Tuesday, 3 April 2007

Nurse prescribers 'flounder'

This is taken from the latest of the GP magazine Pulse:

"Nurses are 'floundering' in their new prescribing role
Issue: 29 March 2007
Section: News

Nurse prescribers lack the pharmacological knowledge and clinical understanding to perform their roles effectively, a scathing evaluation warns.

The analysis bears out doctors' worst fears over nurse independent prescribing after last year's controversial decision to award nurses access to the entire BNF, writes Daniel Cressey. The majority of trained nurse prescribers scored zero points on tasks set to assess their clinical problem-solving abilities, and few were able to identify key problems in clinical scenarios or provide 'acceptable solutions'.

It follows a Pulse survey conducted last year with Doctors.net.uk, which found 89 per cent of doctors believed the new regulations on nurse prescribing were not adequate to protect patients. Study leader Dr Maxine Offredy, reader in primary health care at the University of Hertfordshire, said nurses were 'perhaps knowledgeable in their small area of practice but flounder outside this'. 'We demonstrated lack of appropriate pharmacological knowledge coupled with lack of confidence in prescribing,' she added. Carried out over two PCTs, the study involved 18 qualified nurse prescribers and seven nurses undertaking a prescribing course. All had a minimum of eight years' experience in their area of practice. The majority were 'unable to identify the issues' involved in the four scenarios and 'failed to provide an acceptable solution to the problem'. Only six participants provided a full, correct response to the first scenario and performance was even worse on the other three (see below). In interviews, one nurse criticised her training on pharmacology as 'really awful'. Around half of participants scored zero points out of three in each of the scenarios tested.

Dr James Kingsland, a GP in Merseyside who trains nurse prescribers, warned: 'There's a big difference between nurse prescribers and nurse diagnosticians. When a treatment plan hasn't been drawn up and they're left with uncertainty then you're moving into areas nurses are not trained for.' Dr Nigel Watson, chief executive of Wessex LMCs, said: 'It confirms what many of us thought. I struggle with the idea that everybody can do our job better than we can.' "

There is currently a consultation up and running here that wants to give nurses and pharmacists the right to prescribe controlled drugs.

'This letter seeks your views on the proposals to expand the range of Controlled Drugs that can be prescribed independently by Nurse Independent Prescribers and to enable Pharmacist Independent Prescribers to independently prescribe Controlled Drugs. It also seeks your views on whether nurse and pharmacist prescribers should be allowed to prescribe specific Schedule 2 drugs to addicts for the management of their addiction.'



"To amend the Misuse of Drugs Regulations 2001 to allow the
independent prescribing of any Controlled Drugs from Schedules 2,3,4
and 5 of the 2001 Regulations by Nurse Independent Prescribers and
Pharmacist Independent Prescribers. (Para. 18)
A. I support the proposal.
B. I have no comment to make on the proposal.
C. My comments on the proposal are below/attached."

Amazingly there is no way option here of opposing the proposals! I presume this is a deliberate tactic for the future spinning of the consultation results, this will done by lumping abstainers and dissenters into a meaningless merged conglomerate and brushing opposition under the carpet as it were.

Given that there was no decent evidence that nurse and pharmacist prescribers could adequately diagnose and prescribe in the first place, it is nothing but outright dangerous to hand these groups the right to prescribe controlled drugs.

Not only will they flounder, but they will harm untold numbers of patients during this floundering process. And its all done in the name of patient safety, twisted DoH logic again.


vinay shanthi said...

any idea of critical incidents from these prescribers. is any audit trail present since this new initiative was launched just to see if things were going ok.

Anonymous said...

I could bear to tag this smug comment, but your fish is a plaice

Garth Marenghi said...

well noticed, thanks for pointing it out!

I like the picture more than others though!