Nicola Carey

Patients’ views of nurse prescribing: effects on care, concordance and medicine taking

Background  Skin disease can have a huge impact on quality of life for patients and their families. Nurses have an important role in the delivery of specialist dermatology services, and prescribing enhances the care they provide. The views of dermatology patients about nurse prescribing are unknown.

Nurse independent prescribing and nurse supplementary prescribing practice: national survey

AIM This paper is a report of a survey to provide an overview of nurse independent prescribing and nurse supplementary prescribing across the United Kingdom. BACKGROUND Evidence examining the frequency of prescribing by nurses is conflicting, and it is evident that several factors hamper prescribing practice. As of May 2006, legislative changes gave appropriately qualified nurses virtually the same independent prescribing right as doctors. However, there is currently no evidence available about the prescribing practices of these nurses. METHOD A random sample of 1992 qualified Nurse Independent/Nurse Supplementary Prescribers registered with the Nursing and Midwifery Council was sent a postal questionnaire in 2006. A total of 1400 (70%) questionnaires were returned, of which 1377 were completed. FINDINGS Eight hundred and ninety-one (65%) respondents worked in primary care, and 333 (24.3%) worked in secondary care. Three quarters of the sample had more than 5-year clinical experience in the area in which they prescribed prior to entering the prescribing programme. One thousand one hundred and seven (87%) participants had used nurse independent prescribing and 568 (44.6%) nurse supplementary prescribing. Restriction of local arrangements, implementation of the Clinical Management Plan and access to doctors hampered or prevented prescribing. CONCLUSION The adoption of prescribing by nurses in the United Kingdom has increased patient choice with regard to access to medicines. A number of factors which hamper or prevent prescribing require further exploration.

Nurse-led care in dermatology: a review of the literature

Background  Nurses play lead roles in the delivery of care in dermatology. While a number of primary studies have been conducted evaluating nurse‐led care in dermatology, review and synthesis of the findings from these studies has not been undertaken.

The impact and effectiveness of nurse‐led care in the management of acute and chronic pain: a review of the literature

AIMS AND OBJECTIVES To identify, summarise and critically appraise the current evidence regarding the impact and effectiveness of nurse-led care in acute and chronic pain. BACKGROUND A diverse range of models of care exist within the services available for the management of acute and chronic pain. Primary studies have been conducted evaluating these models, but, review and synthesis of the findings from these studies has not been undertaken. DESIGN Literature review. METHOD Searches of Pubmed (NLM) Medline, CINAHL, Web of Knowledge (Science Index, Social Science index), British Nursing Index from January 1996-March 2007 were conducted. The searches were supplemented by an extensive hand search of the literature through references identified from retrieved articles and by contact with experts in the field. RESULTS Twenty-one relevant publications were identified and included findings from both primary and secondary care. The areas, in which nurses, caring for patients in pain are involved, include assessment, monitoring, evaluation of pain, interdisciplinary collaboration and medicines management. Education programmes delivered by specialist nurses can improve the assessment and documentation of acute and chronic pain. Educational interventions and the use of protocols by specialist nurses can improve patients understanding of their condition and improve pain control. Acute pain teams, led by nurses, can reduce pain intensity and are cost effective. CONCLUSIONS Nurses play key roles in the diverse range of models of care that exist in acute and chronic pain. However, there are methodological weaknesses across this body of research evidence and under researched issues that point to a need for further rigorous evaluation. RELEVANCE TO CLINICAL PRACTICE Nurse-led care is an integral element of the pain services offered to patients. This review highlights the effect of this care and the issues that require consideration by those responsible for the development of nurse-led models in acute and chronic pain.

An overiew of non medical prescribing across one strategic health authority: a questionnaire survey

BackgroundOver 50,000 non-medical healthcare professionals across the United Kingdom now have prescribing capabilities. However, there is no evidence available with regards to the extent to which non-medical prescribing (NMP) has been implemented within organisations across a strategic health authority (SHA). The aim of the study was to provide an overview of NMP across one SHA.MethodsNMP leads across one SHA were asked to supply the email addresses of NMPs within their organisation. One thousand five hundred and eighty five NMPs were contacted and invited to complete an on-line descriptive questionnaire survey, 883 (55.7%) participants responded. Data was collected between November 2010 and February 2011.ResultsThe majority of NMPs were based in primary care and worked in a team of 2 or more. Nurse independent supplementary prescribers were the largest group (590 or 68.6%) compared to community practitioner prescribers (198 or 22.4%), pharmacist independent supplementary prescribers (35 or 4%), and allied health professionals and optometrist independent and/or supplementary prescribers (8 or 0.9%). Nearly all (over 90%) of nurse independent supplementary prescribers prescribed medicines. Approximately a third of pharmacist independent supplementary prescribers, allied health professionals, and community practitioner prescribers did not prescribe. Clinical governance procedures were largely in place, although fewer procedures were reported by community practitioner prescribers. General practice nurses prescribed the most items. Factors affecting prescribing practice were: employer, the level of experience prior to becoming a non-medical prescriber, existence of governance procedures and support for the prescribing role (p < 0.001).ConclusionNMP in this strategic health authority reflects national development of this relatively new role in that the majority of non-medical prescribers were nurses based in primary care, with fewer pharmacist and allied health professional prescribers. This workforce is contributing to medicines management activities in a range of care settings. If non-medical prescibers are to maximise their contribution, robust governance and support from healthcare organisations is essential. The continued use of supplementary prescribing is questionable if maximum efficiency is sought. These are important points that need to be considered by those responsible for developing non-medical prescribing in the United Kingdom and other countries around the world.

The views of patients with diabetes about nurse prescribing

Diabet. Med. 27, 1049–1054 (2010)

Nurse prescriber–patient consultations: a case study in dermatology

AIM This paper is a report of a study exploring the content and processes in consultations between nurse prescribers and patients with dermatological conditions. BACKGROUND Communication skills, consultation time, information and follow-up are central to the treatment and management of patients with dermatological conditions. The contribution nurses make to the care of these patients has great potential. METHOD A multiple case study was conducted with 10 practice settings across England in which nurses prescribed medicines for patients with dermatological conditions. Data were collected between June 2006 and September 2007 using semi-structured interviews (n = 40), patient questionnaires (n = 165/200) and videotaped observations of nurse consultations (n = 40). Data analysis included thematic analysis, descriptive statistics, chi-square and non-parametric tests. FINDINGS Nurses believed that their holistic approach to assessment, combined with their prescribing knowledge, improved prescribing decisions. Listening and explanation of treatments were aspects of nurse communication that were rated highly by patients. Listening and dealing sensitively with emotions were also aspects of the videotaped consultations that were rated highly by assessors. Nurses were less consistent in providing information about medicines. CONCLUSION Triangulated data from this study suggest that nurse prescribing enhances the care of patients with dermatological conditions through improved prescribing decisions. If patients are to be more involved in this decision-making, nurses must give them more information about their medicines. The benefits of prescribing were most evident in the practices of dermatology specialist nurses. Further evidence is required to identify whether prescribing by specialist nurses offers similar benefits in other therapeutic areas.

Stakeholder views on the impact of nurse prescribing on dermatology services

AIM To explore stakeholder views on the impact of nurse prescribing on dermatology services. BACKGROUND Nurse led care enhances the services that dermatology patients receive. Research indicates that care delivered by nurse prescribers can improve efficiency and access to medicines. There is no evidence exploring the impact of nurse prescribing on the configuration of dermatology services. DESIGN Case study. METHOD A collective case study of 10 practice settings across England where nurses prescribed medicines for dermatology patients. A thematic analysis of semi-structured interview data collected during 2006 and 2007. Participants were qualified nurse prescribers, administrative staff, doctors and non-nurse prescribers. FINDINGS Nurse prescribing was reported to support and facilitate the modernisation of dermatology services. It enabled nurses to make effective use of their knowledge and skills, overcome delays in treatment and provide faster access to medicines. However several organisational issues restricted the success of the initiative. CONCLUSION Nurse prescribing is successfully being used to support and deliver a range of services to dermatology patients. Stakeholders reported that both patients and staff had benefited by the adoption of this role by nurses. However issues over support and access to CPD and capacity of the workforce were identified as potential barriers which could affect the contribution of nurse prescribing to dermatology patients. RELEVANCE TO CLINICAL PRACTICE Nurse prescribing contributes to the services provided to dermatology patients; Nurse supplementary prescribing contributes to the ability of dermatology nurse specialists to work in teams and prescribe complex medicines; Provision of adequate support and strategic planning are essential if the impact of nurse prescribing is to be fully realised.

Preparing nurses to prescribe medicines for patients with diabetes: a national questionnaire survey

AIM This paper is a report of a study to examine Nurse Independent/Nurse Supplementary Prescribing for people with diabetes and the extent to which these nurses feel prepared for this role. BACKGROUND An area of care in which nurses, caring for people with diabetes, are involved is the management of medications. There is little or no evidence examining the prescription of medicines by nurses for people with this condition. METHODS The United Kingdom Nursing and Midwifery Council database was used to select a random sample of 1992 Registered Nurse Independent/Nurse Supplementary Prescribers. Of these, 1400 questionnaires were returned. Medicines for people with diabetes were prescribed by 439 respondents. This paper reports on the findings of these 439 nurses. The data were collected in 2006. RESULTS Four hundred and nine (95.1%) participants had used independent prescribing and 214 (49.8%) used supplementary prescribing. The majority of respondents were highly experienced and worked in primary care. Some nurses (7.6%) reported that the prescribing programme did not meet their need. The needs of nurses who had undertaken specialist training in diabetes were met to a statistically and significantly greater extent than those without this training. Nurse prescribing was viewed positively by nurses prescribing for people with diabetes. CONCLUSION Prescribing has extended the role that nurses in the United Kingdom are able to play in the management of diabetes. Specialist training is a prerequisite for nurses adopting this role. There is a need to explore the prescribing programme and the extent to which it meets the needs of nurses prescribing for people with diabetes.

An evaluation of a Diabetes Specialist Nurse prescriber on the system of delivering medicines to patients with diabetes

AIM To evaluate the impact of a Diabetes Specialist Nurse prescriber on insulin and oral hypoglycaemic agent medication errors and length of stay. BACKGROUND The National Health Service has committed to a 40% reduction in the number of drug errors in the use of prescribed medicines. Drug errors in diabetes care are a common cause of significant morbidity and complications. Nurse prescribing creates an opportunity for nurses to improve care for these patients. DESIGN A quasi-experiment using six wards in a single hospital trust. METHODS Inpatient care of a convenience sample of patients with diabetes was evaluated before (n = 27) and after (n = 29) the intervention of a Diabetes Specialist Nurse prescriber. Prospective data were collected to measure insulin and oral hypoglycaemic medication errors and length of stay. RESULTS There was a significant reduction in the total number of errors between the pre-intervention and intervention group (mean reduction 21 errors) (p = 0.016). The median length of stay was reduced by three days. The total number of errors and length of stay were affected by admission category (p = 0.0004). CONCLUSIONS A medicines management intervention, provided by a Diabetes Specialist Nurse prescriber, had a positive effect on the system of delivering medicines to patients with diabetes and significantly reduced the number of errors. This reduction had some effect on length of stay. The cost saving was sufficient to finance a Diabetes Specialist Nurse prescriber post. RELEVANCE TO CLINICAL PRACTICE (i) Errors frequently occur in the prescription and administration of medicines to patients with diabetes. (ii) The education of healthcare professionals is a factor contributing to these errors. (iii) Nurse prescribing provides a new system by which to educate patients and staff about their medicines. (iv) A Diabetes Specialist Nurse prescriber can reduce insulin and OHA MEs. This reduction had some effect on LOS.