6th November 2002

Nurse prescribers are expected to use relevant, up-to-date information and understand the advantages and limitations of different information sources (Outline framework for maintaining competency in prescribing. NPC, 2001). Nothing very surprising there, but how easy will it be in practice?

Moves to increase the range of medicines on the NPEF (see news item: “Nurse prescribing report with Alan Milburn”), introduce supplementary prescribing, and reclassify medicines from POM to P (see news item: “POM to P reclassification made easier") all mean that nurses are likely to be prescribing from an increasing list of medicines for more and more conditions.

At their disposal will be systematic reviews of randomized controlled trials, local and national protocols and formularies, NICE and other guidance, and decision support tools such as PRODIGY. These sources currently rest largely on a medical, rather than nursing, evidence base. Assessing the worth of this mass of material is not always straightforward and can be time-consuming. There is evidence that although nurses value the contribution research could make to practice, they have difficulty using research to inform clinical decision-making (see related article).

Good research evidence does not even exist for all common interventions. Emollient therapy is widely used for atopic eczema but there is little evidence from randomized controlled trials of effectiveness (see “Atopic eczema and self-management”) and there remains controversy over the use of routine antibiotics for acute otitis media (see "Acute otitis media: avoiding routine antibiotics").

According to the government, employers should ensure that nurse prescribers have access to relevant education and training provision (A guide for implementation. Department of Health, 2002). To what extent this will happen in practice remains to be seen, given budget and workload restraints. Initial and ongoing training has been raised as a concern in many of the responses to the government’s proposals on supplementary prescribing (see news item “MCA publishes responses to supplementary prescribing proposals”).

At Nurse Prescriber, we hope to provide a path through the maze of information available to nurse prescribers. Internet Resources in the Links section now contains details of many evidence-based resources, Journals Watch brings recently published articles to your attention and the Education section sets out good practice for different conditions.

Other additions to the site this month include articles on:

• Best practice guidelines for emollient use

• A constipation management pathway for children

• Using local formularies

• Common prescribing pitfalls

Visit Nurse Prescriber regularly to find out the latest developments, use the feedback section to let us know your views on the site, and contact other nurse prescribers in the forum.
 

4th October 2002

The news that courses preparing nurses to prescribe from the extended formulary can now be run over six months rather than three (read news item) should be welcomed by employers and nurses as a way of reducing the pressure of finding and funding replacement staff. If the supplementary prescribing course does run along the same lines (read news item), this relaxation of the rules will be even more significant as more nurses go through the system.

Although training for supplementary prescribing is due to begin early in 2003, some questions about how it will work in practice are unresolved (read Journals Watch item, read RCN response, read RPS and RCGP responses). How can full and immediate access to records be provided for both parties? Can there be more than one independent prescriber in a partnership? How will the clinical management plan work in practice? Log into the forum and let us know what you think and about what is going on in your area.

Other developments on the site this month include an educational module on managing pain with paracetamol under the NPEF, a case study on allergic rhinitis and new sections in Journals Watch on minor injuries and ailments.

As nurse prescribing in its different forms is rolled out, it must be evaluated, its impact investigated and best practice identified. Have a look at out new research and notices section to see what research is underway, and let us know about any you are involved in. We would like to build up a picture of UK research that will be useful for everyone.

As usual you can contact the Nurse Prescriber office via the forum or by e-mail.

10^th September 2002 

By the spring of 2001, 20,000 DNs and HVs were qualified prescribers. Additionally, post registration programmes for DNs and HVs included the necessary educational component that qualifies nurses to prescribe. During 2001 support was given by the Government for this extension and funding was made available for other nurses, as well as those currently qualified to prescribe, to undergo the necessary training to enable them to prescribe from an extended formulary.  

Training for supplementary prescribing is to commence at the end of 2002. It has been proposed (click here) that apart from controlled drugs and unlicensed medicines outside paediatric care, medicines prescribed by a supplementary prescriber will not be restricted by legislation.

Patients’ knowledge of health is increasing. Their expectations for treatment and quality of service are often high. It is therefore important that rigorous evidence is used to support nurses working in these new prescribing roles.

Nurse prescriber is a specific Internet site tailored to the needs of those involved in nurse prescribing. The site provides prescribers with the following advantages:

• It is specific to the needs of the nurse prescriber

• It contains peer-reviewed articles

• All content is quality controlled by the editor

• Immediate publication of the latest information is guaranteed.

• It contains accredited links to societies, journals, and databases.

• It has an online forum

Since the development of the site 18 months ago we have received 1200 voluntary registrations. Feedback has been extremely positive. The website creators are keen to develop the site in order to meet the needs of nurses working in these new roles. Therefore, please let us have your views and comments on the material published on nurse prescriber to date.   

8th August 2002

Nurse prescriber was officially launched in February 2001 and, although registration is not yet compulsory, the site now has over 1000 registered users. Feedback has been extremely positive. Over forty academic institutions list nurse prescriber as recommended reading for their students and the website appears fourth on a Google search for “Nurse prescribing” under the Department of Health and National Prescribing Centre. The news update and journals watch, frequently updated areas of the site, remain very popular enabling users to stay abreast of developments in nurse prescribing. Similarly popular is the forum section where a number of discussions have been generated including the production of computer generated prescriptions, smoking cessation and the plans for supplementary prescribing.

Nurse prescriber is the official site for the Association of Nurse Prescribing (ANP). The ANP site can be accessed directly from the homepage where information including the history of the ANP, its aims, membership details, the constitution and contact details of ANP committee members can be found.

Recent additions to the site include several new educational modules which examine the treatment management for a number of conditions for which nurses using the extended formulary are able to prescribe. Modules available to users include:

• Candidiasis of the skin

• Strains, sprains and contusions

• Low back pain

• Smoking cessation

• Emergency contraception

• Nausea and vomiting

• Restlessness and agitation

A conference calendar, conference reports, research updates and opinion articles are areas of nurse prescriber currently under development.

Log into nurse prescriber and let us know your views and opinions about the information currently available.

25th July 2002

If you click into the news section of the site you can read the response of the Royal Pharmaceutical Society (RPS) of Great Britain and the Royal College of General Practitioners (RCGP) to the consultation document for supplementary prescribing. Generally, plans for supplementary prescribing have been welcomed. However, a number of issues have been identified by the RPS and the RCGP that need to be considered prior to its implementation. These include:

• The need for adequate education and training

• The need for prescribing partnerships to recognise that care is delivered in teams

• The development of evidence-based model clinical management plans which can be modified on an individual basis. This will ensure consistency and save time.
  

A recent publication in The Lancet suggests that prescribing is not a major advance for the professional status of the nurse. It is claimed that nurse prescribing is about filling the gaps left by too few doctors. Prior to increasing prescribing responsibilities’ there is a need to learn more about the prescribing errors made by doctors. The author suggests that if nurses are to prescribe from the BNF their training will, to an extent, have to reflect doctors’ training. More creative and important ways in which nurses can contribute to prescribing practice, such as nurse led intervention groups, are suggested as the way forward.

Should nurses’ training become more like doctors’ training? Is this the way forward for nurses? Are there areas of practice unique to nursing that can be developed in order to enhance prescribing? Log into nurse prescriber and let us know your thoughts on this issue.

Nurse prescriber now has over 1000 registered users and feedback demonstrates that information provided on the site is proving to be a valuable source of information for nurse prescribing. Keep logging into nurse prescriber and make use of the advantages that the site has to offer.

26th May 2002

The role of the nurse working in the NHS is changing. In the future doctors will no longer be the frontline of patient care. It will be nurses who will provide this initial point of contact for patients through a number of changes that are currently taking place. One of these changes is nurse prescribing.

There will be between 30-40,000 independent nurse prescribers by 2004 all making prescribing decisions on a daily basis. Furthermore, training for supplementary prescribing will commence at the end of this year. This means that nurses will be able to prescribe POMs related to specific disease areas, following an initial consultation between the doctor and the patient. Nurse prescriber is a free electronic resource aimed to provide support for nurses working in these roles. You can now read the latest modules for the extended nurse prescribing formulary in our education section.

Nurse prescriber now has over 1000 registered users (why not register now?) and it is evident from feedback that information on the site is proving to be a valuable source of information for those involved in nurse prescribing. The forum section of the site is becoming increasingly popular, recent postings have raised issues surrounding computer generated prescriptions, supplementary prescribing and nicotine replacement therapy. Log into the forum and join these discussions. There have been several enquiries to the site asking how extended prescribing programmes can be accessed. If you wish to undergo training for extended prescribing you need to discuss this with your employer. Places on extended programmes are centrally funded and managers nominate candidates for courses. Support also has to be given by a doctor who will provide support in practice.

Essential Nurse Prescribing will be published next month. Chapters examine preparation available to nurses in the extended formulary and their effects on the human body. Information including product dosage, contraindications, adverse effects, drug interactions, and specific nursing points is presented in detail. Key background information from the relevant life sciences, as it applies to modern clinical practice is also presented.

Order a copy of this book.

10th May, 2002

Training for supplementary prescribing is to commence at the end of this year. Supplementary prescribers will have no formulary, and no restricted list of drugs. There will be no restrictions on the location or type of practitioner other than that they are registered and qualified and safe to prescribe (see DoH website). Training for supplementary prescribing will probably be based upon that of independent prescribers and the Government is presently seeking comments on whether completion of this training should allow nurses to qualify as both independent and supplementary prescribers. If this is the case, nurses working within these roles, and prescribing mentors, will have to be very clear about the conditions and products they are able to prescribe from the extended formulary and those that require a patient management plan. For example, the extended formulary only enables nurses to prescribe antibiotics for a limited number of conditions. However, if they were also a qualified supplementary prescriber, these preparations could be prescribed for a much broader range of conditions, but, would require a management plan. This could become an area of possible confusion.

The extension of nurse prescribing, the introduction of supplementary prescribing and the use of Patient Group Directions (PGDs) means that nurses are becoming increasingly involved in the supply, administration and prescribing of medicines. It has been made clear by the Secretary of State, Alan Milburn, that pre-registration nurse education will be reviewed, ensuring that future nurse prescribing will be included in these programmes. However, although it would seem sensible that knowledge from the life sciences underpinning these roles is developed on pre-registration programmes, this does raise a number of issues not least how space can be made in these curricula for this training (see news article).

25th April, 2002

Plans for the introduction of supplementary prescribing are now out for consultation (see DoH document). Although a doctor will diagnose a patients condition, nurses and pharmacists will be able to decide on the medicine to be prescribed. This mode of prescribing will not be restricted to particular conditions, however, the proposals state that patients with non-acute conditions or health needs such as asthmatics, diabetics, those with high blood pressure, or conditions relating to mental health, will benefit most from supplementary prescribing. Training for supplementary prescribers will probably be based on that for independent prescribers, programmes qualifying nurses to become both independent and supplementary prescribers. Comments on these proposals must arrive by 9^th July.  

Given the restrictions on the number of POMs included in the NPEF, these proposals would seem a big step forward. Supplementary prescribing would mean that nurses will be able to prescribe for a much broader range of conditions than those identified for extended prescribing. Log into the forum section of the site and let us know your views on these proposals. 

For those of you that visit the site regularly you will be aware that there have been several changes including the homepage and the education section of the site. The education section has now been divided into two areas relating to the original formulary (NPF) and the extended formulary (NPEF). Additional modules will be added to this area in the near future.    

Keep logging into Nurse Prescriber and stay abreast of prescribing developments.    

11th April, 2002

Welcome to nurse prescriber and the first newsletter for April. Education and training for extended nurse prescribing commenced in January this year. Nurse prescriber is an online educational resource which aims to provide support for nurses working in the role of prescriber. If you visit the site regularly, you will be aware that there are a number of educational modules that you are able to download and use. A number of changes have recently been made to this section of the site and there are now additional modules available. These modules look at the treatment management for conditions in each of the four areas for which nurses using the NPEF can prescribe i.e. minor ailments, minor injuries, health promotion and palliative care.

Log into this area of the site and let us know your views on this material.

The Journals Watch provides a constantly updated list of recently published articles relevant to nurse prescribing. This section of the site is divided into the following areas:

• Policy, practice and education
• Wound and leg ulcer care
• Health promotion
• Continence and stoma care
• Genitourinary conditions
• Analgesia
• Skin care
• Lice and scabies
• Mental and neurological health
• PGDs

A summary of each article is provided together with a link to the appropriate journal. Articles included within this section provide information for nurses using both the NPF and the NPEF.

Users of nurse prescriber are able to log into details of the Association for Nurse Prescribing (ANP) from our homepage. Read about the work of the ANP and their aims and objectives. You can also become a member of the association by downloading and completing a membership form.

26th March, 2002

The English National Board has now approved over 40 courses for extended nurse prescribers. The first of these courses commenced in January this year. This part-time training programme is at academic level 3 and includes 25 taught days, additional self directed learning, and 12 days learning in practice with a practice supporter (a doctor) delivered over a 3 month period. £10m has been made available by the government to train 10,000 nurses by 2004. The extended formulary includes all general sales list (GSL) items and pharmacy (P) medicines and over 130 prescription-only-medicines (POMs), enabling nurses to prescribe in 4 areas – minor ailments, minor injuries, health promotion and palliative care. The addition of a number of antibiotics to the extended formulary was confirmed by Health Ministers in February (www.doh.gov.uk/nurseprescribing). However, legislation is required prior to the addition of schedule drugs.

The number of district nurses (DNs), health visitors (HVs) and practice nurses prescribing from the Nurse Prescribers Formulary exceeds 20,000. Additionally, post registration programmes for DNs and HVs include the necessary educational component qualifying nurses to prescribe. Many nurses are currently supplying and administering medicines under Patient Group Directions (PGDs) and supplementary prescribing should be available to further groups of nurses later this year.

Nurse prescriber is an online educational resource which aims to provide support for nurses working in these roles. It is also the official site for the Association for Nurse Prescribing (ANP) and from our homepage, you can access information from the Association (just click on the ANP logo or here). Users of nurse prescriber are able to log into a number of areas. You can keep up-to-date with prescribing developments by logging in to News-round-up. A constantly updated list of recently published articles relevant to nurse prescribing can be found in the Journals Watch. Several educational modules and accompanying MCQ can be found under Education and details of website addresses relevant to nurse prescribers are available under links.

Keep logging into nurse prescriber and stay abreast of developments in nurse prescribing.

11th March, 2002

The addition of a number of antibiotics to the extended formulary has been confirmed by Health Ministers (www.doh.gov.uk/nurseprescribing/). Preparations include a number of oral antibiotics for the treatment of:

• Lower urinary tract infections (women)
• Impetigo
• Fungating malodorous tumours
• Bacterial vaginosis
• Acne

Topical antibiotics that have been added to the formulary are those for the treatment of otitis externa i.e. gentamyin sulphate and neomycin sulphate and undecanoate. As these medicines are available in combination with a variety of other preparations, this means that nurses now have a much greater choice of products than they would otherwise have been able to prescribe for this condition. Oral antibiotics for the treatment of acute otitis media, otitis externa and furuncle of the ear however, have not been included.

Topical antibiotics for the treatment of blepharitis (inflammation of the margin of the eyelid) and infective conjunctivitis, have not been added to the formulary by Ministers. Therefore, nurses prescribing powers in these conditions are very limited, chloramphenicol and fusidic acid eye drops and ointments being the only preparations available.

Courses enabling nurses to prescribe from the extended formulary are underway in some institutions. One or two of you have contacted us to let us know of information that you would like to see on the site. Please keep logging into nurse prescriber and let us know how we can best support you in your prescribing role [Feedback].

11th February, 2002

A big thank you to all of you who have competed our questionnaire which can be found and downloaded from the New/upcoming page. Nurse prescriber is keen to develop the site in order to meet the needs of those of you involved in nurse prescribing, so please, if you have a few minutes, download and complete this document. This will help us to identify the types of information that you require to support you in the role of prescriber.

A few additions and changes have been made to the site this week. If you log into the Journals Watch 2002 you will find summaries of (and links to) recent publications on the subject areas of policy, practice and education, wound and leg ulcer care, life style and smoking.

Several new messages have been posted into the forum. It’s evident from these messages that one or two of you are in the process of undertaking research into nurse prescribing. We are very keen to hear about these studies. Therefore, please send us details of projects in which you are involved in and we will put this information on the site [Feedback].

For those of you that visit the site regularly, you will be aware that Nurse Prescriber is the official site for the Association for Nurse Prescribing (ANP). You can enter this area of the site from our homepage. Details of the ANP constitution, and committee members, can now be accessed. If you would like to become a member of the ANP it is possible to do so today by downloading and completing a membership form.

It is still unclear as to whether antibiotics are to be included in the extended formulary. However, nurses’ competence to prescribe antibiotics has been defended by members of the House of Lords (original article: Nursing Times 2002; February 7th-13th: page 6). What do you think about this omission on the extended formulary? Why not enter the forum and let us know.

27th January,  2002

The list of POMs to be included in the extended formulary has now been agreed by Ministers (see www.doh.gov.uk/nurseprescribing/ for this list). A number of preparations have been omitted from the original consultation document. These include some palliative care products, ophthalmic products, and oral antibiotics. Several of these preparations are schedule drugs and so therefore require appropriate legislation to be passed prior to their inclusion on the extended formulary. However, more time has been requested by Ministers to consider oral antibiotics and whether nurses prescribing from the extended formulary, should be able to prescribe these products. It is unclear how long Ministers are going to consider the issue. Therefore, whether or not they will be included within the extended formulary, prior to training course commencing, is not known. As a number of institutions have either been approved for extended prescribing training, or are currently in the process of developing courses, this decision will need to be made quickly, if nurse prescribers are going to be able to prescribe these products. A number of you, for example those of you involved in wound care, may well be disappointed by this decision. Keep logging into Nurse Prescriber and stay abreast of developments. Log into the forum section of the site and let us know your views and opinion on this issue.

Although Nurse Prescriber has been developed as a resource for all those involved and interested in nurse prescribing, the site is beginning to include information surrounding the supply and administration of preparations under PGDs. If you are involved with PGDs and are keen to publish material on Nurse Prescriber, perhaps a case study, please contact the publishers. We are keen to expand this area of the site and would like to hear about your experiences.

Keep logging into Nurse Prescriber. Use the feedback section to let us know your views and opinions about the site.

14th January 2002

Welcome to Nurse Prescriber and the first newsletter of 2002. Since the launch of the site in January 2001, we have received over 700 registrations and on average 6000 page view hits per month. This indicates that there are in fact over 2000 users accessing the site per month. Popular areas of the site include News, Journals Watch, and Modules. A number of developments are currently underway. There will soon be a new homepage and it is planned that in the near future, Nurse Prescriber, as well as providing support for independent prescribers, will, provide support for those nurses involved in using Patient Group Directions (PGDs) and Supplementary Prescribing, when this is introduced.

Nurse Prescriber is now the official site for the Association for Nurse Prescribing (ANP). From our homepage, you are able to log into details of the ANP committee members, and you will soon be able to access further information from the Association.

The consultation on the proposed list of POMs by the Medicines Control Agency ended in October 2001. Following consideration of the results of the consultation during November, the Medicines Commission made recommendations to Ministers. It has now been agreed that, first level Registered nurses and Registered Midwives, having successfully completed the extended prescribing programme, will be able to prescribe from the Nurse Prescribers’ Extended Formulary from April 2002. This is subject to amendments to the POM order and to NHS Regulations. Independent prescribers will be able to prescribe all GSL and P medicines and from a list of POMs. Oral antibiotics and scheduled drugs are not included in this list (see www.doh.gov.uk/nurseprescribing/). Health Ministers are to further consider the inclusion of oral antibiotics. Prior to the addition of schedule drugs legislation changes are necessary. It is envisaged that once these amendments have been made, these drugs will be added to the formulary.

Keep logging into Nurse Prescriber and stay abreast of developments in nurse prescribing. Use the Feedback button to let us know your views and opinions about the site and information you would like to see on Nurse Prescriber.