Bellingham C. How supplementary prescribing is working for pharmacists in practice. Prescribing and Medicines Management 2004; July: 2–3.

Summary

The increased emphasis on evidence-based practice within healthcare has compelled nurses to obtain up to date research information to assist them in clinical decision-making. Electronic databases are a crucial resource for finding this information, but a successful search strategy is vital if relevant information is not to be missed. This article highlights the key steps in the searching process with examples from three databases on the OVID and Dialog Datastar platforms.

Summary

Nurse Prescribing in mental health care is now a reality. As part of a long-term plan to introduce the prescribing role for mental health nurses in the local area, Doncaster and South Humber Health Care Trust and the School of Nursing and Midwifery at the University of Sheffield conducted a study tour of centres well established in the clinical practice and educational preparation for prescriptive authority for nurses. The findings from the visit are explored, for example: a) how is a competence in prescribing achieved by nurse, b) what is the educational delivery needed to prepare the potential prescriber? Insights are offered based on the provision of care by nurse prescribers in the states of Massachusetts and Connecticut that we visited. These are then discussed in the context of the future development of this role, which is now being introduced as an innovation aimed at meeting the mental health care needs of patients in the UK.

Summary

The extended independent and supplementary nurse prescribing programme implemented in 2003 is anticipated to have the potential to improve patient care by enabling faster access to medicine for people with chronic conditions such as Diabetes. Diabetes mellitus is a progressive, life–long, chronic condition which affects an estimated 1.4 million people in the UK and inevitably requires medication to control symptoms and prevent complications associated with the disease.

The supplementary prescribing option of nurse prescribing is an opportunity for Diabetes Specialist Nurses (DSN) to provide timely and appropriate clinical management for patients with diabetes within an agreed management plan. The clinical management plan (CMP) is a patient specific document and can only be implemented to enable supplementary nurse prescribing upon agreement by the individual patient, the independent prescriber (doctor or dentist and supplementary prescriber (nurse or pharmacist). The CMP allows the DSN to manage the treatment of the patient by modifying diabetes therapies tailored to the needs of the individual to achieve treatment goals. The use of a patient specific CMP compliments the National service Framework for diabetes requirement that all patients have a care plan. Involving the patient by seeking agreement to implement the CMP may improve concordance and compliance with therapies and treatment decisions.

Monitoring diabetes control is essential from diagnosis as the information received provides valuable feedback as to the effectiveness of therapies. Comprehensive diabetes education should be tailored to empower the patient with knowledge and skills to manage this chronic condition regardless of treatment regimes.

Consideration should always be given to the type of diabetes, the potential effects on lifestyle and treatment options available today.

Summary

The role of the Pharmaceutical Industry within healthcare has been a debate amongst our medical colleagues for the past decade. However, with the growing number of nurses who are now qualified to prescribe, this controversial aspect of professional practice is becoming an area of interest to nurses. This article reviews some of the literature on prescribing and the pharmaceutical Industry, in an attempt to raise nurses awareness. Nurses have skills that are central to their education of assessment and evaluation. It argues that nurses are well placed to utilise these skills to identify the influences of the Pharmaceutical Industry. The role of the Pharmaceutical Industry in professional development is debated, suggesting that nurses have the skills to analyse the potential impact of this form of education. Concepts of Ethics are discussed in relation to prescribing, patient care and professional education and practice.

Benbow M. Mixed dressings – a clinical governance issue? Journal of Community Nursing 2004; 18(3): 26–32.

Abstract

Mental health nurses are relative latecomers to nurse prescribing. This is primarily because nurse prescribing has been seen as more appropriate for general nurses, particularly those working in the community or primary care. Pharmacists and psychiatrists were concerned about the complexity of prescribing for clients with mental health problems and felt that the training of mental health nurses and their clinical experience did not fit them to take on a prescribing role. These, and other impressions, may have influenced which groups of nurses were first selected to become nurse prescribers. However, recent studies have indicated that mental health nurses add considerably to the effectiveness of assessments and care plans, and that they are in an ideal position to integrate drug treatments with a wide range of non-pharmacological therapies knowledgeably, safely, effectively and in a manner that is acceptable to the patient. They have also been found to have an important role to play in monitoring the side effects of drugs and in providing education about medication, and in maintaining a therapeutic alliance with clients on long-term drug treatment. Whatever the limitations, mental health nurses as prescribers may still be deemed to have by some professional groups, and even by themselves, at this stage in the evolution of nurse prescribing, it is now inevitable that they will play a significant part in the overall improvement of mental health services during this decade. They are likely to challenge the existing prescribing practices and help in identifying the conditions under which medication is most therapeutic.

Summary

Asthma is a common respiratory disease in the UK with over 5 million sufferers. It a reversible airways disease characterised by bronchoconstriction, inflammation, oedema and mucus production. There is a wide spectrum of severity and asthma can be controlled effectively by pharmacotherapy. The British Guideline on the Management of Asthma provides the framework for treatment. Primary care nurses have been involved in the management of asthma for many years and a large number have undertaken asthma training courses. The asthma guidelines recognise the benefit of trained asthma nurses in the provision of care.

The revised General Medical Services contract rewards practices who provide asthma care under the Quality Indicators framework. Supplementary nurse prescribing allows nurses with appropriate training to prescribe asthma medication, providing the diagnosis of asthma is confirmed by a medical practitioner and a clinical management plan is used. Community pharmacists have an important role in the care of patients with asthma as well and some pharmacists have become supplementary prescribers. Their role will become more evident in the future.

The main asthma medications are bronchodilators and inhaled steroids, which should be used at the lowest dose to control symptoms. Caution should be exercised in young children where many asthma medications are used ‘off-label’. Their use can be justified when it is the most appropriate medication and is supported by evidence such as asthma guidelines.

All patients on asthma medicines should be monitored closely, not only to ensure control of symptoms but to monitor for adverse side effects. Sufficient knowledge of appropriate pharmacology is required by those involved in asthma management. Regular asthma review should be structured and include issues of adherence to medication, appropriate use, inhaler technique, current symptoms and effects on lifestyle. All patients should have an asthma action plan so they know how to manage their asthma. This action plan is agreed with the patient and the health professional. Appropriate asthma management and supplementary prescribing will enhance patient care.

Jordan S and Griffiths H. Nurse prescribing: developing the evaluation agenda. Nursing Standard 2004; 18(29): 40–44.

James J. Nurse prescribing: is the gain worth the pain? Journal of Diabetes Nursing 2003; 7(9): 351–356.

Nursing Times 2004; 100(22): 47–67.

Nursing Times 2004; 100(4): 49–69.

Jukes M et al. Nurse prescribing: a case for clinical supervision. British Journal of Community Nursing 2004; 9(7): 291–297.