Controlled drugs: keeping up the pressure
March 31, 2010 by admin
Another parliamentary question has been asked about Home Office plans to amend the Misuse of Drugs Act 1971 to provide for the prescribing of more controlled drugs by nurse and pharmacist independent prescribers, and whether there will be a statement from the Secretary of State.
Late last year, ANP patron Baroness Cumberlege asked a parliamentary question about the changes needed to amend the Act to allow nurse and pharmacist independent prescribers to prescribe from the whole formulary, including controlled drugs (see here) and it looked as though legislation was imminent (see here).
Since then, however, despite the encouraging signs, there has been no change. On 11 March, Anne Milton, who is Shadow Minister for Health, asked the latest question. Matt Griffiths, ANP committee member and visiting professor of prescribing and medicines management at the University of Northampton and the University of the West of England, says, “If the legislation is not passed before the election is called, this will result in a poorer service for patients for a longer period of time. If only the politicians responsible were able to see the effect of these delays on patients, I am sure that they would see this issue as being of higher priority”.
Prescribing responsibilities and litigation
March 26, 2010 by admin
This article sets out the legal background to the development of nurse prescribing in its various forms and runs through the safeguards - such as acting within competence, record keeping and indemnity insurance - that can help reduce the possibility of litigation.
McHale JV. Nurse prescribing: does more responsibility mean more litigation? Br J Nursing 2010; 19(5): 315-317.
Nurse prescribing: mental health in older people
March 26, 2010 by admin
Non-medical prescribing in mental health services has tended to focus on supplementary prescribing. This article describes a pilot in which a successful shift was made to independent prescribing in community mental health care services for older people.
The scheme worked this way: the non-medical prescriber assessed the patient, discussed the current issues and agreed treatment options with the consultant psychiatrist responsible for that patient - and was then responsible for seeing the patient, discussing the treatment, issuing prescriptions, and reviewing the medication, with ongoing discussions with the consultant as needed. Three senior nurses and four consultant psychiatrists were involved. Trust formularies were adhered to throughout the pilot.
Interviews, documentary evidence and patient questionnaires were all used to build up a picture of how the project worked, with encouraging results. The nurse prescribers felt that their relationships with patients were enhanced and that this, along with their accessibility, contributed to a coherent and responsive service. The authors conclude that they recommend this model.
Oldknow H et al. Independent nurse prescribing for older people’s mental health. Nurse Prescribing 2010; 8(2): 66-69.
Pharmacy prescribing and contraception access
March 26, 2010 by admin
The author argues that it is unlikely that schemes to make oral hormonal contraception available through pharmacy prescribing will contribute to a reduction in teenage pregnancies, and highlights all the other issues, as well as access, that are part of this problem. For example, the pilot schemes are unlikely to include under-16s, and if compliance is poor encouraging more women to take oral contraceptives rather than use other methods could result in more pregnancies.
Hand H. Widening access to contraception: the impact of pharmacy prescribing. Nurse Prescribing 2010; 8(2): 58-65.
March CKS new topics
March 26, 2010 by admin
More new and updated topics have been added to the Clinical Knowledge Summaries (CKS) site in March: dementia (new); hand foot and mouth disease (new); head lice; hepatitis C (new); HIV infection and AIDS (new); age-related macular degeneration (new); and malaria (new).
New SIGN diabetes management guideline published
March 26, 2010 by admin
An updated guideline for the management of diabetes has been launched by the Scottish Intercollegiate Guidelines Network (SIGN). There is a quick reference guide too, and a guide for patients and carers.
Nurse prescribing supports diabetes services
March 23, 2010 by admin
Nurse prescribing ’supports and enhances’ established diabetes services, according to the conclusion of this case study of nine English settings in which nurses prescribe for people with diabetes.
Semi-structured interviews with nurse prescribers and other team members (administrative staff, doctors and non-prescribing nurses) revealed that the specialist nurses tended to treat patients with poorly controlled diabetes whereas nurses in general practice usually cared for patients with better controlled diabetes and prescribed a wider range of medicines for diabetes and related co-morbidities. Scope of practice and levels of responsibility varied, with nurses in one general practice setting taking responsibility for the whole of diabetes care with little input from the GPs, whereas one diabetes specialist nurse had been prevented from prescribing for inpatients.
Nurse prescribing was seen as facilitating change rather than causing it, with the shift of diabetes services to the community perceived as the main driver for change. It did, however, provide the flexibility and impetus to consider different ways of working: nurses in general practice were introducing a single review process in which patients with diabetes and co-morbidities had all their conditions reviewed at the same time. Prescribing by nurses was seen as helping to provide a more streamlined, responsive service, with good teamworking being important, for example in sharing information about new medicines.
Carey N, Stenner K and Courtenay M. How nurse prescribing is being used in diabetes services: views of nurses and team members. J Nursing Healthcare Chronic Illness 2010; 2(1): 13-21.
Unlicensed medicines: green light and standards updated
March 23, 2010 by admin
The Nursing and Midwifery Council (NMC) has now issued a circular (04/2010) that permits nurse and midwife independent prescribers to prescribe unlicensed medicines, following legislative changes in December.
The circular updates the “Standards of proficiency for nurse and midwife prescribers“, setting out the requirements for this type of prescribing. The prescriber must be satisfied that an alternative, licensed medication would not meet the patient’s needs and that there is sufficient evidence and/or experience to demonstrate efficacy and safety for that individual; the prescriber must take responsibility for prescribing the unlicensed medicine and for overseeing care; the patient must understand the implications of being prescribed an unlicensed medicine and agree to this; the reasons for choosing this medication must be documented in the patient’s notes; professional advice must be obtained as necessary; and adverse drug reactions must be reported via the Yellow Card scheme. The guidance stresses that nurse and midwife prescribers should pay particular attention to the risks associated with unlicensed medicines, and says that the NMC will consider it best practice to have policies and systems in place to monitor and manage the clinical risks.
A second circular (03/2010) requires approved educational institutions to amend the content and learning outcomes of V300 programmes to reflect the legislative changes. Programmes must conform by 1 February 2011.
Prescribing for paramedics: engagement exercise
March 23, 2010 by admin
Should non-medical prescribing be extended to paramedics and, if so, how? These are some of the questions in a stakeholder engagement exercise launched by the Department of Health. Responses are invited by 12 June and will be used to inform a formal consultation on this subject by the Medicines and Healthcare products Regulatory Agency (MHRA).
The options being considered are: no change - so paramedics will continue to use Patient Group Directions, Patient Specific Directions and exemptions for supply and/or administration of medicines; supplementary prescribing; prescribing for specified conditions from a specified formulary; prescribing for any condition from a specified formulary; prescribing for specific conditions from a full formulary within the practitioner’s competence; and prescribing for any condition from a full formulary within the practitioner’s competence.
Some of these options will be familiar from the introduction of nurse and pharmacist prescribing, where making changes to formularies, for example, proved time-consuming.
The document says that if prescribing within competence for any condition from a full formulary is chosen, the experience of nurse and pharmacist prescribing should be used. Prescribing by paramedics could support better integration of urgent and emergency care services, in line with the government’s vision, so patients do not have to obtain their prescription from another healthcare professional.
If you would like to respond to the engagement exercise, click here.
Specialist mental health nurse prescribing: professionals’ views
March 11, 2010 by admin
Once again, education for other professionals about the training and role of non-medical prescribers has been identified as an issue, this time in establishing nurse prescribing in specialist mental health teams.
In this case study, which aimed to explore the views and experiences of professionals within one specialist mental health team, nine health professionals from different disciplines attended a focus group and two psychiatrists were interviewed separately.
In general, the views were positive and a range of benefits identified including improved care and more teamworking. One striking finding in the focus group was that there was very little knowledge about aspects of nurse prescribing: training, requirements, responsibilities and practicalities. So even in a team with a practising nurse prescriber, colleagues were uncertain about their role and responsibilities. In the psychiatrists’ interviews it became clear that they had no training or support for their supervisory role, and that they had some anxieties, which the authors link to the perception that they might be expected to supervise an inexperienced prescriber who might make errors that they would be responsible for.
Categories
Recent Posts
- Non-medical prescribing in A and E and sexual health
- Formularies can support prescribing in mental health
- GP prescribing errors study hit headlines
- RCN briefing on nurse prescribing
- CDs: prescribing, mixing and PGDs - more information now available
- 23 April: CD changes come into effect
- ANP 2012 conference dates announced
- NICE to produce medicines adherence standard
- Consultation on healthcare regulators
- Home Office says CD changes expected in April
Tags
- ANP ANP conference Carey N CD children CKS Clinical Knowledge Summaries consultation controlled drugs COPD cosmetic treatments Courtenay Courtenay M CPD dermatology DH diabetes district nurse prescriber generic substitution Home Office Matt Griffiths mental health MeReC MHRA Misuse of Drugs Misuse of Drugs Act mixing medicines National Prescribing Centre NICE NMC non-medical prescribing NPC NPF NPSA Nurse prescribing Patient Group Directions PGD PGDs Prescribing Prescribing errors RCN Stenner Stenner K supplementary prescribers unlicensed medicines
