Non-medical prescribing for IBD: audit results
February 4, 2010 by admin
This article describes how an audit was taken of independent non-medical prescribing practice in one hospital in a large cohort of patients with inflammatory bowel disease (IBD), and the changes that were implemented as a result.
When the IBD nurse specialist began prescribing, it was agreed that prescribing practices would be regularly audited. The results showed that prescribing practice was safe and evidence-based, but that there were some variations in it. As a result, a list of recommendations for practice was developed, for example about whether enteric-coated prednisolone is needed, and the necessary changes implemented.
Greveson K. An audit of independent non-medical prescribing in inflammatory bowel disease. Gastrointestinal Nursing 2009; 7(10): 23-27.
Diabetes care enhanced by nurse prescribing
February 4, 2010 by admin
This case study of nurse prescribers caring for people with diabetes found that the care they provided was enhanced by prescribing and that their prescribing and communication skills integrated well.
The evidence and analysis from interviews, patient questionnaires and videotaped consultations highlighted their good communication skills - particularly empathy and listening. The consultations included clear exchanges of information about medicines management and self-care. These aspects of care are particularly important to people with diabetes. The process was also seen as more efficient by nurses, and the patients reported good access and short waiting times.
The nurse prescribers were less consistent about explaining the risks and benefits of treatments and their side effects, a concern which has been noted before, although it is always difficult to know what had been said in previous consultations. In addition, although prescribing by nurses was seen as conferring some safety benefits (for example, that doctors were not signing prescriptions for patients they had not seen), the nurses did not consistently explore the use of non-prescribed herbal or over-the-counter medicines.
Courtenay M, Stenner K and Carey N. An exploration of the practices of nurse prescribers who care for people with diabetes: a case study. J Nursing Healthcare Chronic Illness 2009; 1(4): 311-320.
Encouraging results from evaluation of mental health supplementary prescribing
February 4, 2010 by admin
How effective has non-medical supplementary prescribing been in mental health? This paper reports encouraging findings from a national evaluation funded by the Department of Health, which suggest that the effect of transferring from an independent medical prescriber to a mental health nurse prescriber may be negligible.
The study used two groups of patients - matched for age, gender, diagnosis and chronicity - prescribed for by nurse supplementary prescribers and by psychiatrists. The outcomes for medication adherence, health status, side effects and satisfaction with overall care did not differ significantly between the two groups. It was therefore important to know whether the costs differed: although the different prescriber groups used resources in different ways, there were no significant cost differences. The authors say that this is the first known study to compare the cost and clinical impact of independent medical prescribing and mental health nurse prescribing.
The authors add a note of caution: although the patients were matched on some characteristics, one group may still have been more seriously illl at baseline; and the patients were not randomly allocated to the different types of prescriber. Nonetheless, the results are encouraging.
Independent Prescribing: Practical Prescribing
February 3, 2010 by admin
Am I able to administer a vaccine using a Patient Specific Direction (PSD) as opposed to a Patient Group Direction (PGD)? My local pharmacist told me that this is possible, and that details about the medicine dose, do not need to be included in the PSD but can be provided verbally. Is this correct?
To read the answer to this question, click here.
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