Better job satisfaction but more stress: prescribing in general practice?
October 20, 2011 by admin
Independent prescribing increased job satisfaction for nurse practitioners working in general practice but also increased the levels of work-related stress, according to this small study involving interviews with six nurse practitioners working in a busy inner city general practice.
Cousins R and Donnell C. Nurse prescribing in general practice: a qualitative study indicates increased job satisfaction and work-related stress. Fam Pract 2011; published 28 September online ahead of print.
http://dx.doi.org/10.1093/fampra/cmr077.
NPC seeks non-medical prescribers
October 20, 2011 by admin
The NPC is looking for active non-medical prescribers to help it validate a draft of a new generic competency framework for all prescribers, including doctors. It will be holding focus groups on the framework on 8 November in London and 28 November in Liverpool and would like to hear from interested nurses, midwives, physiotherapists, podiatrists, radiographers and optometrists. See here for more information.
DH consults on independent prescribing by podiatrists and physiotherapists
October 20, 2011 by admin
Should independent prescribing be extended to podiatrists and physiotherapists? The Department of Health and MHRA have published two consultations with these proposals, which can be found here. The deadline for responses to both is 8 December 2011.
The physiotherapist consultation proposes that physiotherapists can become independent prescribers and that physiotherapist independent prescribers should be able to mix medicines before administration, and direct others to do so, and to prescribe some specified controlled drugs independently. Those physiotherapists who are currently supplementary prescribers would have to undergo additional training to become independent prescribers. The proposals would need changes to the Misuse of Drugs Regulations 2001, as well as to the Medicines Act 1968. Independent prescribing of unlicensed medicines is not included in either document.
The consultation sets out the list of options, ranging from prescribing for any condition from the complete formulary, to prescribing for specified conditions from a specified formulary. The proposals for podiatrists are similar and both consultations give examples of areas where independent prescribing could be useful.
An analysis of the responses to last year’s engagement exercise (see here) is included in the consultations, and shows a lot of support for the option of prescribing for any condition from the full formulary (option 5). The most limited extension - independent prescribing for specified conditions from a specified formulary - found support with the BMA and the Royal College of Physicians, among others. The more limited versions are likely to require frequent revisions to the lists of conditions and/or formularies, a process that those nurses who were prescribing before the formulary was opened up will remember only too well!
Audit of non-medical prescribing in a mental health trust
September 28, 2011 by admin
A questionnaire survey of nurse and pharmacist prescribers within one mental health trust has concluded that although there is a high degree of compliance with the UK standards adopted by the trust, clinical supervision and training needs improving to meet them fully. Additional regular monitoring arrangements would ensure compliance.
Of the 24 non-medical prescribers included, 18 nurses and two pharmacists replied and their answers revealed two groups - high-frequency and lower-frequency prescribers (including the two pharmacists). The high-frequency prescribers were specialists, working in areas such as mental health services for older people, and were prescribing repeat or maintenance specialist medications whereas the lower-frequency prescribers started treatments themselves.
The authors say that the shortfall in supervision could be because of a lack or supervisors, lack of training for them or simply a lack of availability of supervision. Although the respondents were positive about the benefits of non-medical prescribing, 60% believed that training and supervision had shortfalls.
Some conflict with psychiatrists was reported but all respondents said they would seek advice from psychiatrists when necessary.
Gumber R, Khoosal D and Gajebasia N. Non-medical prescribing: audit, practice and views. J Psychiatr Men Health Nurs 2011; published online 18 July.
http://dx.doi.org/10.1111/j.1365-2850.2011.01779.x.
Welsh guidance on prescribing dilemmas
September 28, 2011 by admin
New guidance has been published on non-NHS and other prescribing dilemmas by the All Wales Medicines Strategy Group and can be found here. It covers topics such as immunisations, unlicensed medicines, private prescriptions, prescribing outside national guidance and minor ailments.
Jersey to implement non-medical prescribing
September 28, 2011 by admin
Jersey is to implement a non-medical prescribing programme: the first legislative changes needed have been made and the aim is to start the first V300 course, on the island, in January 2013. Geoff White (Consultant Nurse, Practice Development, who has been very involved with this project) told the ANP that this is pivotal to the development of specialist and advanced nursing practice on Jersey, and that nurses and midwives will probably be the first groups to start the training, but that the legislation allows for other professions as well. Separate legislation would be needed for controlled drugs. Mr White predicts that nurses working in the following areas will be targeted initially: emergency care, unscheduled care, night nurse practitioners, mental health, sexual health, palliative care, and chronic disease management including diabetes. Jersey will be developing a ‘robust implementation strategy’ that takes on board lessons learned from the implementation of non-medical prescribing elsewhere; ANP committee members have provided support for this extension of non-medical prescribing.
Controlled drugs rules change: SI being prepared?
September 28, 2011 by admin
The latest news on the long-delayed but promised changes to the Misuse of Drugs Regulations is that the Home Office is said to be preparing a statutory instrument that will both allow non-medical prescribers to prescribe all controlled drugs within their competence and regularise the practice of mixing of medicines that include controlled drugs before administration. This information - although still no date - was given in a written answer to a question asked in the House of Commons by David Mowat MP which can be seen here for the discussion at last year’s ANP conference of this issue.
Pharmacist prescribing in Northern Ireland: some way to go
September 16, 2011 by admin
The number of qualified pharmacist prescribers in Northern Ireland is still relatively small and many of those qualified to do so are not actually prescribing, according to recent research. The story is familiar: although benefits for patient care and perceptions of pharmacists’ roles are recognised, barriers to prescribing remain.
McCann L et al. Pharmacist prescribing in Northern Ireland: a quantitative assessment. Int J Clin Pharm 2011; online first.
http://dx.doi.org/10.1007/s11096-011-9545-7.
Important safety information missing on herbal medicines
September 16, 2011 by admin
Vital safety information was missing from three-quarters of the 68 herbal preparations containing five herbal products analysed in this study. All the preparations bought were over-the-counter, oral, single-use and contained St John’s wort, echinacea, garlic, ginkgo or Asian ginseng.
Although forthoming EU legislation should mean that most products using St John’s wort and echinacea, for example, are likely to include safety information in future, this will not apply to those not making claims about disease prevention or treatment, or to any bought outside the EU - perhaps over the internet.
The researchers were looking for information such as the possibility of St John’s wort interacting with warfarin or the contraceptive pill. Their report highlights the importance of accurate and complete information being provided with herbal products, pointing out that these products are often used with conventional prescribed medicines with which they may interact, and that patients may be reluctant to tell their healthcare practitioner that they are using herbal products.
Consultation on Misuse of Drugs Regulations
September 16, 2011 by admin
The Home Office is planning to update, consolidate and clarify the Misuse of Drugs Regulations 2001 to ensure that they work effectively and reflect current policies and professional practice about controlled drugs. The proposals are set out in a consultation, and the deadline for responses is 28 October.
At present, there are 18 amendments to the original statutory instrument that introduced the regulations, so the government is proposing both that all 19 are consolidated into a single piece of legislation that will be less complex to follow, and that changes are made at the same time to update the regulations in line with current policy on controlled drugs where appropriate.
Some examples of the changes proposed are:
- making Midwife Supply Orders specific to patients rather than midwives;
- giving Ambulance Trusts similar authority to possess and supply controlled drugs to NHS Hospital Trusts and care homes;
- and clarifying some issues relating to prisons.
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