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
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
Nurse prescribing: mental health in older people
March 26, 2010 by admin
Non-medical prescribing in mental health services has tended to focus on supplementary prescribing. This article describes a pilot in which a successful shift was made to independent prescribing in community mental health care services for older people.
The scheme worked this way: the non-medical prescriber assessed the patient, discussed the current issues and agreed treatment options with the consultant psychiatrist responsible for that patient - and was then responsible for seeing the patient, discussing the treatment, issuing prescriptions, and reviewing the medication, with ongoing discussions with the consultant as needed. Three senior nurses and four consultant psychiatrists were involved. Trust formularies were adhered to throughout the pilot.
Interviews, documentary evidence and patient questionnaires were all used to build up a picture of how the project worked, with encouraging results. The nurse prescribers felt that their relationships with patients were enhanced and that this, along with their accessibility, contributed to a coherent and responsive service. The authors conclude that they recommend this model.
Oldknow H et al. Independent nurse prescribing for older people’s mental health. Nurse Prescribing 2010; 8(2): 66-69.
Specialist mental health nurse prescribing: professionals’ views
March 11, 2010 by admin
Once again, education for other professionals about the training and role of non-medical prescribers has been identified as an issue, this time in establishing nurse prescribing in specialist mental health teams.
In this case study, which aimed to explore the views and experiences of professionals within one specialist mental health team, nine health professionals from different disciplines attended a focus group and two psychiatrists were interviewed separately.
In general, the views were positive and a range of benefits identified including improved care and more teamworking. One striking finding in the focus group was that there was very little knowledge about aspects of nurse prescribing: training, requirements, responsibilities and practicalities. So even in a team with a practising nurse prescriber, colleagues were uncertain about their role and responsibilities. In the psychiatrists’ interviews it became clear that they had no training or support for their supervisory role, and that they had some anxieties, which the authors link to the perception that they might be expected to supervise an inexperienced prescriber who might make errors that they would be responsible for.
Increase in nurse prescribing in mental health
March 11, 2010 by admin
There has been a ‘marked growth’ in nurse prescribing in mental health services in England in the last three years, according to the results of a national survey of directors of nursing in mental health trusts. Trusts may be going in different directions: some are mainly, or exclusively, developing supplementary prescribing; others are planning to focus mostly on independent prescribing, using supplementary prescribing as a stepping stone for nurses to develop skills and confidence before prescribing independently.
Despite the overall growth in nurse prescribing in mental health, both the numbers of nurse prescribers and the proportions of independent and supplementary nurse prescribers vary between trusts. It is still not clear which type of prescribing is most appropriate for different settings and which aspects of the supplementary prescribing role will continue to be useful as nurses begin to use independent prescribing (overall seen as more valuable in the survey). Organizations need to examine workforce planning models for nurse prescribing in specific specialties or services and further work is needed to maximize the development of prescribing roles and the benefits gained them. The authors caution that despite a reasonable response rate, it is possible that trusts with no interest in the subject were less likely to respond to the survey.
Encouraging results from evaluation of mental health supplementary prescribing
February 4, 2010 by admin
How effective has non-medical supplementary prescribing been in mental health? This paper reports encouraging findings from a national evaluation funded by the Department of Health, which suggest that the effect of transferring from an independent medical prescriber to a mental health nurse prescriber may be negligible. Â
The study used two groups of patients - matched for age, gender, diagnosis and chronicity - prescribed for by nurse supplementary prescribers and by psychiatrists. The outcomes for medication adherence, health status, side effects and satisfaction with overall care did not differ significantly between the two groups. It was therefore important to know whether the costs differed: although the different prescriber groups used resources in different ways, there were no significant cost differences. The authors say that this is the first known study to compare the cost and clinical impact of independent medical prescribing and mental health nurse prescribing.
The authors add a note of caution: although the patients were matched on some characteristics, one group may still have been more seriously illl at baseline; and the patients were not randomly allocated to the different types of prescriber. Nonetheless, the results are encouraging.
Mental health nurse prescribing: psychiatrists’ concerns
June 6, 2009 by admin
How is mental health nurse prescribing viewed by psychiatrists and nurses, given the slower than expected uptake of nurse prescribing by mental health nurses, and the suggestion that psychiatrists’ behaviour is a barrier for implementation? It seems that a majority of both groups are now in favour of mental health nurse prescribing but with more psychiatrists expressing concerns, according to a recent study.
This study, the first large in-depth attempt to explore and compare these attitudes and perspectives of mental health nurses and psychiatrists, used a specially created questionnaire returned by 82 psychiatrists and 119 mental health nurses, after random selection of recipients from staff lists in two large metal health trusts. So, importantly, it was not a sample of those undertaking nurse prescribing or involved with it necessarily, although a rather low response rate may be explained by the suggestion that many recipients had no knowledge of, or interest in, nurse prescribing, perhaps leading to some bias in respondents.
Although psychiatrists and mental health nurses were overall in favour of mental health nurse prescribing, psychiatrists had particular concerns about aspects of clinical and legal responsibility, and the appropriate setting for use, with nurses being much more positive about the notions of mental health nurses prescribing in acute inpatient wards and of nurses prescribing medication (including intravenous medication in emergency situations) for rapid tranquilisation. Interestingly, about half the participants from both groups thought mental health nurse prescribing would cause conflict in clinical teams, 61% of psychiatrists thought it would make services more complex, and nearly half of the psychiatrists disagreed with the assertion that it has an increasingly favourable evidence base.
The authors argue that some of the findings may be explained by a perceived change in power balance.
Patel MX et al. Attitudes regarding mental health nurse prescribing among psychiatrists and nurses: A cross-sectional questionnaire study. Int J Nurs Stud 2009;Â 46(11): 1467-1474
Nurse prescribing in Mental Health - new book
April 10, 2009 by admin
Nurse prescribing in mental health: A practical handbook on nurse prescribing in mental health, costing £27.99 and by Adrian Jones. It is aimed at those mental health nurses who are trained nurse prescribers, or who are currently training or who would like to train. The publisher says it is evidence-based throughout and includes both the principle and practice of prescribing as applied to mental health nursing and an exploration of the different types of medicines used. For more details, click here.
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