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.
Training of pharmacists as supplementary prescribers
May 30, 2010 by admin
This study used focus groups, interviews and analysis of recorded critical incidents to look at how GPs and pharmacist supplementary prescribers see the different aspects of the supplementary prescriber training, and continuing experience, in the context of the challenge to professional territory presented by the role changes involved in the non-medical prescribing policy.
Although some of the GP partners in the practices concerned were vocal about their concerns surrounding non-medical prescribing, and often anxious about the issue of diagnosis and exactly what it involves, the designated medical practitioners (DMPs) in each case were supportive. The pharmacists, all of whom had previously established effective working relationships with the practices as they worked as prescribing advisors, were very enthusiastic about their period of learning in practice, and the skills of the DMPs. The academic component of the training was less valued, although they did acknowledge that the reflective learning skills they gained were useful later in their work-based learning. Interestingly, reciprocal learning was acknowledged by both the DMPs and the pharmacists, and it seems that the DMPs were seeing their pharmacist colleagues in a new light as a result and were developing new ways of working together. Learning on the job was a key component of continuing professional development.
Tann J et al. The great boundary crossing: perceptions on training pharmacists as supplementary prescribers in the UK. Health Education Journal 2010; 69: 183-191.
Mixing medicines - legal aspects
May 30, 2010 by admin
This article provides an account of the legal situation around independent nurse prescribing, unlicensed medicines, and mixing medicines (see here and here). Although it is the responsibility of the relevant health professional to decide if the person has needs that can only be met by an unlicensed medicine, the author believes it is likely that trusts and boards will seek to limit their use on cost grounds. At present, the situation about controlled drugs has not changed, so mixing products that would create an unlicensed controlled drug is not covered.
Have the legislative changes and recent guidance made any difference to your practice? Why not log into the members’ forum and share your experiences?
Griffith R and Tengnah C. Prescribing and administering unlicensed medicines. Br J Community Nursing 2010; 15(5): 232-235.
New website for NMC
May 30, 2010 by admin
The Nursing and Midwifery Council (NMC) has launched a new website, with a prescribing section under ‘Nurses and Midwives’. It is asking for feedback on what users think of the site now.
May CKS topics published
May 30, 2010 by admin
Some new topics have been added to the Clinical Knowledge Summaries (CKS) site in May: Baker’s cyst; coeliac disease; Dupuytren’s disease; mastitis; meibomian cyst; psoriasis; scarlet fever; styes (hordeola); and vitiligo.
NICE guidance: male lower UTI symptoms and childhood constipation
May 30, 2010 by admin
NICE has published guidance about the management of lower urinary tract symptoms in men, pointing out that, ‘uncertainty and variation’ exist in clinical practice at the moment. The symptoms are storage, voiding and post-micturition symptoms affecting the lower urinary tract. They can reduce quality of life and sometimes indicate serious pathology.
There is also new NICE guidance on constipation in children and young people.
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