Ensuring safe prescribing - Carnegie Conference centre, Dunfermline, 30th April 2009

May 26, 2009 by admin 

Workforce planning, medico-legal aspects of prescribing, medication errors, and the impact of prescribing on service delivery in chronic disease management were all highlighted at the recent ‘Ensuring safe prescribing practice’ ANP conference, held Scotland in April. Some of the more complex prescribing issues specific to different therapy areas (palliative care, COPD, minor illnesses and sexual health) were explored in a number of workshops.

The importance of safe prescribing practice was the theme emphasised throughout the day. The strategic framework ‘A safe prescription’, designed to provide NHS Boards with a framework from which they can develop and support Nursing Midwifery and Allied health Professions (NMAHPs) prescribing services that are right for the patients, the public, NMAHPs and fellow health professionals, was highlighted by Sheena Williamson ( Project Officer, NMAHP Prescribing).

Later in the morning, Omar Ali (Formulary Development Pharmacist, Surrey and Sussex NHS Trust) and Alison MacRobbie (Palliative and Community Care Pharmacist, NHS Highland) went on to look at the medico-legal aspects of prescribing and polypharmacy. Omar described the size of the medico-legal bill - the majority of medical mistakes being medication errors. Delegates were provided with the chance to play ‘judge and jury’ throughout the presentation, and asked to comment on a number of actual cases. The Bolam Principles were explained, ensuring delegates were aware of the issues surrounding legal investigations. How to make practice, prescribing and patient follow-up safe, were issues touched on throughout. Alison explored polypharmacy. What counts as polypharmacy, the cost drivers, over-prescribing versus under-prescribing, pharmacokinetics, concordance were issues covered. Alison also described a new scheme ‘Supporting medicines management in the community - NHS Highland’, designed to help maintain individuals in their own home through the safe use of medicines.

After lunch, prescribing errors - rates, impact on patients and the NHS, and Government targets, were examined by Ross Lynton (Associate Lecturer, Edge Hill University, Pharmacy Consultant-bpas, Lead Pharmacist, Fylde Coast medical Services). Cases were presented to explore the application of bad rules and systems failures. The need to reduce the frequency and severity of errors in order to improve the quality of patient care and the role of the NPSA were also covered.

Later in the day, Alison MacRobbie, in the palliative care workshop provided an overview of the medicines commonly administered to palliative care patients at the end of life. Unlicensed medicines, drug combinations, and potentially irritant drugs were some of the issues explored. Jane Jones (Senior Practice Nurse/Midwife Inverness) used a number of case studies to explore treatments in COPD. Scenario’s and case studies were used by William Craig-Macleman (Night Nurse Practitioner, Raigmore Hospital, Inverness), Lucy Store (Nurse Practitioner, Nurse Practitioner Unscheduled Care Services, Raigmore Hospital) and Steve Baguley (Consultant Genitourinary Physician, Aberdeen) to examine prescribing issues in minor illnesses, unscheduled care and sexual health. Changing antibiotics, blood results, maintaining competencies, PGDs, mixing medicines, PSDs, Chlamydia and HIV were some of the topics covered.

The benefits of nurse prescribing on service delivery - specifically continuity of care, efficiency and access, communication and safety were some of the advantages described by Molly Courtenay (Reading University), from her research exploring independent and supplementary prescribing in diabetes.

The conference was well attended by practitioners from both community and acute sectors, with many nursing specialities. Plenty of opportunity was provided for debate and discussion and there was plenty of networking.

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