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The training that nurses and others receive in preparation for
prescribing, as well as barriers to the implementation of initiatives
extending prescribing, have all been discussed recently.
Are nurses receiving sufficient scientific and clinical preparation for
prescribing? One recent survey suggests not (Nurse
practitioners not using their prescribing qualifications). A
questionnaire was sent to A&E departments, minor injury units and walk-in
centres, and one manager comments that it is “near criminal that no
pharmacology is taught”: although the application of clinical pharmacology
is included, this sort of comment suggest that interpretations differ. The
survey also identified reasons why nurse practitioners were not being sent
by their units on the extended prescribing course. These included the
limitations of the formulary, funding, number of study days and lack of
medical supervisors. The published responses to the consultation about
extending the formulary (Extending
the formulary: responses to consultation) suggest that although the
consultation was generally welcomed, a number of professional bodies have
concerns about some of the proposals.
Another author argues that there should be a more clinically focussed
pre-registration programme that would provide both professional and
scientific knowledge (Deficits
in nurses’ educational preparation for prescribing). This review
identifies deficits in nurses’ training in applied pharmacology and
therapeutics, and suggests that the extended and supplementary courses will
not be able to fill the gap satisfactorily.
If more pharmacology is added to pre-registration programmes in future, to
meet the educational needs of nurse prescribers, and if nurse prescribing
expands, does this reflect a move to a more medical model of nursing (Preparing
for nurse prescribing in hospitals)? This author concludes that nurses
should ensure that prescribing is adopted as a tool allowing nurses to
provide holistic, patient-centred care.
The extent of nurses’ pharmacological training and knowledge has been the
subject of previous discussion (September
Newsletter). Let us know what you think of both the district
nurse/health visitor course and the extended and supplementary courses by
contributing to our forum. Which
aspects did you find most useful and what components would you like to see
added?
On supplementary prescribing, MPs in the All Party Parliamentary Group on
Skin have also raised the question of lack of training in therapeutics, in a
report which expresses concern about the lack of national strategy to train
pharmacist supplementary prescribers (MPs
call for strategy over clinical areas in supplementary prescribing). The
Royal Pharmaceutical Society takes the view that continuing professional
development should be used to maintain specialist training.
The limitations of the Nurse Prescribers’ Formulary (NPF) are raised in a
study of the views of seven district nurse/health visitor prescribers (Nurse
prescribers “predominantly positive” about prescribing). Although the
situation has improved since nurse prescribing was first introduced, their
practice continues to be restricted unnecessarily. The nurses had mainly
positive views of nurse prescribing, citing benefits as time savings,
increased convenience and continuity of care, more confidence in the nurse,
and improved communication skills. Although they did not see opposition from
GPs as an issue, they found support from pharmacists and peers were most
important.
There have been some more interesting accounts of how the implementation of
supplementary prescribing is working in practice. One pharmacist
supplementary prescriber is working in a chemotherapy consent clinic,
prescribing chemotherapy (Pharmacist
supplementary prescribing for chemotherapy), and others are running or
planning to run asthma, smoking cessation, COPD and hypertension clinics (Pharmacist
prescribers: current experiences and what the future holds). The issue
of access to medical records still appears to present a barrier, and primary
care pharmacists are experiencing more difficulties in obtaining funding.
When it was introduced, supplementary prescribing was seen as most suitable
for the management of chronic conditions. One interesting account describes
the introduction of pharmacist supplementary prescribing in an intensive
care unit, and how issues of consent for unconscious or very ill patients
were resolved (Pharmacist
prescribing in a computerised intensive care unit). The range of
settings in which supplementary prescribing is being implemented shows how
the framework can be adapted.
Finally, the latest articles in our ‘Focus On’ series look at:
Other recent additions to the site include:
Click here for 2004 archive
Click here for 2003 archive
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