Independent Nurse: Practical Prescribing
September 22, 2009 by admin
I recently started a two-year MSc Advanced Practitioner programme with a special interest in COPD, and work with a community COPD team. I qualified as a nurse independent prescriber/nurse supplementary prescriber in 2005, prescribing within my competence in my specialist area. However, my current line manager says I will not be able to prescribe until the end of the course in 2011. I would appreciate your view.
To read the response to this question, click here.
Nurse prescribing by children’s nurses: doctors’ views
September 15, 2009 by admin
What do doctors think about nurse prescribing in specialist children’s hospitals? This was one of the questions that this study set out to address, given that increasing numbers of specialist children’s hospital nurses are becoming prescribers.
Interviews with 11 doctors and three clinical leads in one specialist children’s hospital, performed as part of a larger study, revealed that the major benefits were thought to be improved access to medicines and better continuity of care, seen as a particular priority for children and their families. The doctors thought that nurses were able to provide patients with more medicines information than doctors and that nurses were in a better position to develop long-term relationships with their. The authors point out that because nurses at this hospital already worked at an advanced level, and were running their own clinics, prescribing was supporting existing structures.
The concerns of the doctors and clinical leads included: the selection of candidates for prescribing training; the need for doctors to have confidence in the ability of nurses becoming prescribers; clinical skills; and concerns or confusion about roles. It is important that nurses have acquired the appropriate clinical skills before they register for prescribing training. Doctors need to understand nurse prescribing, and good communication across the professional boundaries is vital for this.
Courtenay M and Carey N. Nurse prescribing by children’s nurses: views of doctors and clinical leads in one specialist children’s hospital. J Clin Nursing 2009; 18: 2668-2675.
OSCE used to train and assess potential prescribers
September 15, 2009 by admin
How can a nurse’s competency to prescribe be assessed and what options are there to supplement the generic course and provide subject-specific training? These and other questions are addressed in this study, in which an Objective Structured Clinical Examination (OSCE) for potential nurse prescribers in dementia was validated, comparing the performance of nurses after 12 days of dementia prescribing training with that of small numbers of doctors of different grades. Not all the doctors taking the exam had done the course, and not all the course participants took the exam.
The Oxford Advanced Dementia Course was one day a week for 12 weeks and at the end, participants could, if they wanted to, take the OSCE. The purpose of the course was to help participants feel confident enough to attend the independent prescribing course.
Interestingly, the performance of nurses was not correlated with their years of experience working in old age psychiatry, but that of doctors was, with the competency of staff grades and junior doctors varying considerably. Almost all memory clinic nurses passed the exam, along with all specialist registrars and consultants; however, only a third of community psychiatric nurses (CPNs) performed at the level thought necessary to become a supplementary prescriber even though they had considerable experience of managing patients with dementia. The authors point out that experienced CPNs are likely to make up any extended cadre of  supplementary prescribers in dementia.
The authors conclude that the OSCE provides useful evidence to employers of the competency of potential prescribers. They point out that most forms of continuing professional development appraisal are based on course attendance, not performance, and suggest that a practical exam such this could provide invaluable information about which nurses can safely prescribe, complementing the assessment of the designated medical practitioner and the results of the generic prescribing course. It could make a significant contribution to maintaining high standards of patient safety with nurse prescribing.
Cubbin S et al. Training and assessing independent nurse prescribers: a model for old age psychiatry. Psychiatric Bull 2009; 33: 350-353
Generic substitution - autumn consultation
September 15, 2009 by admin
The Department of Health has now announced that it will launch, after all, a full formal consultation about plans for automatic generic substitution later this year, according to press reports. The plans mean that pharmacists would substitute generic versions for branded medicines unless the prescriber has ticked a box saying do not substitute.
The proposals have caused much debate, with several groups calling for consultation after the plans were announced.
New and updated CKS topics
September 15, 2009 by admin
New or updated Clinical Knowledge Summaries (CKS; see here)
include:Â atrial fibrillation; bed-wetting (enuresis); headache - assessment (new); headache - cluster (new); headache - medication overuse (new); headache - tension-type (new); influenza - seasonal; pelvic inflammatory disease; anti-platelet treatment; chronic kidney disease - not diabetic (new); hypertension - not diabetic; immunizations - seasonal influenza; insomnia; otitis media - acute; palliative cancer care - malignant ulcer; and sleep disorders - shift work and jet lag (new).
Independent Nurse: Practical Prescribing
September 12, 2009 by admin
I am a qualified nurse independent prescriber (NIP) / nurse supplementary prescriber (NSP) and work in a rural minor injury and urgent care unit. Can you advise on the use of intra-nasal diamorphine?
To read the response to this question, click here.
Study comparing consultations seeks nurse and pharmacist prescribers
September 7, 2009 by admin
A study that will compare the consultations and communication methods of different prescribers - nurses, pharmacists and GPs - is looking for nurse and pharmacist prescribers working in Bath, Swindon, Wiltshire, Bristol, North Somerset, Gloucestershire, Berkshire East, Berkshire West, and Devon Primary Care Trusts.
Participating prescribers will audio-record about 10 of their consultations with patients (with patients’ agreement). The research team is led by Professor Marjorie Weiss, Department of Pharmacy and Pharmacology, University of Bath.
If you would like more information about the study, please contact: Ruth Riley, Department of Pharmacy and Pharmacology, University of Bath; email rr256@bath.ac.uk; Tel: 01225 384165
New codeine advice and warnings to minimise addiction risk
September 7, 2009 by admin
The MHRA announced new warnings and guidance about over-the-counter (OTC) medicines containing codeine and dihydrocodeine on 3 September, aimed at minimising the risk of addiction and overuse.
The changes are:
- Indications relating to colds, flu, coughs and sore throats, and minor painful conditions, will be removed.
- The remaining indications will be for the short-term treatment of acute, moderate pain which is not relieved by paracetamol, ibuprofen or aspirin alone.
- Patient Information Leaflets (PILs) and labels will state that the products are only for short-term use - up to three days - for the treatment of moderate, acute pain and that they can cause addiction or overuse headache if used continuously for more than this. On the front of the pack, a prominent warning will be displayed: “Can cause addiction. For three days use only”.
- PILs will also contain information about the warning signs of addiction.
- All packs containing codeine or dihydrocodeine OTC medicines, including effervescent formulations, with more than 32 will no longer be available as P products.
- The advertising and promotion code of practice will be updated to reflect these indications and warnings and to remove all reference to painkilling power and strength.
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