The Hidden Benefits of Nurse Prescribing in Care of the Older Person

Daragh Rodger, Lorraine McNamee, Winah Quijano, Christine Scanlon, Donna Mitchell, Charina Hogan, Maree

Barry, Gabriel Germino, Elena Deveney. St Mary’s Campus Phoenix Park & SeanChara Community

Unit, Dublin

Background: A recent review of nurse prescribing activity in care of the older person identified the outcome didn’t always indicate the need for a prescription and therefore is not captured on the Nurse and Midwife Prescribing Data Collection System. This was also alluded to in the National Evaluation of the Role of the Nurse and Midwife Prescribing Initiative (2009). The uncaptured activity is not seen as a negative by our Registered Nurse Prescribers but a hidden benefit of their role.

3. Promotion of best practice through staff education The role of the RNP has also resulted in improved practices with the assistance of the Drugs and Therapeutics committee (DTC). DTC’s were set up initially to provide a platform for Registered Nurse and Midwife Prescribers. Through reviewing drug prescription sheets in a more informed and critical manner, RNP’s have found a number of positive outcomes which are not reflected in the database. Reduction in polypharmacy and the risk of drug interactions. Improved use of prescribed medications Improved medication prescribing, management and administration through staff education Reduction in the risk of medication errors.

These interventions have a positive impact on the quality of life of the patients and residents in our care but are not recordable on the Nurse and Midwife Prescribing Data Collection System.

1. Increased compliance of pre prescribed medication through education As a nurse prescriber the assessment process and physical examination of the patient provides a wealth of information. Relationship is formed which encourages openness and honesty Diagnosis and discussion of plan of care Need for a medication to be prescribed Revelation medication has been prescribed previously by GP but not taken Opportunity to educate on the effectiveness of the medication Monitor the ongoing progress and effect of the medication Promotes compliance Patients needs are met Many scenarios occur similar to this and are not captured on the Nurse and Midwife Prescribing Data Collection System. There is no national record of

this valuable intervention.

2. Proactive approach to antibiotic therapy In a quarterly local audit the total number of resident assessments was n=15. The number of prescriptions ordered was n= 3. This highlights that n= 12 residents received comprehensive nursing assessment and physical examination by the RNP which is not captured on the Nurse and Midwife Prescribing Data Collection System. The majority of assessments were for perceived respiratory tract infections and eye infections. However following nursing assessment and the absence of infection perceived antibiotic treatment was not required. The RNP submits this data to the prescribing site coordinator for auditing purposes.

Conclusion: This initiative highlights the benefits of the assessment process by RNP’s and how the time and documentation afforded to this practice is not always captured on the Nurse and Midwife Prescribing Data Collection System. It identifies the skills and expertise of the RNP in the development of best practise in the clinical area through staff education. It reinforces the use of local audit trails to capture effective nurse prescriber activity for future care of older persons.

Reference: Drennan J., Naughton C., Allen D., Hyde A., Felle P., O’Boyle, K., Treacy P., Butler M. (2009) Independent Evaluation of the Nurse and Midwife Prescribing Initiative. University College Dublin, Dublin.