Tuesday 12th June 2012
Independent non-medical prescribing has improved efficiency and patient care for a community-based nursing team.
As a community-based team of Macmillan clinical nurse specialists (CNSs), we cover two Trusts within Nottingham and have a case load of around 190 people. Where possible, each CNS works across a designated area, which includes GP practices with different needs and levels of support. The service is supported by a consultant in specialist palliative medicine.
Independent prescribing was introduced into the team in 2010 with the aim of improving care, raising our profile and increasing professional autonomy. Two nurses have so far gained the qualification and are now familiar with the relevant laws, particularly around prescribing drugs in palliative care.
Non-medical prescribing has improved our knowledge base and we are now able to make timely changes to medication in the patient’s home. This has enabled patients to commence appropriate treatment sooner and symptoms are relieved more promptly.
Establishing new processes
Before prescribing began, all GPs were informed that we may be prescribing for their patients. GPs were asked to contact the team if they had objections, however no concerns were raised. We also observed how other prescribing teams function and what measures they put in place, some of which have been adopted by our team.
As well as the advantages noted, there have also been a number of challenges, including how best to communicate medication changes to GPs to avoid misunderstandings, duplication and errors. This has been complicated by working with a number of GP practices using different IT systems. However, a robust process of communication has been established.
This includes completing and faxing a form to the relevant GP surgery within 24 hours of the prescription being issued or changes made. The form includes details of the drug prescribed, dose, frequency, amount, rationale and review. Receipt of the fax is confirmed by contacting the surgeries.
The team has limited access to patients’ medical history, co-morbidities and pathology results, which are held by the GPs. This has been an issue particularly as prescribing medication requires careful consideration, for example when assessing a patient’s renal function.
This lack of information has caused team members to be very cautious and resulted in a limited list of medications being prescribed. Strategies have already been implemented to improve access to blood results, but it is hoped that in future there may be wider access to IT systems.
The prescribers will continue to have ongoing medical supervision with the consultant, and other team members are have commenced the training.
Email Helen Coxon, Senior Community Macmillan CNS, or Rebecca Weller, Community Macmillan CNS or call them on 0115 8834370.
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