Journals
Non-medical prescribing in A and E and sexual health
May 9, 2012 by admin
The evidence base for safe and effective non-medical prescribing is given a boost by a recent study examining retrospectively 764 case notes from nurse prescribers in accident and emergency and sexual health departments in a London hospital. Case notes for 490 patients from nurse practitioners not trained in prescribing were included for comparison. Just over half (409) of the prescribers’ patients needed medication and in 99.4% of consultations (n=566), safe prescribing practice was evident.
Formularies can support prescribing in mental health
May 9, 2012 by admin
Team and individual formularies can support independent nurse prescribing in mental health, according to a recent evaluation piloting the use of formularies in a mental health trust.
There has been an issue with trained nurse prescribers in mental health either not prescribing or only prescribing as supplementary prescribers. One mental health trust has now tried using individual and team formularies to provide support for existing prescribers and for those who have qualified but are yet to make the step to independent prescribing, and the results are encouraging, with the formularies being seen as helpful by those new to this role, as they can ‘clarify and formalize each prescriber’s area of competence, thus setting clear boundaries’. This is useful in increasing confidence and reducing uncertainty, and has other benefits, but it is important that the formularies are kept up to date and in line with local practice.
Dobel-Ober D, Bradley E and Brimblecombe N. An evaluation of team and individual formularies to support independent prescribing in mental health care. J Psychiatr Mental Health Nursing 2012; published online ahead of print 5 March.
http://dx.doi.org/10.1111/j.1365-2850.2012.01885.x
Psychiatric drugs as effective as other medicines
March 2, 2012 by admin
Contrary to what could be called popular belief, it appears that psychiatric drugs are as effective, in general, as those used in other specialties, according to a new review of meta-analyses [1], also discussed in the BMJ here [2]. This is an interesting study, despite its limitations, because it tries to compare different outcomes in different diseases, and therefore provides a qualitative perspective only. Nonetheless, although some general medicines drugs did have very high ‘effect sizes’, for example proton pump inhibitors for the treatment of reflux oesophagitis, many had much smaller ones and, overall, psychiatric drugs were in the same range as the general medicine ones.
[1] Leucht S et al. Putting the efficacy of psychiatric and general medicine medication into perspective: review of meta-analyses. Br J Psychiatry 2012; 200: 97-106.
http://dx.doi.org/10.1192/bjp.bp.111.096594
[2] News. Psychiatric drugs are not inferior to other drugs, review concludes. BMJ 2012; 344:e856.
http://dx.doi.org/10.1136/bmj.e856
Non-medical prescribing: learning in practice
March 2, 2012 by admin
Lack of time with their designated medical practitioners (DMPs) was identified as a problem by nurses and midwives who had recently completed the non-medical prescribing course in this small study. There also seemed to be advantages in the student choosing their own DMP, although some DMPs still appeared unprepared for the role, relegating some of the prescribing competencies to a less important status, and might benefit from more formal preparation. Perhaps it is unrealistic to expect any one DMP to be able to supervise all the competencies.
The authors conclude that managers are important in making supervision effective: they need to understand the requirements of the course and ensure that DMP support is suitable and that there is enough time for teaching and learning. Educators must also monitor the experience of DMPs and their students, and the students for their part need to make their learning needs clearer to their managers and DMPs.
McCormick E and Downer F. Students’ perceptions of learning in practice for NMPs. Nurse Prescribing 2012; 10(2): 85-90.
http://www.internurse.com/cgi-bin/go.pl/library/contents.html?uid=4333;journal_uid=15
Future of non-medical prescribing
March 2, 2012 by admin
The need for more strategic direction and a robust evidence base to underpin non-medical prescribing has been highlighted again in a recent review.
Stewart D, MacLure K and George J. Educating non-medical prescribers. Br J Clin Pharmacol; published early online 2 February 2012.
http://dx.doi.org/10.1111/j.1365-2125.2012.04204.x.
Why aren’t mental health nurse prescribers prescribing?
February 17, 2012 by admin
A lack of support for the prescribing role was one of the main barriers to independent prescribing identified in this study of nurse prescribers working in mental health, with more than half wanting more support from their managers. Another major barrier was seen to be the lack of recognition, in terms of both status and pay, of the extra responsibilities that come with prescribing.
The authors point out that the sample of mental health nurse prescribers in Scotland in this questionnaire and focus group study was small, and that the research was carried out in 2008, when independent nurse prescribing was relatively new in the mental health area. Sixty per cent of the prescribers were not prescribing
They conclude that although further research is needed, possible barriers may be identified from this work, some of which have been articulated previously and some of which are new. One barrier discussed that is specific to mental health nurse prescribing is the impact on the therapeutic relationship and whether there is a potential role conflict between prescribing and mental health nursing. Other issues included delays between qualification and prescribing, the generic nature of the prescribing course and need for pharmacological updates, difficulty in getting medical supervision, and lack of a clear prescribing policy and guidance.
Ross JD and Kettles AM. Mental health nurse independent prescribing: what are nurse prescribers’ views of the barriers to implementation? J Psychiatr Mental Health Nursing 2012; published online ahead of print 1 February.
http://dx.doi.org/10.1111/j.1365-2850.2011.01872.x
Prescribing in prisons
February 17, 2012 by admin
It would be ‘unconscionable’ for someone not to receive proper palliative care because they are in prison and yet otherwise useful new guidelines provide no advice on palliative care, says an interesting editorial in the BMJ, which discusses the prescribing in prison guidelines published in 2011 by the Royal College of General Practitioners and the Royal Pharmaceutical Society.
Levy M. Editorial. Safer prescribing for prisoners. BMJ 2012;344:e447
http://dx.doi.org/10.1136/bmj.e447
Where is the evidence base: NMP in primary care?
January 3, 2012 by admin
A review of the literature on non-medical prescribing (NMP) in primary care that looked for evidence of patient outcomes has found that most such studies were undertaken in the UK, and that there are ’substantial gaps’ in the knowledge base that could inform evidence-based policy making.
The authors identified 17 empirical studies providing patient outcome evidence of NMP in primary care, with only two looking at clinical outcomes. Some papers were surveys, had qualitative designs, few participants, or reported on prescribing from limited formularies, and the authors comment that, ‘the strength of evidence they provide on the whole is limited’.
NMP in primary care does seem to improve: ‘patients’ understanding of treatment, condition and self-care and provides a better level of care’, was well accepted by patients and professionals, and improved access to medicines and healthcare professionals. Other indicators of effectiveness such as clinical outcomes or patient safety had very limited evidence, and papers on health economics and efficiency were also lacking.
Bhanbhro S et al. Assessing the contribution of prescribing in primary care by nurses and professionals allied to medicine: a systematic review of literature. BMC Health Services Research 2011; 11:330.
http://dx.doi.org/10.1186/1472-6963-11-330
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.
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.
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Recent Posts
- Non-medical prescribing in A and E and sexual health
- Formularies can support prescribing in mental health
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