Nurse PrescribingJohn Carson Lead Nurse

Lanarkshire Heart Failure Service

Changes May 2006• Following the discontinuation of the

Nurse Prescribers' Extended Formulary on 30 April 2006, Nurse Independent Prescribers (formerly known as Extended Formulary Nurse Prescribers) are now able to prescribe any licensed medicine for any medical condition, including some Controlled Drugs

Benefits to patients

• Service delivery closer to home• Reduces clinic/surgery visits• Individualised care• Promotes EBP• Effective therapy delivered promptly• Improves communication between

prescriber and pharmacy• Improves compliance

NMC requirements for prescribers

• successfully completed a Nursing and Midwifery Council (NMC) approved programme of preparation

• have their prescribing status entered onto the NMC register

• be employed by a NHS Trust and have access to a prescribing budget

• be currently working in a designated prescribing post

Training and educational aspects

• Allocated funding via Scottish Exec• Courses must be recognised by NHS

Education for Scotland (NES)• Nurse must be nominated by manager• Flexible course format• Intensive course (broad subject areas)• Requires commitment / support from

medical team

Benefits to prescriber

• Allows greater autonomy• Nurtures patient relationship • Improves time management• Promotes sense of accountability• Encourages self- development • Facilitates service development

Role of the Trust

• Clarity for implementation• Provide a framework which

supports the prescriber• Provide a framework that ensures

patient safety• Clinical Governance - Provide a

framework that reduces the risk to the organisation

Methods of therapy management for HFLN?

• Patient group direction• Supplementary prescribing• Independent prescribing

www.nes.scot.nhs.uk/pgds

Role of the prescriber in Medicines Management

• Agree a management plan• Patient education• Manage symptoms• Ensure maximum benefit• Ensure minimum side effects

Accountability of the Prescriber

• Work within own professional body’s guidance• Ensure that they work within their competence• Professional Indemnity• Audit service provided• Risk assessment• Continuous Professional Development

• www.nes.scot.nhs.uk/nursing/prescribing

Lanarkshire’s practice to date…

• Medical therapy guidelines• PGDs for diuretic and Beta

blockers• GP or Cardiologist signature

for other changes• Development of HFNS

Frusemide (diuretics) prescription 2004-05 cost = £203 Bumetanide  Bisoprolol (betablockers) prescription 2004-05 cost = £ 1309Carvedilol  Lisinopril (ACE I ) prescription 2004-05 cost = £ 978 Ramipril  Candesartan (ARBs) prescription 2004-05 cost = £1008Losartan Total P.A £3498 

Estimated maximum costs for NHSL p.a

Lanarkshire DeveIopment

• Ratification of area policy• Communication with key

personnel• Developing CMP templates and

management algorithms• Consultation for prescribing

budget!!!!!!

Challenges for the future…

• Improving competency• Audit of practice• Integration of prescribing

services• Clarity from SEHD• National Strategic Framework