Professionalism and ethics
July 25, 2010 by admin
In this article, the author discusses what professionalism means in the context of advanced nursing practice, and discusses the nature of conscientious objection, for example in the area of reproductive medicine and abortion. As nursing practice extends, along with technological and medical advances, non-medical prescribers may find themselves faced with new ethical dilemmas.
Another issue is that of conflict of interest, particularly between professionals and any private interest whose income depends on the professionals’ approval or prescription of their product - so including but not limited to the pharmaceutical industry. The author says that non-medical prescribers need a better understanding of the Association of the British Pharmaceutical Industry (ABPI) Code of Practice, and that perhaps there should be active policing of the Code and publication of case details. The article also points out how many drug trials, and how much nursing and medical education, are funded by the pharmaceutical industry and the impact this has. There is accumulating evidence that does not support the industry’s stance that education is the true intent of its programmes, argues the author, who says that there is now a body of thought that policies and guidelines are needed in this area.
Nurse prescribing extends beyond the therapeutic alliance into areas of research, human rights, policy, promoting change, financial issues and ethics. The author concludes by urging the Nursing and Midwifery Council (NMC) to set the highest standards, provide robust guidance for practitioners and show that it is willing to stand up to private industry.
Young A. Professionalism and ethical issues in nurse prescribing. Nurse Prescribing 2010; 8(6): 284-289.
Practice nurses and prescribing
July 25, 2010 by admin
What is the experience of prescribing for practice nurses, how do they feel about it, and what has its impact been on their role? These were some of the issues explored in a small, qualitative study using semi-structured interviews with eight prescribing practice nurses. Their experiences were mainly positive, but some tensions with medical colleagues in particular remain.
Many or all of the nurses felt that there were benefits for patient care through prescribing, that there were misunderstandings among practice staff about their role, that it is both ‘imperative and intuitive’ to follow appropriate guidance, that their role had changed as a result of prescribing, and that they were unwilling to prescribe outside their competence or boundaries. Some felt that workload had increased. It emerged during the interviews that minor illness is increasingly being incorporated into the role of these nurses. Although some GPs welcomed the change and were supportive, others were less happy about it and lacked understanding about the nurse prescriber’s role and competency.
The authors make some recommendations: all staff working with prescribing nurses should get full explanations of the circumstances in which they can prescribe; after the initial mentoring period, doctors or experienced nurse prescribers should provide a further period of mentoring and supervision, to further mutual respect and understanding; and a continued learning or system of monitoring could be introduced to help nurse prescribers demonstrate their credibility - as nurses’ roles extend, something like the GP performance monitoring system may become more appropriate. Clearly, as the authors point out, this is a small study and further work is needed.
Daughtry J. and Hayter M. A qualitative study of practice nurses’ prescribing experiences. Practice Nursing 2010; 21(6): 310-314.
New CKS topics
July 25, 2010 by admin
New topics on polycythaemia/erythrocytosis and post-traumatic stress disorder have been added to the Clinical Knowledge Summaries (CKS) website.
National approach pays off in Ireland
July 14, 2010 by admin
Two articles about the implementation of nurse and midwife prescribing in Ireland have highlighted the importance of a structured, national approach. One [1] describes the national processes used and argues that the “critical success factor” was “the introduction of a standardised approach applied in a systematic manner by each health service provider….”. Another [2] describes how one aspect of the national framework used to support the initiative, the national nurse and midwife prescribing minimum dataset, was developed - and how its reports can be used to examine the prescribing activity of nurse prescribers in Ireland.
[1] Adams E et al. Prescribing in Ireland: the National Implementation Framework. Nurse Prescribing 2010; 8(4): 182-188.
[2] Adams E et al. Nurse and midwife prescribing in Ireland: the Minimum Dataset. Nurse Prescribing 2010; 8(5): 234-241.
CDs: Another question asked in Lords
July 14, 2010 by admin
Post election, what has happened to the long-awaited legislation about controlled drug prescribing by nurse and pharmacist prescribers (see here)? On 7 July, during a House of Lords short debate on pain control services, Baroness Emerton raised the question, asking whether the current situation could be untangled. She pointed out that nurse prescribers can prescribe some controlled drugs for specified conditions (for example, in palliative care or myocardial infarction) but not for chronic pain, which is a very frustrating position for all concerned. 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 that this can mean patients with chronic back pain, for example, waiting for several hours to see a doctor, who may then ask the specialist pain nurse running the clinic for advice on what to prescribe.
The answer, from Earl Howe (Department of Health Parliamentary Under-Secretary of State in the Lords), said that, “it is essential that the right person gives the right medication at the right time……… Nurse prescribing is a welcome development that can benefit patients significantly. She would agree that services should continue to look at what professional mix can best deliver safe, timely and effective treatments for patients.” No further details were given on progress with the legislation in his answer. Although the relevant changes were made to the Prescription Only Medicines (Human Use) Order 1997 in April 2008, changes to the Misuse of Drugs Regulations 2001 are currently with the Home Office.
The latest news is that these changes plus changes to the rules on patient group directions and mixing medicines where one or more controlled drugs is involved, may come through this summer. Watch this space!
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.
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Recent Posts
- 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
- Pharmacist prescribers’ skills going unused
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