Nurse Prescribing John 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

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

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 cost = £203 Bumetanide Bisoprolol (betablockers) prescription cost = £ 1309 Carvedilol Lisinopril (ACE I ) prescription cost = £ 978 Ramipril Candesartan (ARBs) prescription cost = £1008 Losartan 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