This section features a regularly updated list of recently published articles relevant to nurse prescribing.

Abstracts of the papers are included and users are encouraged to submit their views about published papers through the feedback section.

Please note: In this section of the website we aim to cover articles on areas where nurses do prescribe. However, not all the treatments or appliances mentioned are prescribable by nurses. For that reason, nurses should check the up-to-date versions of the Nurse Prescribers’ Formulary for District Nurses and Health Visitors (NPF) and the Nurse Prescribers’ Extended Formulary (NPEF) and Drug tariff if they are in any doubt. Alternatively contact your Regional Nurse Prescribing Lead for clarification.

Minor Ailments
Click on the article title below to read the summaries. 

• Treating UTIs in adults in general practice
• Constipation treatment pathway for children
• Sore throats and their management
• Acute otitis media: avoiding routine antibiotics
• Acute constipation

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• Acute constipation

Ring M. Managing acute constipation in adults in the community. Primary Health Care 2002; 12(17): 41-46

This article describes the development and content of guidelines for district nurse and health visitor nurse prescribers on managing simple constipation in the community. They were developed in Coventry Primary Care NHS Trust after an audit highlighted the need for clinical guidelines to ensure decisions were made on the basis of evidence.

In many cases, advice on diet and exercise is enough to control symptoms. The guidelines incorporate a flowchart showing the different treatment pathways available. They ask the nurse to consider those symptoms or factors that would require referral to the GP throughout the assessment process.

Website: Primary Health Care

 

• Acute otitis media: avoiding routine antibiotics

Hurley G. Acute otitis media. Practice Nurse 2002; 24(5): 20-23

The controversy over the routine prescription of antibiotics for acute otitis media (AOM) highlight the challenge nurses taking on wider roles face. They need to make sure they are trained and up-to-date. There are many ways for nurses to ensure that they have the appropriate competencies for extended practice.

At least 10% of children will have experienced one episode of AOM by the age of three months but the management options remain controversial and vary widely in different countries. A Cochrane review concluded that 80% of cases in children resole without treatment in 2-7 days. Some studies have shown that pain and fever persist longer in the absence of antibiotics. Standardised diagnostic criteria are important to ensure that any treatment is as effective as possible.

The increase in antibiotic resistance is one concern about the routine use of antibiotics. Much lower levels of resistance are found in The Netherlands, where antibiotic use is much lower than in England and Wales.

The symptomatic treatment of AOM with paracetamol or ibuprofen for pain and fever provides an alternative. There is some evidence that the risk of conditions such as mastoiditis is minimal compared with the risks of antibiotics. Analgesia is a prudent alternative to antibiotics, given adequate follow-up to ensure safe and successful outcomes, according to Dutch guidelines for AOM treatment. The appropriate use of analgesia and provision of health advice should help reduce routine prescribing of antibiotics for this condition.
 

• Sore throats and their management

Blenkinsopp A. et al. Nurse prescribers: Respiratory illness 1 – Sore throat. Primary Health Care 2002; 12(8): 33-34

Oral analgesics are the first-line treatment for sore throat, with antibiotics rarely being necessary. These are among the key points in this guide for primary care nurse prescribers.

Paracetamol, aspirin and ibuprofen provide rapid and effective relief of pain in sore throat. Other analgesic constituents such as codeine were not found to provide benefit in a systematic review. Patients should be offered a choice of dosage forms. There is no evidence that gargling with dispersible analgesics is helpful although there have been anecdotal reports that gargling with salt water or aspirin helps some people.

Patients may wish to buy their own OTC remedies, and nurses need to ensure that their knowledge of the effectiveness of such medicines is updated regularly. Lozenges and pastilles are commonly used but, where a viral infection is the cause, the main use of antibacterial and antifungal preparations is to soothe and moisten the throat. Local anaesthetic lozenges can help to relieve pain.

Clinically, it is almost impossible to distinguish between viral infections, which are the cause of most sore throats, and bacterial ones. Most infections are self-limiting and 85% resolve within a week, with antibiotics causing a very modest reduction in this time.

On the few occasions where antibiotics may be needed, the nurse will need to refer the case, as independent nurse prescribers cannot prescribe antibiotics for a sore throat. On the basis of NICE guidance about the use of antibiotics, nurses should refer if there are/is: features of marked systemic upset secondary to the acute sore throat; unilateral peritonsillitis; a history of rheumatic fever; or increased risk of acute infection (child with diabetes mellitus or immunodeficiency). The article offers further advice on the use of antibiotics and ‘delayed’ prescriptions, where the patient is given a prescription to be filled if symptoms do not resolve.

Website: Primary Health Care

• Constipation treatment pathway for children