District nurse and independent prescribing
September 27, 2010 by admin
What is the experience of district nurses who are independent prescribers? This study explored this issue using interviews with eight district nurses practising as nurse independent prescribers in the west of Scotland. It found that their experiences were largely positive but identified a particular problem - which may be less of an issue for practice nurses - to do with administration and particularly duplicate record keeping (nursing and medical notes). This was of great concern and involved all sorts of difficulties to do with different locations, paperless systems and computer access. It is possible that the cumbersome systems were causing some nurses to limit their prescribing, although the authors point out that they were also relatively inexperienced as prescribers and lacked confidence (five expressed a lack of confidence in their prescribing ability).
Support - both organisational and peer - was a major issue too, with nurses reporting a lack of support from the time they qualified as prescribers: even when support mechanisms existed, they may be insufficient or inconsistent. As well as confidence and support, education and ongoing development, and nursing relationships and roles were identified as influences on prescribing practice. Other difficulties included an increase in workload associated with prescribing, partly because of the administrative issues, and a lack of remuneration and recognition.
Benefits identified by the nurses included saving time, a more seamless service for patients, and increased autonomy and job satisfaction, which supported the development of the district nursing role.
Downer F and Shepherd CK. District nurses prescribing as nurse independent prescribers. Br J Community Nursing 2010; 15(7): 348-352.
EMA suspends rosiglitazone
September 27, 2010 by admin
On 23 September, the European Medicines Agency (EMA) recommended that the marketing authorisations for medicines containing rosiglitazone be suspended (Avandia, Avandamet and Avaglim). This means these medicines will stop being available in Europe within a few months. After a review of all the data about cardiovascular risk, the EMA concluded that the benefits no longer outweigh the risks.
The advice from the Medicines and Healthcare products Regulatory Agency (MHRA) is that patients should not stop treatment but should seek advice. Advice for healthcare professionals can be found here: it says that prescribers should “put in place a system to ensure that all patients are reviewed and changed to another suitable treatment in line with NICE recommendations.”.
CD changes - with Ministers
September 27, 2010 by admin
The summer came and went without the promised changes to allow non-medical prescribers to prescribe more controlled drugs (see here) - but it looks like there has been progress. The Home Office has now confirmed that, subject to Ministerial agreement, it plans to include the amendments needed to regularise the mixing of medicines that include controlled drugs before administration (see here) in the statutory instrument to allow non-medical prescribing of controlled drugs, within prescribers’ competence.
The latest advice from the Advisory Council on the Misuse of Drugs, which endorses the proposed changes about the mixing of medicines, is now with Ministers and the Home Office says a decision is expected shortly, and a statutory instrument could follow shortly, subject to their agreement.
The legislative changes made at the end of last year to allow nurse and pharmacist prescribers to mix medicines for administration and direct others to mix, did not apply to controlled drugs as changes to the Misuse of Drugs regulations were needed.
Managing infections in primary care
September 27, 2010 by admin
The Health Protection Agency (HPA) has updated its guidance on the management of infection in primary care, for local consultation and adaptation. It covers common infections such as acute sore throat and urinary tract infections, and makes a series of simple recommendations in line with guidance from NICE and other bodies, with references to further resources.
Changes to NPF
September 27, 2010 by admin
On 1 September, some changes were made to the Nurse Prescribers’ Formulary (NPF) - see here for details.
Warning on Botox and remote prescribing
September 27, 2010 by admin
If nurses administer injectable cosmetic treatments such as Botox as ‘remote prescriptions’, they could be risking their registration, according to this article. The remote prescribing procedure is for use in exceptional circumstances, as the Nursing and Midwifery Council (NMC) advice in November 2009 made clear. West D. Nurses risk registration by breaching rules for Botox. Nursing Times 2010; 31 August.
New and updated CKS topics
September 27, 2010 by admin
New and updated topics were published on the Clinical Knowledge Summaries (CKS) website in August and September: Addison’s disease; alcohol - problem drinking; cataracts; constipation in children; cough; Gilbert’s syndrome; glaucoma; neuropathic pain - drug treatment; analgesia - mild-to-moderate pain; breathlessness; bronchiectasis; corticosteroids - inhaled; corticosteroids - oral; corticosteroids - topical (skin, nose, and eyes); epistaxis; hepatitis A; hepatitis B; hypercalcaemia; and lower urinary tract symptoms in men, age-related (prostatism).
NPC lists 15 areas for prescribing action
September 27, 2010 by admin
The National Prescribing Centre (NPC) has published an initial list of 15 common drugs where prescribing savings can be made or quality improved in primary care. A fuller report will follow but this list, says the NPC, is of “therapeutic topics for early consideration, which offer real opportunities for maintaining or improving quality and enhancing value for money”. Director of Evidence-based Therapeutics at the NPC, Neal Maskrey, introduces the report by stressing that although this is all about increasing the efficiency of primary care prescribing, “the evidence base for all the topics identified has been carefully examined to ensure that safety and clinical effectiveness would be maintained, or in some cases even improved, if they were incorporated into prescribing practice with less variation than at present.”
The topics are: renin-angiotensin system drugs; statins; newer hypoglycaemics; proton pump inhibitors; non-steroidal anti-inflammatory drugs (NSAIDs); low-dose antipsychotics in people with dementia; long-acting insulin analogues; self-monitoring of blood glucose in type 2 diabetes; clopidogrel; ezetimibe; antibiotic prescribing - especially quinolones and cephlasporins; hypnotics; orlistat; high-dose inhaled corticosteroids; and alendronate. Much of the advice refers to NICE or other existing guidance, highlighting common areas of over-treatment, and instances where higher doses than needed are often prescribed, or where the evidence does not support the use of more expensive drugs.
Some will not save costs but will improve quality, says the document, whereas in other cases small local savings can contribute to large national ones. It cites analysis showing savings of £443 million in 2009 (compared with 2005) from more cost-effective prescribing across four drug categories.
The National Pharmacy Association has said that the NHS should, “look through the other end of the telescope for the big wins”, highlighting problems with what patients actually do with their medicines, and pointing out that up to half of all medicines may not be taken as the prescriber intended. It is calling for a national medicines concordance scheme to be rolled out in pharmacies in England.
Nurses prescribing 13 million items a year
September 27, 2010 by admin
There are (as of June) 13,100 nurse independent prescribers and 21,220 community practitioners on the NHS Prescription Services database of prescribers, according to its latest report, published in September. Nurses prescribed 13.2 million items in the year to June - an increase of just over 10% on the previous year. Prescribing by pharmacists, although at lower levels (273,227 items) has increased dramatically - by over 70% in the year to June 2010 compared with the previous year, although it is still patchy geographically (53% of total pharmacist prescribing occurs in five Primary Care Trusts).
Consultations in diabetes care with nurse prescribers: patients’ views
September 20, 2010 by admin
Nurses prescribing for people with diabetes do so using the principles of patient-centred care, to the benefit of their patients, according to the conclusion of this study involving interviews with 41 patients with diabetes from the primary care case loads of seven nurse prescribers. Other benefits, for example improved understanding of treatments and conditions and improved self-care, seemed to result from the combination of a person-centred care approach combined with the additional knowledge and abilities of the nurse prescriber. Patients felt that continuity of relationships, flexibility over consultation length, nurses’ interpersonal skills, and specialist diabetes knowledge were all crucial. The authors argue that a number of related aspects of the nurse consultation style are coming together, enhancing patient care - in ways that may improve treatment decisions and adherence.
The extent to which patients wanted information about treatment options, or wanted to be involved in the decisions, varied widely and they were largely happy with the extent of their involvement. The provision of information about possible side effects seemed to be an area of inconsistency, however.
Stenner KL, Courtenay M and Carey N. Consultations between nurse prescribers and patients with diabetes in primary care: a qualitative study of patient views. Int J Nurs Stud 2010; in press. doi:10.1016/j.ijnurstu.2010.06.006.
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