Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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Further Developing Nurse Prescribing in Secondary Care
- Nitin Gupta (21 August 2007)
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Governance and patient Safety in Nurse Prescribing
- Kiran CR Patel (23 August 2007)
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Pharmacology training
- Richard Bartley (23 August 2007)
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Developing nurse prescribing in the UK
- Ahmed Mohammed Al Siyabi, 412/250 Barkly st. VIC 3011, Australia (1 September 2007)
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Educating nurses to prescribe – don’t forget about medical students
- Simon RJ Maxwell, David J Webb (3 September 2007)
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Nitin Gupta, Consultant Psychiatrist-South Staffordshire and Shropshire Healthcare NHS Foundation Trust Margaret Stanhope Centre, Belvedere Road, Burton upon Trent, DE13 0RB.
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I have been mentoring Nurse Prescribers (NP) in their role of Supplementary and/or Independent Prescribing since 2005. I am not debating about the pros and cons of Independent Nurse Prescribing (INP), as this topic has already generated considerable debate and controversy [1, 2]. The editorial [2] points out how detractors for INP are highlighting their concerns, and suggest areas to be further addressed for INP to contribute effectively. The need for strong clinical governance to ensure high quality prescribing has been highlighted earlier [1], but the current editorial does not provide any research or audit findings addressing this key issue. Is it because of lack of robust data, OR is it that Trusts do not have effective governance processes in place, OR that the authors did not feel this strand to be important and of value in trying to address the issue in question? I raise this query as, in my opinion; findings based on clinical governance processes related to INP may help in contributing constructively to the development of the role and utility of INP. Also, the issues highlighted by them focus mainly on primary care. It is with interest I note their comment that” comparative figures for secondary care are not available”. It is indeed surprising that despite Nurse Prescribing being practised for a reasonable number of years, INP in secondary care is not receiving that degree of attention as that in primary care. One would beg to ask the question- WHY, and I would probably leave it open to further availability of information and possible debate. I agree with their observations regarding the short training course for Independent NPs as one of the key issues in being able to practice safe and effective prescribing, within scope of practice and competency, is having a robust knowledge of basic and clinical pharmacology. From my personal limited experience of mentoring NPs and my broader experience of a practising psychiatrist for over a decade I am of the firm belief that the scope and effective practice of INP can be greatly enhanced by integrating pharmacology along with other components of the training modules for nurses at all levels of basic and advanced nurse training. This issue has both significant relevance and impact for INP in secondary care. “Safe stands the house (INP) in the face of strong adverse forces of nature (difficult clinical challenges) that has been built on a strong foundation (integration of basic and clinical pharmacology coupled with a more robust training framework)”. REFERENCES [1] Avery AJ, Pringle M. Extended prescribing by UK nurses and pharmacists. BMJ 2005; 331: 1154-5. [2] Avery AJ, James V. Developing nurse prescribing in the UK. BMJ 2007; 335; 316. Competing interests: None declared |
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Kiran CR Patel, Consultant Cardiologist and Honoarary Senior Lecturer in CV Medicine Sandwell & West Bham NHS Trust
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The principles and benefits of nurse led prescribing are unquestionable(1) but patient safety must remain at the forefront of developments. The presence of specialist nurses with prescribing skills within a defined area of medicine has its diasadvantages as well as advantages. Too often one witnesses scenarios such as beta blocker prescription for hypertension in patients with airways disease, illustrating the absence of a wider knowledge of pharmacology. A wider comprehension of pharmacology and more specifically, drug interactions is essential in order to safely deliver prescribing of as high a quality as medical practitioners. Alternatively, a medical practitioner or Trust must carry responsibility for the risks inherent in a system which does not stipulate such high standards and a system of near miss reporting must be instituted. Safety, promoted by education and national standards in prescribing for all prescribers, is paramount. Avery AJ, James V. Developing nurse prescribing in the UK. BMJ 2007; 335; 316. Competing interests: None declared |
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Richard Bartley, Physiotherapist Denbigh, Wales
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I attended a national one-day conference on non-medical prescribing in Birmingham in June 2006. Two of the speakers had attended a six month nurse-led prescribing course at a Midlands university. The syllabus included considerable coverage of medical ethics, but very little actual pharmacology training. The graduates learnt about side-effects, interactions and contraindications specific to the drugs they would prescribe only as part of their locally agreed PGD. They felt fustrated at not having a greater knowledge of pharmacology in general. They questioned the value of the university course. Competing interests: None declared |
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Ahmed Mohammed Al Siyabi, general practitioner, studying master of health services, Australia Armed forces medical services, Oman, 412/250 Barkly st. VIC 3011, Australia
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It is now time to build prescribing into the development of advanced nursing practice, so that it becomes a complementary part of the training in assessment, diagnosis, clinical decision making, audit, evaluation and referral. [1] As rightly pointed out by the editors, it is not only a matter of prescribing or allowing rapid expansion of a prescribing force, but what matters is the level of the service that would be served to people. Reminding those concerned with the patient safety, that the drug- related side events rank high in the list, and it is not a matter of changing roles or arming the nurses with the prescribing power to satisfy the status quo, but the whole spectrum of quality care is threatened. Reference. 1. Avery AJ, Pringle M. Developing nurse prescribing in the UK.BMJ2007;335:316. Competing interests: None declared |
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Simon RJ Maxwell, Senior Lecturer in Clinical Pharmacology Clinical Pharmacology Unit, University of Edinburgh, Edinburgh, EH16 4TJ, UK, David J Webb
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Avery and James are right to identify the need for the independent nurse prescribing initiative to be underpinned by a thorough education in the principles of good prescribing practice [1]. However, they failed to draw attention to the fact that undergraduate medical education in the UK is only just beginning to get its own house in order following widespread expressions of concern on this same point [2]. Indeed, it was notable that, in the very same edition of the BMJ, Todres et al lamented the ‘obsession with vertical and horizontal integration that led to the destruction of valuable free-standing courses in subjects such as … therapeutics’ [3]. There is now reason for some optimism about the future. Following a meeting at the General Medical Council in January, which considered the concerns of various stakeholders, the Medical Schools Council has set up a Safe Prescribing Working Group. This group is working to clarify the knowledge and skills in relation to prescribing that might be expected of a medical graduate and ensure that the appropriate learning opportunities are available to all students in the UK. We welcome this initiative at a time when the pressures on prescribers have increased significantly and adverse medication events are still common in NHS hospitals [4]. 1. Avery AJ, James V. Developing nurse prescribing in the UK. BMJ 2007; 335; 316. 2. Aronson JK, Henderson H, Webb DJ, Rawlins MD. A prescription for better prescribing. BMJ 2006;333:459-460. 3. Todres M, Stephenson A, Jones R. Medical education research remains the poor relation. BMJ 2007;335:333-335. 4. National Patient Safety Agency. Quarterly report from the National Reporting and Learning System (NRLS) database. Reports from acute/general hospitals to the NRLS between April and June 2006. Competing interests: SM and DW are members of the Safe Prescribing Working Group set up by the Medical Schools Council and General Medical Council |
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