NURSE PRESCRIBING

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NURSE PRESCRIBING

• MY JOURNEY
• PRESENTATION BY
• VALERIE M WOOD
• Drug Alcohol Liaison Nurse Specialist
• Doncaster Bassetlaw Hospitals NHS Foundation
  Trust

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MY ROLE RESPONSIBILITIES

• AN OVERVIEW
• Senior clinical specialist practitioner in
  substance misuse
• Responsible for ensuring continuity of care for
  those patients with substance misuse presenting
  in treatment in the acute hospital setting or
  those who are identified as having a drug or
  alcohol concern and require treatment.
• OTHER RESPONSIBILITIES INCLUDE
• Direct responsibility for the development,
  delivery and continuity of the nurse led service
  in which I am the lone practitioner.
• Full autonomy as there is no medical consultancy
  attached to the service
• Seamless transfer of care to and from the
  community
• Ensure exit prescribing and follow up care for
  those patients whose treatment has been initiated
  during their hospital admission

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DRUG ALCOHOL NURSE SPECIALIST SERVICE

• Through the formulation of a treatment / care
  plan the service is able to provide a
  comprehensive range of interventions that
  endeavors to achieve optimal well being in those
  patients presenting with either drug or alcohol
  concerns.
• The service promotes the enablement of the
  patient by client centered approaches which
  endorses health promotion, abstinence and harm
  reduction strategies that facilitates the patient
  to abstain or minimise damage to them selves,
  their families and the wider community.

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DRUG ALCOHOL NURSE SPECIALIST SERVICE

• Offers a broad choice of care packages ranging
  from health promotion to managing severe alcohol
  / drug dependency.
• Psychosocial approaches are the mainstay of
  treatment as pharmacological treatments currently
  have a limited application
• Hazardous drinkers
• Harmful drinkers
• Patients suffering from acute alcohol withdrawal
  syndrome are treated appropriately unplanned
  alcohol detoxification, supported by
  psychosocial interventions.

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PATIENT GROUP

• Medical emergency due to severe alcohol
  withdrawal
• Alcohol related seizure
• Delirium tremens
• Medical condition
• Cardio myopathy
• Gastric bleed
• Chronic obstructive airway disease
• Surgical emergency
• Pancreatitis
• Surgical elective admission

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NURSE PRESCRIBING PRIOR TO COURSE

• Try and see the patient first
• Mad Monday Run
• Full reduction regime written up immediately by
  Drs
• Direct discussion with the medical and nursing
  team.
• Written recommendation in patients notes
• Direct management of patient care supported by
  the medical and nursing team
• Includes
• Initiation of treatment
• Reduction regimes
• Alteration of existing treatments

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WHY BOTHER

• To determine scope of practice.
• Improve knowledge and skill base
• Identify accountability and responsibility within
  my role specific to prescribing
• El- facto prescribing v independent prescribing
• Gain some kind of control and consistency with
  the medication regime that was appropriate the
  individual needs of the patient
• Utilise the service consultant champion as my
  supervisor to the course

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INDEPENDENT PRESCRIBING

• The prescriber takes responsibility for the
• clinical assessment of the patient,
• establishing a diagnosis
• the clinical management plan (CMP) required
• prescribing where necessary
• the appropriateness of any prescription.
  (Department of Health, (DOH), 2005). .

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BEING AN INDEPENDENT PRESCRIBER

• DISADVANTAGES
• Complicated systems of working within the
  structure of the Trust to have all individual
  consultants to subscribe
• Inequality of care those consultants who agree
  v those who dont
• Clinical management plan - too time consuming to
  be practical
• Increase in capacity
• Need to reconfigure the existing role

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• DISADVANTAGES
• Less time for psychosocial interventions
• Increased autonomy
• Greater responsibility and accountability
• No financial or promotional incentive to take on
  the challenges that this presents to the
  practitioner
• No obvious supervision structure in place

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INITIAL REATION AFTER QUALIFICATION

• Uncertain
• My gut reaction - not to take up the challenge
• Needed time to determine a model of prescribing
  that I could trust and feel confident in
  delivering
• Write an alcohol policy that addresses the
  unplanned admission for acute alcohol withdrawal
  syndrome.
• Policy to be include management of Wernicke's
  encephalopathy

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MODEL OF PRESCRIBING

• To promote nurse prescribing by the Drug Alcohol
  Liaison Nurse Specialist within the acute medical
  setting using a multidisciplinary approach.
• INDEPENDENT
  SUPPLEMENTARY
• ADVISOR

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MODEL OF PRESCRIBING

• Ascertain permission to prescribe from all
  consultants.
• Prescribe for those patients admitted the ward
  having previously assessed by the appropriate
  clinical team.
• Work in conjunction with the team and any other
  health professional to determine a clinical
  management plan required.
• Plan entered into patient notes.

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CRITERIA FOR INDEPENDENTPRESCRIBING

• Uncomplicated alcohol withdrawal no other
  diagnosis
• Uncomplicated alcohol withdrawal - compensating
  liver
• After initial prescribing of chlordiazepoxide by
  medical team
• Vitamin replace therapy for dependant alcohol
  misuse
• Symptomatic alcohol withdrawal relief
• Symptomatic opiate withdrawal relief.

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MEDICATION

• Chlordiazepoxide
• Diazepam
• Vitamin B supplements
• Anti-emetic

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BEING AN INDEPENDENT PRESCRIBER

• ADVANTAGES
• Increase in professional knowledge and skill base
• Consistency of care for those patient who
  regularly attend
• Increase referral rate
• Early interventions
• Easier and quicker access to treatment
• Informed consent

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BEING AN INDEPENDENT PRESCRIBER

• ADVANTAGES
• More user/care involvement
• Specialist monitoring
• Review of care more frequent
• Training / learning opportunities for staff
  working along side specialist

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PRESENT DAY

• All the consultants agreed to the model.
• I attend the post-take ward round.
• The consultants and senior doctors sign post the
  junior doctor to the service
• Direct discharge by the service
• Development of the alcohol liver disease
  out-patient clinic
• Fast track patient into hospital
• Order blood tests
• Referral onto other hospital services.

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QUESTIONS

• Thank you