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News Round-Up 2005 Updated: 23/05/2005 Prodigy publishes
formulary guide It highlights the role that supplementary prescribing can play in allowing nurses to use new and existing skills more efficiently and effectively and to make mental health services more responsive to users. The guide also points out that specialist services could develop training and policies so that nurses could prescribe independently using the Nurse Prescribers’ Extended Formulary (NPEF). It says that thus far, there has been wide variation in the extent to which Trusts actively plan to use and develop mental health nurses’ skills and experiences and that they need to adopt a strategic approach to maximise the benefits of new ways of working with medication. The guidance stresses the importance of maintaining competency after qualification. A survey of directors of nursing in Trusts providing mental health services in mid-2004 that supported the development of the guide showed that these nursing leaders recognised the potential that new ways of working presented. They identified the following areas as being most likely to benefit from the introduction of supplementary prescribing (descending order): older people’s community services; assertive outreach; drug and alcohol teams; community mental health teams; older people’s inpatient services; and acute inpatient care. There could also be benefits in clinic services where nurses may already have particular expertise: clozapine clinics, cognitive enhancer or “memory” clinics and methadone clinics. On supplementary prescribing, the guidance considers issues such as: what happens if a service user cannot give consent, what medication can be prescribed, what the CMP should contain and how detailed it should be, whether locum psychiatrists can be independent prescribers, supplementary prescribing in inpatient care, the framework for supplementary prescribing, and educational issues. It refers to forthcoming changes to allow supplementary prescribers to prescribe controlled drugs – these are now in place (see News items here and here). It also provides guidance on the use of patient group directions (PGDs) in mental health services, giving examples of their use and the training that is needed for nurses working with them. In certain circumstances, controlled drugs can now be administered or supplied under a PGD, allowing some mental health nurses to supply and/or administer benzodiazepines, for example, for treatment of anxiety or agitation or to produce night sedation. The guide also discusses the use of independent nurse prescribing in mental health. Although the NPEF does not include mental health conditions or the medicines used to treat them, it does contain medicines and conditions that are seen in mental health settings. There are circumstances in which it would be appropriate for a nurse to prescribe such medication: for example, if the nurse has particular expertise in the condition or if the service user is unlikely to access mainstream medical services. Potential uses include: in stand-alone units for older people with mental health problems; treatment of minor injuries on acute admission wards; with homeless people who do not receive GP services or want to attend elsewhere; and vaccinations and treatment of minor illness in substance misuse services. Competency to prescribe from the NPEF is likely to be an issue for mental health nurses, even if they hold general nursing qualifications. The guidance discusses the organizational implications of extended prescribing and medication roles, including clinical governance, cost, views of users, and workforce planning. It then looks at the policies that will be needed, and at good practice in medication management. Interestingly, many of the Trusts surveyed said that nurses taking the prescribing course were also required to take a medication management course. The guide lists the standard assessment tools that may be useful in mental health services, as well as physical assessment and key skills needed. Continuing professional development and
maintaining competency are essential for extending prescribing roles. In
addition, there should be prescribing supervision appropriate to needs that
continues beyond training and is separate from routine clinical supervision.
Peer group supervision and extra training may be useful. Health Committee concerned about pharma interests The regulatory regime meant to ensure that the pharmaceutical industry works in the pubic interest is failing, according to the cross-party Commons Health Committee (see report here). A number of current practices act against the public interest and the report is critical of the industry, the Medicines and Healthcare products Regulatory Agency (MHRA), the Department of Health, and some prescribers and “key opinion leaders”. It makes many recommendations, including calls for:
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