily used prescribing to improve the efficiency of their existing practice, with fewer diagnostic and assessment skills and little feeling of needing prescribing support; in contrast, those wanting to develop their practice further had greater involvement in new patient assessment, greater assessment and diagnostic skills, and would like more support. The authors highlight the importance for organizations of the link between nurses’ expectations of their prescribing roles, the extent to which they use their prescribing qualifications, and the support they need.
The findings highlight the importance of a strategic approach to workforce planning: this approach had quickly superseded selection of nurses based around individual needs, and fostered consideration of issues such as education and support.
Carey N, Stenner K and Courtenay M. Views on implementing nurse prescribing by children’s nurses. Nurse Prescribing 2009; 7(5): 205-210.
New NPCi resources on medicines management
June 6, 2009 by admin
Three new subsections, on shared care of medicines, medicines management in care homes, and pharmaceutical public health, have been added to the NPCi website in the general medicines management section (click here). They include quizzes, online training and case studies.
Diabetes Type 2 guidance adds new treatment options
June 6, 2009 by admin
The DPP-4 inhibitors - sitagliptin and vildagliptin - should be considered for patients on metformin with inadequate blood glucose control for whom adding sulfonylurea is not appropriate. This is one of the new recommendations issued by NICE, in its short clinical guideline ‘Type 2 diabetes: newer agents’, at the end of May.
NICE says the guideline increases the treatment options for blood glucose control in patients with Type 2 diabetes and is a partial update of last year’s clinical guideline update. Other recommendations tackle insulin therapy (including long-acting insulin analogues), and the use of exenatide and the thiazolidinediones. NICE has estimated that the cost of implementing these recommendations will be £27,288,000 annually in England.
The chair of the guideline development group, consultant physician Amanda Adler, said that the guidelines, “acknowledge that the treatment of type 2 diabetes may require many drugs, often used simultaneously”.
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