Effective Nurse/ Non-Medical Prescribing in End of Life Care: Updates and Speaker Presentations
This conference focused on the important issue of Nurse/Non Medical Prescribing in End of Life Care. It is widely recognized that pain and symptom control at the end of life is not always optimal, the development of non medical/nurse prescribing has a key role in improving pain and symptom control for patients at the end of life. The day included national updates, extended in depth sessions and case studies will focus on developing your skills as a non medical/nurse prescriber in end of life care.
Speakers and Presentations from the day Include:
Margaret Gibbs, Specialist Senior Pharmacist, St Christopher’s Hospice
Nurse/Non Medical Prescribing in a Hospice Setting
- Nurse/non-medical prescribing in a hospice setting: issues and benefits
- overcoming issues such as training required, engagement and support of primary care, expectations of the role, not wanting to de-skill doctors and difficulties in accessing prescription pads
- the benefits we have seen from non medical prescribing
Margaret Gibbs Full Presentation Click Here
In her presentation Margaret discussed:
Nurse Prescribing in a hospice setting - Issues include Setting up the system, Who to train, Convincing medical mentors, Suited mostly to community CNSs and Ongoing training and supervision. Benefits include more independence, Self-governing and Easier to create policies.
Over coming the issues for training
- Moving from a traditional establishment was new and different – but most people saw the benefit got nursing prescribing.
- Timing for nurses and mentors
- Finding replacements
- Writing policy
- Manging the out of hours situation
- Supervision and on going training
Over coming the issues – support of primary care
- We work with 5 CCG’s (PCT) and I do find them a little bit more complicated to work with. they no longer have community pharmacies if we want to go to community pharmacies we have to go to NHS England. So we set up a dummy GP practice for the hospice,
- Funding the cost of the prescribing – small amount of money.
Expectations of the role from the organisation
- Empowering CNSs to be autonomous
- Giving CNSs increased confidence – partnering CNSs with GP’s
- Reducing workload for doctors? – some doctors were happy with not having to prescribe for EOLC and others were not to sure on this.
The training you get for independent prescribing is far superior to that that doctors get.
Expectations of the role from the partners we work with
- Some expected to be relieved of their prescribing responsibilities
- Less interruptions to request prescriptions
The CNSs are more keen to prescribing and check if the patient has had the prescription
Overcoming the issues – Practicalities and logistics
- Internal prescription for IPU and homecare just in-case supplies
- Formulary/competency for Palliative Care
- For the community – FP10s
- Time lag between qualifying and starting to prescribe – this has been sorted out now. but because we are a hospice and unusual and we have the dummy GP it was a difficult process. Thankfully this is all sorted
- Systems/personal change
- Unusual = Awkward!!
- Review from PACT data – errors found. – coding can be entered wrong it is really important to check these and keep a log
Supervision and ongoing support
- All prescribers keep a log of prescriptions
- Sharing experiences and decisions in bi-monthly peer support meeting, sometimes with teaching sessions
- Discuss complex prescribing with MD team
- Support from colleagues
- Patient expectations for prescriptions are higher when a nurse is prescribing
- Nurse Prescribing has helped to steam line the process for patients
- Faster access to medicines
- Reassurance for patients and teams that the medicines are on their way
- Increased respect from patients
- Gradually increase the number of prescribers in the homecare teams
- Exploring the discrepancy between professions in prescribing for patients they have not seen
- Explore the reasons why some NIPs prescribe more often than others
Margaret Gibbs Biography:
Margaret Gibbs trained as a pharmacist in Brighton where she later obtained a post-graduate certificate in Applied Therapeutics. She gained an MSc in Pain Management from Cardiff School of Medicine. She has worked mostly as a clinical pharmacist in hospitals but enjoyed short spells working in the community.
Margaret has been the Hospice pharmacist at St Christopher’s since 1999. She provides information and guidance on all medicine-related matters to other healthcare professionals both within the hospice and outside. She has written and contributed to a number of publications, teaches varied groups of professionals and users within the hospice and at outside organisations and locations. She chairs the Hospice Medicines Optimisation Group and instigated and was chair of the UK Palliative Care Pharmacists Network for 7 years. She has been on the guidelines group for two recent NICE guidelines involving Controlled Drugs.
Deborah Robertson, Consultant Editor, The Journal of Nurse Prescribing, Senior Lecturer & Programme Leader Non-medical Prescribing, University of Chester
Nurse Prescribing for Symptom Control in End of Life Care
- nurse prescribing for symptom control: current issues
- improving confidence in prescribing practice
- empowering nurses to prescribe in end of life care
- improving non medical prescribing practice
- supporting non medical prescribers: infrastructure needed to support the safe and effective development and implementation of Non Medical Prescribing
- developing advanced roles around non medical prescribing
- keeping your prescribing knowledge up-to-date: accessing education, training and resources
Deborah Robertson Full Presentation Click Here
In her presentation Deborah discussed:
“Prescribing in end of life care is often more complex, consideration of the condition itself, consideration of the symptoms, consideration of other medications, contributes to polypharmacy, risk of interactions, increased risk of adverse drug reactions and concordance issues”
“Key areas for safe prescribing that you need to be able to do include, consultation and examination, diagnostics, clinical decision making, monitoring and reviewing, a basic pharmacological knowledge and how to find out the details of what you are going to prescribe. All of these equal to safe, and professional prescribing”
“The important areas of palliative care are improving quality of life, provide relief from pain and other distressing symptoms, supports life and regards dying as a normal process, doesn’t quicken or postpone death, combines psychological and spiritual aspects of care, offers support to help people live as actively as possible until death, offers a support system to help family cope during a person’s illness and in bereavement, uses a team approach to address the needs of the person who is ill and their families and also applies to the earlier stage of illness, alongside other therapies that are aimed at prolong life.”
“We have to continually review what we are prescribing and ensure that we are prescribing the right thing at the right time for the patient. Not all patients in palliative care can take oral medications right the way through for example”
“People at the end of life are propane to infections; this can be the life ending part of the care. We need to consider how we should treat them and what stage they are at.”
Key issues include, time to review your patients and what they need, confidence in what you are providing, if you have a question ask, limited by competence, fear of prescribing and knowing if it is right and out of hours, you may not be there you need to make sure that you have clear instructions on what the patients wants.
“We want nurses to be empowered to prescribing - get the appropriate prescribing qualification V100/150/300, you may need to be in a specialist role, you have the responsibility in care management, you need to be supported by multidisciplinary team and valued”
“Everybody that can prescribe in the team should be prescribing and there should be clear roles for each member of the team, with clear lines of communications between all the prescribers.”
“Ensure CPD is actively managed to maintained competence and confidence”
“We need more nurse prescribers”
Deborah Robertson Presentation Abstract:
It is widely recognized that pain and symptom control at the end of life is not always optimal, the development of non-medical/nurse prescribing has a key role in improving pain and symptom control for patients at the end of life.
The presentation explored the key areas of prescribing for symptom control and management in end of life care. Deborah also explored the current issues around pain management and how, by improving and supporting Non-Medical Prescribing in this area we can address some of these issues. And also discussed advanced practice roles and specialist palliative care situations and how implementing Non-Medical Prescribing can enhance and improve service design and provision. A case study has been included in the presentation so that knowledge can be applied in context.
Deborah Robertson Biography:
Dr Deborah Robertson joined the faculty of Health and Social Care at University of Chester in, from the University of Dundee, to help teach NMP, and where she continues to be employed as a Senior Lecturer in the Department of Public Health and Wellbeing. Deborah would describe herself as an RGN first and foremost but she also holds a BSc (Hons) and a PhD in Pharmacology. She worked for 3 years as a postdoctoral research fellow in the Department of Psychiatry at the University of Dundee and published her work in the area of stress and depression.
She has been programme leader for the Non-Medical Prescribing Course for more than 5 years and her teaching areas on the programme focus on her areas of expertise, namely Pharmacology, Legal Aspects of Prescribing and Public Health. She has been part of the North West Collaborative of Higher Education Institutions in NMP since her appointment and has been involved in the development and continued provision of e-learning resources for NMP education. Deborah holds a postgraduate diploma in professional education and her current pedagogical interests involve e-learning and the delivery of the Non-Medical Prescribing Course.
Deborah is co-author, with Paul Barber, of a popular textbook, Essentials of Pharmacology for Nurses now in its third edition, published by McGraw- Hill.
For the past 4 years Deborah has been consultant editor for the journal Nurse Prescribing a role which is challenging but one she thoroughly enjoys.
Future events of interest:
Masterclass: Nursing Revalidation
Ward Manager Summit: Developing your skills as an Effective Ward Manager
Masterclass: Setting up your Nurse-Led Clinic
Nurse/Non-Medical Prescribing in Mental Health
Nurse/Non-Medical Prescribing in Paediatrics and Child Health
Safe Staffing Summit: A Practical Guide to Safe and Effective Nursing Staffing Levels and Skill Mix
Effective Discharge Planning and Practice
Nurse/Non-Medical Prescribing in Cardiology
Nurse Clinics 2016
Masterclass: Medico-Legal Aspects of Non Medical Prescribing in today's NHS
Masterclass: Nurse Led Discharge
16 September 2016