Journals
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.
Non-medical prescribing in secondary care: more is needed
November 10, 2010 by admin
“When are the other night sisters going to do their prescribing course?” was the question asked of this orthopaedic night sister with a non-medical prescribing qualification working in a centre for elective orthopaedic surgery, by nursing colleagues who felt they were able to provide better care for their patients as a result of her prescribing. This interesting article describes an audit of the author’s prescribing practice and some of her experiences as a prescriber.
The plan for this prescriber had been that she would start by prescribing for patients on the close observation unit within the centre and then after three months to start prescribing for the rest of the centre, but in fact her skills were needed sooner than that by other wards.
An audit was conducted after four months using her prescribing diary, a list of drugs she was allowed to prescribe, annotated to indicate the number of times they were prescribed, and the Trust audit tool. This showed that her prescribing was readable, clear, correct and in line with local policy and guidelines. She was prescribing a mean of 5.4 times a night, with the most common items being analgesia and intravenous fluid The author comments that one issue was that she sometimes had to prescribe and administer medicines to a patient, so would ask another trained nurse to check and co-sign the prescription before administration. She points out also that it is appropriate not to prescribe in situations where the prescriber does not feel confident (an example was requests for night sedation from patients who had already had large amounts of morphine).
It is still unusual to find nurses prescribing in wards, although specialist nurses and nurse consultants are prescribing in hospitals: the author explains the rationale and benefits for introducing nurse prescribing in her particular setting, concluding that more non-medical prescribers are needed in secondary care.
Crew S. Non-medical prescribing in secondary care: an audit. Nurse Prescribing 2010; 8(10): 498-502.
Where has non-medical prescribing got to?
October 17, 2010 by admin
Non-medical prescribing needs to be fully and effectively integrated into service delivery and workforce planning if it is to be rolled out into new practice areas and its full benefits realised, concludes this author in an assessment of non-medical prescribing now, more than 15 years since district nurses and health visitors started to prescribe from a very restricted list.
Important systems and processes for non-medical prescribing include: ensuring students and designated medical practitioners (DMPs) understand the expectations of the prescribing programme; defining a prescribing role for each student when qualified; identifying clear criteria for going on the course; and putting support systems involving clinicians and managers in place.
Mental health nurse prescribing and understanding of medicines
October 17, 2010 by admin
“Previously unknown levels of incompetence” are revealed by the better understanding of medicines mental health nurses acquire when they become prescribers, argue the authors of this article, concluding by suggesting that there is a case for structured education in medicines management to be introduced into pre- and post-registration mental health nursing in the UK.
They use a variety of methods to come up with a theory that describes the process of becoming competent in mental health nurse prescribing, consisting of four themes that could provide a starting point for breaking down the skills nurses need to manage medicines safely. The authors highlight the sidelining of medicines management in mental health nursing, and how there is still debate over whether mental health nurses should be prescribing.
Snowden A and Martin CR. Mental health nurse prescribing: a difficult pill to swallow? J Psychiatric Mental Health Nursing 2010; 17: 543-553.
District nurse and independent prescribing
September 27, 2010 by admin
What is the experience of district nurses who are independent prescribers? This study explored this issue using interviews with eight district nurses practising as nurse independent prescribers in the west of Scotland. It found that their experiences were largely positive but identified a particular problem - which may be less of an issue for practice nurses - to do with administration and particularly duplicate record keeping (nursing and medical notes). This was of great concern and involved all sorts of difficulties to do with different locations, paperless systems and computer access. It is possible that the cumbersome systems were causing some nurses to limit their prescribing, although the authors point out that they were also relatively inexperienced as prescribers and lacked confidence (five expressed a lack of confidence in their prescribing ability).
Support - both organisational and peer - was a major issue too, with nurses reporting a lack of support from the time they qualified as prescribers: even when support mechanisms existed, they may be insufficient or inconsistent. As well as confidence and support, education and ongoing development, and nursing relationships and roles were identified as influences on prescribing practice. Other difficulties included an increase in workload associated with prescribing, partly because of the administrative issues, and a lack of remuneration and recognition.
Benefits identified by the nurses included saving time, a more seamless service for patients, and increased autonomy and job satisfaction, which supported the development of the district nursing role.
Downer F and Shepherd CK. District nurses prescribing as nurse independent prescribers. Br J Community Nursing 2010; 15(7): 348-352.
Consultations in diabetes care with nurse prescribers: patients’ views
September 20, 2010 by admin
Nurses prescribing for people with diabetes do so using the principles of patient-centred care, to the benefit of their patients, according to the conclusion of this study involving interviews with 41 patients with diabetes from the primary care case loads of seven nurse prescribers. Other benefits, for example improved understanding of treatments and conditions and improved self-care, seemed to result from the combination of a person-centred care approach combined with the additional knowledge and abilities of the nurse prescriber. Patients felt that continuity of relationships, flexibility over consultation length, nurses’ interpersonal skills, and specialist diabetes knowledge were all crucial. The authors argue that a number of related aspects of the nurse consultation style are coming together, enhancing patient care - in ways that may improve treatment decisions and adherence.
The extent to which patients wanted information about treatment options, or wanted to be involved in the decisions, varied widely and they were largely happy with the extent of their involvement. The provision of information about possible side effects seemed to be an area of inconsistency, however.
Stenner KL, Courtenay M and Carey N. Consultations between nurse prescribers and patients with diabetes in primary care: a qualitative study of patient views. Int J Nurs Stud 2010; in press. doi:10.1016/j.ijnurstu.2010.06.006.
Independent pharmacist prescribing in primary care
September 20, 2010 by admin
How can independent pharmacist prescribing be supported in primary care, as some pharmacist prescribers struggle to develop their roles and overcome barriers? In this interesting article, consultant pharmacist for cardiovascular disease Helen Williams describes how she works in primary care to develop prescribing roles for pharmacists, to convince GPs to commission pharmacist prescribing services - in the case of one of the new clinics, funding has now been taken over by a GP practice - and to support all prescribers. She describes how, for example, they have been able to demonstrate improvements in overall QOF achievements for blood pressure control in GP practices associated with the clinics she has been involved in setting up.
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.
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