Where is the evidence base: NMP in primary care?
January 3, 2012 by admin
A review of the literature on non-medical prescribing (NMP) in primary care that looked for evidence of patient outcomes has found that most such studies were undertaken in the UK, and that there are ’substantial gaps’ in the knowledge base that could inform evidence-based policy making.
The authors identified 17 empirical studies providing patient outcome evidence of NMP in primary care, with only two looking at clinical outcomes. Some papers were surveys, had qualitative designs, few participants, or reported on prescribing from limited formularies, and the authors comment that, ‘the strength of evidence they provide on the whole is limited’.
NMP in primary care does seem to improve: ‘patients’ understanding of treatment, condition and self-care and provides a better level of care’, was well accepted by patients and professionals, and improved access to medicines and healthcare professionals. Other indicators of effectiveness such as clinical outcomes or patient safety had very limited evidence, and papers on health economics and efficiency were also lacking.
Bhanbhro S et al. Assessing the contribution of prescribing in primary care by nurses and professionals allied to medicine: a systematic review of literature. BMC Health Services Research 2011; 11:330.
http://dx.doi.org/10.1186/1472-6963-11-330
Jersey to implement non-medical prescribing
September 28, 2011 by admin
Jersey is to implement a non-medical prescribing programme: the first legislative changes needed have been made and the aim is to start the first V300 course, on the island, in January 2013. Geoff White (Consultant Nurse, Practice Development, who has been very involved with this project) told the ANP that this is pivotal to the development of specialist and advanced nursing practice on Jersey, and that nurses and midwives will probably be the first groups to start the training, but that the legislation allows for other professions as well. Separate legislation would be needed for controlled drugs. Mr White predicts that nurses working in the following areas will be targeted initially: emergency care, unscheduled care, night nurse practitioners, mental health, sexual health, palliative care, and chronic disease management including diabetes. Jersey will be developing a ‘robust implementation strategy’ that takes on board lessons learned from the implementation of non-medical prescribing elsewhere; ANP committee members have provided support for this extension of non-medical prescribing.
Audit demonstrates impact of non-medical prescribing
July 18, 2011 by admin
The introduction of non-medical prescribing schemes reduced the number of GP and consultant appointments and hospital admissions, according to a Pulse report of an audit carried out by NHS North West.
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.
Non-medical prescribing continues to grow
October 5, 2009 by admin
NHS Prescription Services received 11.6 million items for processing from nurse prescribers in the year to March 2009, an increase of 18.8% on the previous year according to a recent report from the NHS Business Services Authority.
In March this year, there were over 11 000 nurse independent prescribers and more than 21 600 community practitioners on its database of prescribers, and there are now also nearly 600 pharmacist prescribers.
The number of items prescribed by nurse independent prescribers is increasing, while that prescribed by community practitioners is decreasing, although this is probably down to the increasing numbers of the latter taking the prescribing course. Penicillins are the largest single category for nurse prescribing, followed by emollients. Non-medical prescribing also appears to be reducing the pressure on GPs.
Extending non-medical prescribing
August 14, 2009 by admin
Independent prescribing should be extended to physiotherapists and podiatrists, according to the conclusions of a Department of Health scoping project report on the allied health professions and medicines supply mechanisms. The report says that quality of care is compromised by the limitations of the current system and considers the case for change in existing arrangements for each profession.
It recommends that supplementary prescribing by dietitians is established and a specific list of potential exemptions for them be considered, and that a specific list of exemptions for orthoptists is established.
Although there is some evidence supporting a progression to independent prescribing for radiographers it is less strong than for physiotherapists and podiatrists and further work may be needed to consider the need for this, along with the possible need for supplementary prescribing by speech and language therapists, orthoptists and occupational therapists.
Support for coordinated research into the impact of prescribing by allied health professionals on patients, services and prescribing trends should also be considered, although the report is clear that this should not delay change. It also says that the incremental approach - moving from supplementary to independent prescribing that has been adopted so far (although not for nurses) - should be continued.
DH updates non-medical prescribing leads list
June 21, 2009 by admin
The Department of Health (DH) has published an updated list of non-medical prescribing leads in Strategic Health Authorities, which can be found here.
Public awareness of non-medical prescribing
May 11, 2009 by admin
The Scottish public seem to be reasonably well aware of non-medical prescribing, with more than half the respondents to a survey saying they knew that trained health professionals could write prescriptions for medicines previously prescribed only by doctors. They were most comfortable with pharmacist prescribing, closely followed by nurse prescribing.
The postal questionnaire was sent to 5000 members of the public in November 2006, and generated a response rate of 37.1%.
Stewart DC et al. Cross Sectional Survey of the Scottish General Public’s Awareness of, Views on, and Attitudes Toward Nonmedical Prescribing. Ann Pharmacother 2009; 43(9): published online 5 May.
NPC launches non-medical prescribing support programme
May 1, 2009 by admin
The National Prescribing Centre (NPC) has launched a new programme to support non-medical prescribing (NMP).
The Department of Health has commissioned it to ‘assist in promoting and supporting the continued development of NMP, within prescribers’ competencies, through effective policy implementation, advice and promotion’, explains the NPC, which says it aims to increase recognition and understanding of NMP by better communications and to provide a resource of knowledge, information and advice.
Non-medical prescribing in an acute cardiac ward
April 10, 2009 by admin
Non-medical prescribing in an acute cardiac ward can provide timely and safe access to medication, suggests the experiences of two nurse prescribers on their ward. These nurses have found that they are in a position to correct prescribing errors immediately, support prompt discharge by being able to prescribe discharge medication, increase patient involvement in treatment through their greater knowledge of medicines management, and that once they had got used to identifying appropriate situations, prescribing became second nature to them. Prescribing only really started once the formulary was opened up and its successful growth in this setting was through multidisciplinary collaboration, as suggested by the literature. These nurses have found that prescribing is never done in isolation, but tends to be discussed either before or afterwards. The authors found they could progress only with the support of other clinical prescribers in their specialty; the CPD group they attend cannot meet individual needs although it addresses wider prescribing issues.
Do you prescribe in an acute ward setting? If so, do share your experiences with others on the forum.
Goswell N and Siefers R. Experiences of ward-based prescribers in an acute ward setting. Br J Nursing 2009; 18(1): 34-37
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