Making a difference - the benefits and challenges of non-medical prescribing
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Making a difference – the benefits and challenges of non-medical prescribing Nikki Embrey RN MSc BSc (Hons) North Midland MS Service University Hospital North Midlands [email protected] Nikki Embrey RN MSc BSc (Hons) North Midland MS Service University Hospital North Midlands [email protected]
Transcript of Making a difference - the benefits and challenges of non-medical prescribing
Making a difference – the benefits and challenges
of non-medical prescribing
Nikki Embrey RN MSc BSc (Hons) North Midland MS Service
University Hospital North Midlands [email protected]
Nikki Embrey RN MSc BSc (Hons) North Midland MS Service
University Hospital North Midlands [email protected]
Introduction – how prescribing has influenced practice at UHNS
• Nurse Prescribing – what it involves in clinical practice
• What are the barriers to prescribing
• What are the benefits?
• Does it make a difference to patient outcomes?
• Does it make a difference to the CNS’s role
Super Nurse?
Should nurses prescribe?
Facts about Nurse Prescribing
• 1998 first limited national formulary published for D/N’s & HV’s
• 2002 – The NMC introduces the first independent nurse prescriber course
• 2003 – Supplementary prescribing introduced (CMP).• 2004 – NMC changes nurse prescriber course to a dual
independent/supplementary prescriber course• 2005 – NPEF extended • 2006 – Almost all of the BNF opened up to independent
and supplementary nurse prescribers• Today - prevalence in community but growing number
NP’s in Acute setting
Tradit ional nursing
MS Nurse prescribing UK
Pros and cons of NP
Argument for nurse prescribing• Specialist nurses become autonomous• Advances practice and empowers individual
• Improves patient outcomes / access to treatments
• Provides a more holistic approach.to care• Increases knowledge of pharmacology • Provides greater expertise in patient group• Enables dissemination for best practice
• Increases flexibility, service efficiency
• Helps support patient adherence and education
• Improves satisfaction in the role.
The debate for nurse prescribingAIMING to improve quality of care and reduce access issuesIn Scotland evidence shows that:
•Nurses are regarded as safe prescribers
•Doctors workloads reduced
•Public has considerable confidence in NP
•NP believe their role is more effective
The debate FOR nurse prescribing• Increased nurse autonomy, job satisfaction,
independence• Evidence shows it improves patient care – timely
access to meds, increases flexibility service efficiency avoids unnecessary A/E visits and hospital admissions improves access to treatment – particularly in LTC
• NP enables specialist nurses to educate service users and helps supports adherence to meds
• Since NP patients report higher levels of satisfaction and confidence in nurses
Counter argument
Independent prescribing
• “the prescriber takes responsibility for the clinical assessment” of the patient, establishing a diagnosis, & the clinical management required as well as responsibility for prescribing where necessary and the appropriateness of any prescription”. (NPC 2006)
Debate against nurse prescribing
Why nurses should prescribe• A qualitative study on effectiveness of NP in acute
setting found NO difference in prescribing methods of doctors and nurses IT increased patient satisfaction
• Medication errors at the hands of NP are minimal• Benefits summary – consistently reported in
literature: evidence shows improved care, satisfaction, better access to meds, reduced waiting times, higher quality of care delivered
• AND • Need more empirical evidence (RCN Policy and International Dept. 2012)
Barriers to Nurse prescribing
Nurse Prescribing course
Learning sets
Reflective incidents based on cl inical practice
Action Plans Improve the management of Relapse serviceImproved knowledge of pharmacology DMT’s Concordance
Assessment and examination of patients
- Nursing assessment and patient examination skills fit well with
Nurse prescribing – the two really should go hand-in-hand
Making a Difference in MS care
• Relapse management – Infusion Suite and Out-patients
• Disease modifying treatments - ALL
• Symptom management – advice & recommendation
• In-patient stays
How patients benefit
– Access and prompt response to patients in relapse
– Access to symptomatic management at appropriate time to meet their needs
– Disease modifying therapies – choices of therapies, increased knowledge of drugs, pharmacology, adherence, side effect management
Assessment of Clinical Prescribing Preparation Competency Framework
New treatments in MS
Prescribing Proforma
Should MS practitioners prescribe?
• YES – YOU are control
• YES – YOU know the patient and condition
• YES - You have the experience with MS Drugs
• Yes – it is a better use of resources
• YES – it makes clinical sense for long-term conditions
• Resources to support
QUESTIONS
1. For those who are prescribers – what do you prescribe?
2. Those who do not prescribe – what reasons?
3. Those who are prescribers and don’t use it – why?
4. If you are thinking about prescribing – what has influenced you?
Consider the possibi l i t ies
