Putting an end to prescribing by postcode?
March 2, 2012
NICE has announced that it will produce a guide to best practice in developing local formularies to help ensure that all patients in England have access to clinically effective and cost-effective drugs. NICE deputy chief executive Dr Gillian Leng said that, “At the moment there is no standard process for them and there tends to be a lot of variation and inconsistencies across England”.
The announcement follows publication of a Department of Health report, ‘Innovation, health and wealth‘, at the end of last year. The report said that, “There should be no local barriers to accessing technologies recommended in NICE appraisals, beyond a clinical decision relating to an individual patient.” It commented that local formulary processes should be “seen as supporting timely and planned implementation of NICE Technology Appraisals”, and they should not try to duplicate NICE assessments or to prevent the uptake of NICE-approved medicines. In fact, all these appraisal recommendations in the future should be automatically incorporated into local formularies, where clinically appropriate, within 90 days. The report also describes the other measures that will be taken to support the new regime.
Why aren’t mental health nurse prescribers prescribing?
February 17, 2012
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
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
Evidence into practice: key therapeutic topics
February 17, 2012
What are the gaps between the evidence base for some important therapeutic areas and current prescribing data? The January MeReC bulletin from the National Prescribing Centre (NPC) is the first in a series of three highlighting some possible areas for action, starting with non-steroidal anti-inflammatory drugs (NSAIDS), antibiotic prescribing (especially quinolones and cephalosporins), and high-dose inhaled corticosteroids in asthma.
For example, the prescribing data show wide variation in the volumes of NSAIDS being prescribed and in the proportion that are ibuprofen or naproxen. Prescribing of NSAIDs should be reviewed routinely, especially for high-risk groups, and most of this prescribing should be for low-dose ibuprofen or for naproxen.
MHRA still working on unlicensed medicines review
February 17, 2012
The Medicines and Healthcare products Regulatory Agency (MHRA) has said it is carrying out further work on the proposals generated in its review of the regulation of unlicensed medicines but has not published a timetable for further progress, although it says it hopes to do this soon.
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Recent Posts
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