NURSE PRESCRIBING
MY JOURNEY
PRESENTATION BY
VALERIE M WOOD
Drug & Alcohol Liaison Nurse Specialist
Doncaster & Bassetlaw Hospitals NHS Foundation Trust
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
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.
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.
PATIENT GROUP

Medical emergency due to severe alcohol withdrawal



Medical condition




Cardio myopathy
Gastric bleed
Chronic obstructive airway disease
Surgical emergency


Alcohol related seizure
Delirium tremens
Pancreatitis
Surgical elective admission
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
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
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). .
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 don’t
Clinical management plan - too time consuming to be
practical
Increase in capacity
Need to reconfigure the existing role
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
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
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
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.
CRITERIA FOR INDEPENDENT
PRESCRIBING






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.
MEDICATION




Chlordiazepoxide
Diazepam
Vitamin B supplements
Anti-emetic
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
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
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.
QUESTIONS

Thank you