Remaining barriers to prescribing for practice nurses
February 25, 2010 by admin
Many services in primary care are now led by practice nurses working at an advanced level but not prescribing, either independently or as supplementary prescribers. What are the barriers as perceived by these nurses? Age, salary, support and training all emerged as factors in this questionnaire survey of practise nurses in one English county where prescriber numbers are low.
The authors make recommendations to improve the situation, including some central funding for course fees and expenses for practice nurses, study time and mentoring systems, a funded post of professional lead for practice nurses in each Primary Care Trust (PCT), a clear career pathway for practice nursing, and realistic financial incentives for professional development.
Of the 251 practice nurses in the county, 151 responded to the survey, most of whom were mature and experienced. About one-third will be reaching retirement age within 15 years, so GPs and PCTs will need to provide incentives to recruit and retain practice nurses.
More than 90% were managing at least one chronic condition but of these only 17% held a prescribing qualification and nearly half did not hold or intend to study for the prescribing qualification. Similarly, 37% of those providing first contact care for minor illnesses did not hold or intend to study for the prescribing qualification. The intention to train was strongly related to age, as might be expected.
Other factors included lack of support, time factors, anxiety about prescribing or the course, and lack of interest or opposition by GPs. There was a widespread view that respondents would receive little or no financial reward for doing the course. The authors point out that few GPs have adopted Agenda for Change, which would ensure parity with NHS colleagues.
Kelly A, Neale J and Rollings R. Barriers to extended nurse prescribing among practice nurses. Community Practitioner 2010; 83(1): 21-24.
Administration of medicines in emergencies: MHRA consults
February 25, 2010 by admin
The Medicines and Healthcare products Regulatory Agency (MHRA) has launched a consultation about exemptions to the POM Order, which will extend the range of medicines that can be administered by non-prescribers, in emergency situations. This could be good news, says ANP Committee member Matt Griffiths, who points out that Patient Group Directions (PGD) legislation does not allow authorised practitioners to delegate this responsibility.
Legislation specifies that prescription-only medicines (POMs) can only be supplied through registered pharmacy premises against prescriptions written by appropriate practitioners (including non-medical prescribers). There are two separate sets of exemptions to this: the Article 7 (of the POM Order) list and the paramedic list.
The Article 7 list allows some parenteral medicines (all parenteral medicines are POMs) to be administered by anyone to save a life - given people doing this have to have access to the medicine at the time, this usually takes place in hospitals or ambulances. The proposed change here is that glucose, used to treat hypoglycaemia in people with diabetes, should be allowed to be administered at strengths other than 50%. At present, only glucose 50% is included in the list but modern practice is to use 10% (particularly for children) or 20%, as 50% can be both difficult to administer and an irritant.
The other set of exemptions allows registered paramedics to administer some parenteral medicines on their own initiative to meet immediate needs. The specific change proposed here is that adrenaline hydrochloride be added to the list as an alternative to adrenaline acid tartrate, for paramedics to use in anaphylaxis and cardiac arrest.
Professor Griffiths is concerned that certain medicines, such as adrenaline 1:10,000, used in cardiac arrests by advanced life support providers (some of whom are not prescribers) are not included in the current legislation. He urges organisations to respond to this consultation, and to consider including any other life-saving medicines, as the list of exemptions has become out of date and doesn’t support current clinical guidelines. The closing date is 7 May 2010.
Should PILs and SPCs be available online?
February 25, 2010 by admin
Should patient information leaflets (PILs) and Summaries of Product Characteristics (SPCs) be available online and if so, what should the site look like? Would this be beneficial and increase use of this information by the public and health professionals? The Medicines and Healthcare products Regulatory Agency (MHRA) has commissioned a discussion site aimed at healthcare professionals and the public about these issues.
February changes to NPF
February 25, 2010 by admin
Some changes have been announced to the Nurse Prescribers’ Formulary for Community Practitioners. The following emollients have been added: Aquadrate Cream 10%; Balneum Plus Cream; E45 Itch Relief Cream; Eucerin Intensive Cream 10%; Eucerin Intensive Lotion 10%; and Nutraplus Cream. These medicinal preparations have been deleted: Phenothrin Aqueous Lotion NPF and Zinc Paste and Calamine Bandage.
Podcasts of pharmacology lectures ‘useful’
February 25, 2010 by admin
Non-medical prescribing students found podcasts of the pharmacology lectures in their course useful, according to this study. Comparison with previous groups of students suggested that the podcasts might have helped improve exam performance.
The authors discuss the difficulty of communicating the necessary breadth and depth of pharmacology information to nurses on the non-medical prescribing course, particularly given the wide variation in knowledge of pharmacological concepts among nurses starting the course. This ‘foreign language’ is, however, clearly very important and yet time is limited on the course.
More than 90% of the students on two non-medical prescribing courses at the University of Nottingham accessed at least one podcast, and the vast majority rated them as helpful or very helpful, with some providing very positive feedback and saying they would be useful in other areas of the course.
Meade O, Bowskill D and Lymn JS. Pharmacology as a foreign language: a preliminary evaluation of podcasting as a supplementary learning tool for non-medical prescribing students. BMC Medical Education; published 18 December 2009.
The debate continues…
February 14, 2010 by admin
A GP blogger on the Financial Times website argues that nurses wishing to learn diagnosis and prescription should do so at medical school on a reduced length course, rather than the “few weeks training” she believes they receive at present. Interestingly, the examples she quotes to back her argument were of inappropriate prescription requests from - yes - nurses who were not prescribers. Avoiding these sorts of scenarios was one of the reasons for introducing nurse prescribing in the first place.
Medicines Act exemptions and off-label/unlicensed drugs
February 14, 2010 by admin
Answers to questions about the supply and administration of unlicensed and off-label medicines under Medicines Act exemptions have been published here.
NMC consults on pre-registration nursing education
February 14, 2010 by admin
What standards should nursing students be able to meet at the point of registration? The Nursing and Midwifery Council (NMC) has launched an online survey to obtain views on the proposed new standards. They include both standards for competence (the knowledge, skills and attitudes that all graduate nurses need to demonstrate at registration) and standards for education (the requirements that pre-registration nursing programmes must meet). To complete the survey, or find out more, see here.
Recent CKS updates
February 14, 2010 by admin
The Clinical Knowledge Summaries (CKS) has added the following new topics: colorectal screening; halitosis; hirsutism; Lyme disease; Osgood-Schlatter’s disease; urinary tract infection (lower) - men; fibroids; gastro-oesophageal reflux disease in children under two - management; mumps; premenstrual syndrome; restless legs syndrome; retinal detachment; and rubella.
HEI Educators workshop - 5th March
February 5, 2010 by admin
The HEI Educators Spring workshop will be held on 5th March at the University of Cumbria, Lancaster. This is a lively and supportive event which offers the opportunity to share ideas and to network on a day specifically designed for prescribing educators. For more details, or took book your place on the course, see the “Diary Dates” page.
Categories
Recent Posts
- NPSA to be abolished
- Professionalism and ethics
- Practice nurses and prescribing
- New CKS topics
- National approach pays off in Ireland
- CDs: Another question asked in Lords
- Patients ‘confident’ about nurse prescribing
- Push for non-medical prescribing in Wales
- Insulin safety guidance issued
- Prescribing book - July publication
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