community practitioner nurse prescribing- then, now and onward dianne hogg, queen’s nurse...
TRANSCRIPT
Community Practitioner Nurse Prescribing- then, now and onward
Dianne Hogg, Queen’s NurseNon-medical Prescribing Lead,
East Lancashire Hospitals NHS Trust;
Cumbria & Lancashire NMP leads Network Chair, Health Education North West.
A quick reminder• Two academic routes in:
– V100- part of courses leading to NMC registered/recorded community qualifications
– V150- stand alone• Rigorous education programme, peer
supervision• Limited formulary- wound care, continence,
emollients, topical antimicrobials.
CPNP success story
• History from 1992 pilots• National roll out 1999 embraced in the North
West- implemented collaboratively• Enabled development of new services and
enhancement of existing ones• Cost effective.
Where are they?
• Most health visitors, district nurses, few practice nurses/school nurses
• Community nurses• Usually in services where the formulary fits.
Why do we (still) need CPNPs?
• Largest body of non-medical prescribers – over 36,300
• Prescribing accuracy very high- audit of 126 FP10s – 3 minor errors (2014).
Why do we (still) need CPNPs?
• High prescribing activity• Fits current district nursing structure well• Cost effective• Good time management/use of nursing skills.
Work in progress
• Some lack of confidence• OTC = reluctance to prescribe• Minor ailments schemes
PACT data doesn’t reflect true picture of prescribing activity.
Franklin P (2009) Prescription to Practise, Community Practitioner 82:6
Side effects- but not adverse events!
• Developing workforce• Increased focus on medicines• Awareness of cost effective prescribing etc• Impact on other areas of practice• Aware of gaps in knowledge.
What else do they do?
• Audit of 56 responses from 17 CPNPs:• Prescribed in 38 instances• Whilst they were there they checked their
patients’ medicines.
What else do they do?
• They also prevented: – 22 GP home visits – 24 follow up by /referral to another HCP – 9 GP surgery appointments – 1 follow up by consultant.
Future of CPNP?• New additions to NPF proposed• Included in National HV Core Service
Specification 2015/6• Wound care, continence, skin care still core
areas of specialism.
What prescribers say:“Non-medical prescribing allows me to prescribe a treatment change when dealing with non-healing leg ulceration in the community. I know that the patient /carer can pick the prescription up and the treatment can begin at the next dressing change.”
“Being a nurse prescriber enables me to complete treatment plans and prescribe appropriate compression hosiery whist the patient is in clinic.
This not only results in a quicker service by not having to request from the GP; but is more cost effective by reducing errors and ensuring the required garment is prescribed.”
What prescribers say:
What prescribers say:“Being a prescriber is beneficial to both myself and patients as I can provide and deliver a complete, holistic episode of care”
“I have found being a prescriber gives patients a more seamless service and I have greater control over the choice of products and the maintenance of supplies.”
What prescribers say:“After completing patient assessments, being a non-medical prescriber enables me to prescribe the most appropriate products/treatments and provide seamless patient care”
“My patients get their treatment started much more quickly than before I became a prescriber.”
What prescribers say:“I can initiate patient’s treatment immediately. I prescribe as I make my assessment of the patient’s wound, it’s taken to pharmacy straight away by the patient and treatment is started the following day by the community nurse.
Before I was a prescriber there was often significant delay”
Themes from comments…
TimelyAccurateSeamless
Cost-effectiveHolistic
Complete.
