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Prescribing appropriately and cost effectively by Dianne Bowskill, University of Nottingham

Dianne Bowskill, Lecturer Non Medical Prescribing Lead, Faculty of Medicine & Health Sciences , University of Nottingham spoke today at the Nurse Prescribing conference and her presentation focussed on cost effective prescribing within medicines management in the context of non medical prescribing, specifically exploring the medication review.

Medicines management is defined as a system of process and behaviours that determine how medicines are used by patients and by the NHS (2008). It is an important factor for patient safety in modern healthcare systems and an important skill for the nurse prescriber.  Cost effective prescribing means safer prescribing for patients, prescribing that meets the clinical need of patients and prescribing that offers best value for money from NHS resources.

Dianne said the antithesis of cost effective and therefore appropriate prescribing is inappropriate prescribing. Referred to in the literature as potentially inappropriate  prescribing  this is prescribing in the absence of clinical need and incorporates both  duplicate prescribing and polypharmacy, which is a particular problem for older people. Inappropriate prescribing,  whilst avoidable is unfortunately  common and often results  in unnecessary hospital admissions,  longer  hospital stays and increased mortality for patients. It is suggested that inappropriate prescribing can be reduced by allowing patients a greater involvement in the prescribing process. Prescribers are advised to take careful and detailed patient histories, to obtain information at the point of prescribing and undertake timely reviews of the medicines patients are actually taking.

Helen discussed that whilst nurses have a long history of working with medicines, mostly in medicine administration but their role in medication review is relatively new. Nurses and other non medical prescribers have a valuable opportunity to engage with patients and through the medication review to not only optimise the clinical and cost effectiveness of the medicines prescribed but in also to identify adverse events which pose a potential risk to the patient.

The professional literature uses the terms compliance adherence and concordance interchangeably in theoretical discussion of best practice in prescribing and the achievement of cost effective prescribing.  Their interchangeable use demonstrates a lack of clarity and definition of the terms and yet the terms are different. Nurse prescribing education encourages nurse prescribers to develop concordance with patients when prescribing.  Achieving concordance in both prescribing and the medication review is a high level skill. This skill draws extensively on the professional communication skills of the prescriber and takes time and practice to achieve.  The prescriber must allow the patient voice to be heard, to provide appropriate information and most importantly to respect the decisions patients and their families make about the medicines they take. The government is calling for health professionals to make ‘no decisions about patients without patients’. Allowing patients a choice can leave prescribers feeling vulnerable, particularly when the choice made by the patient is not consistent with best practice, national standards and research evidence. As prescribers this aspect of cost effective prescribing is a challenging one but one which must be addressed. Involving patients in prescribing decisions and medication reviews puts patients at the centre of medicines management and enables cost effective prescribing.

Events of Interest:

Reducing Medication Errors
Wednesday 19 March 2014 Birmingham


Improving Anticoagulation Therapy Services
Wednesday 19 March 2014 London


Prudent Antimicrobial Prescribing
Thursday 8 May 2014 London


Pharmacist Led Care
Wednesday 2 July 2014 London



Download: Dianne Bowskill Presentation

12 February 2014


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