Patients ‘confident’ about nurse prescribing
June 25, 2010 by admin
In diabetes care, patients were confident about nurse prescribing and reported improved access to medicines and greater efficiency, in this interview-based study. The 41 patients with diabetes were under the care of a seven nurse prescribers - some general practice nurses and some diabetes specialist nurses.
Interestingly, the patients were able to demonstrate specific improvements in efficiency and access - for example, being able to get an appointment with a nurse at short notice. Nurses were seen as more flexible than doctors but doctors’ time was also perceived as more important! So, nurse prescribing had contributed to improving the service in ways which patients noticed and cared about.
Patients expected teamwork among health professionals, preferring to see doctors for conditions perceived to be more serious or undiagnosed, and expected nurses to have had the necessary training and experience, as well as specialist diabetes knowledge, if they were to prescribe. Confidence in their ability to prescribe was inspired by these attributes and also patients’ direct experience, nurses’ willingness to refer to doctors or others when unsure, good communication skills, and attention to detail.
Patients of the diabetes specialist nurses expected the nurse prescriber to prescribe new medication or equipment but only that related to diabetes. In contrast, some patients of the general practice nurses saw the role as monitoring and continuing to prescribe medication initiated by the doctor although others were happy for the nurse to prescribe medicines for co-morbidities - there was a varied range of views among these general practice patients.
The authors conclude that workforce planners need to include services provided by nurse prescribers alongside those of doctors.
Push for non-medical prescribing in Wales
June 25, 2010 by admin
Non-medical prescribing in Wales has been given an organisational push in a letter from the Chief Executive of NHS Wales to all Health Boards. The Boards are being asked to consider the recommendations made in a report of an All-Wales conference on non-medical prescribing. In the letter, Mr Williams says that the investment being made in training nurse and pharmacist prescribers is not being “utilised to its full potential” and highlights the current importance of making best use of available resources.
The recommendations ask NHS leaders to “harness the expertise” of non-medical prescribers with seven practical steps, including creating local registers of all non-medical prescribers, appointing a director within each board to lead on local non-medical prescribing developments, and using the report to explore the potential of non-medical prescribing in service and workforce planning.
Insulin safety guidance issued
June 25, 2010 by admin
The National Patient Safety Agency (NPSA) has issued guidance that aims to reduce the number of insulin-related wrong dose incidents. It applies to all English and Welsh NHS organizations. Two common errors that the guidance seeks to address are: the inappropriate use of non-insulin syringes, which are marked in ml not insulin units; and the use of abbreviations such as ‘U’ or ‘IU’ for units which can lead to doses being misread (eg, 10U being read as 100).
Prescribing book - July publication
June 25, 2010 by admin
A book aimed at medical and non-medical prescribers is to be published in July. ‘The New Prescriber: An Integrated Approach to Medical and Non-medical Prescribing’ is edited by Fiona Bath-Hextall, Joanne Lymn, Roger Knaggs and Dianne Bowskill, and will cost £29.99. It is divided into three sections: the patient (including chapters on the ethics of prescribing, legal issues, and consultations), evidence-based practice (including chapters on how to find evidence and how to appraise it), and a large section on pharmacology (including chapters on different organ systems and types of disorders). See here for further information.
Pharmacist prescribers’ skills going unused
June 19, 2010 by admin
The skills of pharmacist prescribers, particularly in primary care, are not being used to the full, according to the results of this study in north-east England which confirms previous anecdotal evidence. So, what are the barriers?
A major stumbling block is the absence of clear organisational strategies (something that will be familiar to some nurse prescribers). Some pharmacists have never used their prescribing qualification. Organisations need to develop prescribing roles that are underpinned by policies and procedures. Some individuals have worked hard to use their skills to improve patient care and it is clear that pharmacists can set up and run innovative services that focus on patients. New roles need, however, to be ‘embedded’ in an organisation to be sustainable. Lack of funding, insurance costs, and controlled drugs regulations were also seen as barriers.
In secondary care, pharmacist prescribing seemed to be better established, with almost 10% of hospital pharmacists being prescribers, although preliminary results suggest that the overall number of items prescribed is small. In the absence of a strategic plan for how pharmacist prescribing should develop, the existing working relationships between hospital pharmacists and medical colleagues make it easier for individual services to develop as a results of those relationships. The logistics - access to medical records and prescription pads - are also more straightforward. Support from colleagues, networking and continuing professional development were also seen as easier to develop in secondary care as there is more teamworking.
Pharmacist prescribing in primary care is tiny - accounting for less than 1% of all items prescribed in this part of England. The picture is varied regionally, however, with pharmacists in some areas prescribing more than in others.
Baqir W, Clemerson J and Smith J. Evaluating pharmacist prescribing across the north east of England. B J Clin Pharm 2010;2:147-149.
New CKS topics published
June 19, 2010 by admin
New topics on haematospermia, itch in pregnancy, and Morton’s neuroma have been published in June on the Clinical Knowledge Summaries website.
Knowledge Network launched for Scotland
June 19, 2010 by admin
An online health and care resource for Scotland, The Knowledge Network, has now been launched. It builds on the NHS Scotland e-library, and includes a range of resources and services.
Midwives exemptions - updates and students’ position
June 13, 2010 by admin
The list of prescription-only medicines that midwives can supply and administer (as distinct from prescribe) in the course of their professional midwifery practice - the midwives exemptions list - has been updated and expanded. Further details can be found here.
Does the exemptions list apply to student midwives? Chief Nursing Officer Dame Christine Beasley says that the Medicines and Healthcare products Regulatory Agency (MHRA) has issued advice about the position of student midwives, until it provides further clarification after considering the options. The advice is that the MHRA will not consider taking enforcement action against student midwives administering medicines in the list that are not controlled drugs, under the direct supervision of a midwife, unless it would be in the public interest to do so. This also applies to a supervising midwife.
Mixing medicines: new guidance and resources
June 13, 2010 by admin
The Department of Health (DH) has now published guidance about the mixing of medicines before administration, following the recent legislative changes (see here for guidance and here for more information).
The National Prescribing Centre (NPC) has produced a resource with tools and advice about how to implement the guidance points (here).
The DH guidance points out that, “These changes apply not only to palliative care, but to all clinical areas where the mixing of medicines prior to administration is accepted practice and supported by the employer’s policies for the delivery of healthcare.” It reiterates the advice from the Medicines and Healthcare products Regulatory Agency - that it would not consider ‘enforcement action against those prescribing and administering mixtures of licensed medicines in clinical practice, unless it would be in the public interest to do.’ So, for controlled drugs (where the legislative changes do not yet apply) existing good practice arrangements should continue.
The NPC resource provides advice on when medicines should be mixed, emphasising that this should only happen when it is essential to meet the needs of the patient, what issues the prescriber and the person doing the mixing should consider, what counts as instructions ‘in writing’ and much else. It suggests that organisations and practitioners should review systematically their current practice in the light of the new guidance, using this resource.
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