Journals
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.
Time to make prescribing safety a primary care priority?
July 15, 2011 by admin
There are ‘considerable’ opportunities to improve primary care prescribing safety and it is time that prescribing safety becomes a priority in primary care, according to the authors of this study. They analysed data from 315 Scottish general practices and found that nearly 14% of patients who were defined as being vulnerable to adverse drug events had received one or more high-risk prescriptions in the last year.
Vulnerability was assessed on the basis of age, pre-existing condition such as heart failure or chronic kidney disease, or existing prescription of a drug with potential for interaction such as warfarin or diuretics. Indicators for high-risk prescribing were defined on the basis of safety alerts, national clinical guidelines, the BNF and prescribing advice. What this means is that although few of these prescriptions were absolutely contraindicated and may have been appropriate, explicit guidance mostly underpinned by a solid evidence base existed that they carried significant risk of harm and should be avoided in most situations. Of those patients prescribed 11 or more drugs in the long term, more than a quarter received a high risk prescription, and increasing age also increased the risk, up to the age of about 80. There was wide variation in high-risk prescribing between practices, with none of the variables examined accounting for this.
The authors suggest that drug reviews could be targeted at those receiving high risk prescriptions defined using these indicators, so that their appropriateness can be the subject of clinical judgement. Despite the significant harm caused by prescribing, these results suggest that prescribing improvement activity does not focus enough on safety.
Guthrie B et al. High risk prescribing in primary care patients particularly vulnerable to adverse drug events: cross sectional population database analysis in Scottish general practice. BMJ 2011; 342:d3514.
http://dx.doi.org/10.1136/bmj.d3514.
Clarity needed about the role of non-medical prescribing leads
June 8, 2011 by admin
Non-medical prescribing leads (NMP leads) make a significant contribution to the development of NMP and its oversight within Trusts, despite lack of clarity about the role and workload and other issues, according to this report of an interview study with 28 NMP leads across one Strategic Health Authority.
The role of the NMP lead included: information and communication between the Trust and prescribers; promoting and co-ordinating NMP and integrating it into service planning; clinical governance; and support and training. There was inconsistency and lack of clarity about the functions and scope of the NMP lead, and dedicated time for the role was often insufficient. The authors conclude that there should be clear national guidelines about the responsibilities, role and workload of NMP leads, and that greater consistency is also needed in clinical governance systems as NMP expands. In particular, all NMPs should be able to review their prescribing data.
Conversely, where strategies for the development of NMP did exist, it was more likely to be embedded within organisations, and practitioners faced fewer barriers.
Courtenay M, Carey N and Stenner K. Non medical prescribing leads’ views on their role and the implementation of non medical prescribing from a multi-organisational perspective. BMC Health Services Research 2011; 11:142.
http://dx.doi.org/10.1186/1472-6963-11-142
Paracetamol prescribing in children
June 8, 2011 by admin
There are ‘relatively high levels of potential overdosing in the youngest children and potential underdosing in the oldest children’ in paracetamol prescribing in primary care, according to the conclusions of this study. It analysed a year’s data about paracetamol prescriptions in children aged 0-12 in general practices in Scotland.
About one-fifth of the paracetamol prescriptions were defined as off-label - being outside the BNF for Children age and dose recommendations - with incorrect doses being the most common reason. In addition, another 15% of prescriptions did not have dosage instructions.
The risk of over-dosing in young children carries a risk of toxicity, particularly as parents and carers often use paracetamol for children before they seek professional advice. For older children receiving doses that are too low, there is a risk of treatment failure and prescribing not being cost-effective.
Kazouini A et al. Paracetamol prescribing in primary care: too little and too much? Br J Clin Phamacol 2011; in press.
http://dx.doi.org/10.1111/j.1365-2125.2011.03993.x
Potential of nurse prescribing in dermatology
February 3, 2011 by admin
This commentary on a recent article (see here) argues that nurse prescribing has an important contribution to make to the development of dermatology services given its scale and its potential to improve treatment outcomes and access to care. As ways of improving treatment effectiveness develop and are evaluated, it is important that they take account of nursing activity.
Ersser SJ. Nurse prescribing, concordance and the therapeutic consultation. BJD 2011; 164(2): 236-237.
Pharmacist independent prescribing: a community-based mental health clinic
February 3, 2011 by admin
A pharmacist independent prescriber describes his experiences in a community-based clinic for secondary care patients, mostly with affective disorders. A nurse prescriber and a consultant psychiatrist run clinics in tandem: he says there is a niche for pharmacist prescribers to see more complicated cases where people are taking multiple medicines and that more pharmacists could do this kind of work - although seeing patients like this and being responsible for them as a prescriber is outside the traditional comfort zone for many pharmacists.
Kirk S. Independent prescribing for secondary care patients in a community-based clinic. Br J Clin Pharmacy 2010; 2(11): 347-348.
http://www.clinicalpharmacy.org.uk/2010/december.html
Evaluating nurse prescribing in acute care: a case study
February 3, 2011 by admin
Nurse prescribers and doctors were found to provide equivalent care in this small case study in an acute hospital. This is interesting because much research so far has focussed on community settings and also because this study sought views from a range of levels within the organisation, including managers and patients from a range of ethnic groups.
The researchers used semi-structured interviews with nurse prescribers, medical, nursing and pharmacy colleagues and senior hospital staff, observations of nurse and doctor consultations, and patient questionnaires.
Nurse prescribing was seen as a positive development: there were benefits for patients through better use of staff skills and improved service delivery and both the prescribers and their colleagues were positive about the changes and their impact. Patients were more likely to be satisfied with the medication information they had received if they had seen a nurse rather than a doctor. Patients from different ethnic groups appeared to have similar views about their experience and medication. The prescribing practice of the doctors and nurses were found to be similar. Shared vision, local championship, action learning and team, peer and buddy support were all identified as factors that actively enabled implementation.
Jones K, Edwards M and While A. Nurse prescribing roles in acute care: an evaluative case study. J Advanced Nursing 2010; 67(1): 117-126.
Numeracy standards: could do better?
January 24, 2011 by admin
This author, a course leader for independent and supplementary nurse prescribing courses, raises questions about how well the current numeracy standards work and whether a review of the way numeracy is taught and assessed in the prescribing programme is needed. More consistency in assessment methods, which vary widely, and continuing education in the clinical setting, could perhaps help reduce drug errors - and also increase the competence and confidence of prescribers.
Axe S. Numeracy and nurse prescribing: do the standards achieve their aim? Nurse Education in Practice 2010; in press.
http://dx.doi.org/10.1016/j.nepr.2010.11.008
Pharmacist prescribing on a surgical ward
January 24, 2011 by admin
Pharmacist prescribing does not always seem to have realised its potential - this account of how pharmacist prescribing was introduced to a surgical ward looks at some of the benefits, as well as describing the process of implementation. The author highlights the fact that of the new items prescribed for patients in the first three months, the three most common categories - anticoagulants, analgesics and antibacterials - all correlate with priority areas in patient safety initiatives, and there had also been previous incidents on the ward in all three areas. Anecdotally, benefits included speedier prescribing on admission and a faster discharge process. The author believes that a close working relationship with the surgical team was crucial to the success of this initiative.
Sassi-Jones K. Benefits of implementing pharmacist prescribing on a surgical ward. Br J Clin Pharmacy 2010; 338-340.
Dermatology and nurse prescribing: patients’ views
December 16, 2010 by admin
Nurse prescribing in dermatology services can increase both their efficiency and patients’ involvement in treatment, according to the views reported here of patients with acne, psoriasis or eczema treated by seven specialist dermatology nurse prescribers.
The patients reported improved access as a result of greater efficiency, more appointments, telephone access to nurse prescribers (particularly noted) and the provision of local services. They also said they were involved in treatment decisions and care planning and, in contrast to some previous work, that they were happy with the information about the medicines provided. They rated the continuity of care provided, and the consultation style of the nurse prescribers, highly - and levels of trust and confidence were also high.
The authors comment that, given the financial constraints the NHS will be operating under, these results could have important implications for using resources to their maximum and improving access to, and quality of, dermatology specialist services.
Courtenay M, Carey N, Stenner K, Lawton S and Peters J. Patients’ views of nurse prescribing: effects on care, concordance and medicine taking. Br J Dermatology, in press.
http://dx.doi.org/10.1111/j.1365-2133.2010.10119.x.
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