Huge explosion in nurse prescribing

Huge explosion in nurse prescribing

Joined: April 1st, 2004, 4:56 pm

August 23rd, 2007, 3:26 pm #1

Huge explosion in nurse prescribing
 

http://www.pulsetoday.co.uk/story.asp?s ... 114218&c=2

<P class=date>23 Aug 07

<DIV class=byline>
<SPAN>By <STRONG>Richard Hoey</STRONG> </SPAN>
</DIV>
<DIV class=standfirst>
The full extent of the UK’s nurse prescribing revolution is exposed by new data showing an explosion in nurse prescriptions for antidepressants, anti-biotics and cardiac medication.
</DIV>
Nurse independent prescribers are taking full advantage of their access to the entire drug formulary, with use of some medicines leaping by more than 200% in the year since prescribing regulations were changed.
Among the growing number of drugs prescribed by nurses are many whose use requires high-level clinical skills, such as venlafaxine, rosiglitazone, rimonabant and amiodarone.
The figures, obtained by Pulse under the Freedom of Information Act, reveal that overall numbers of nurse scripts have leapt by 49% in the year since independent prescribers were handed access to the entire BNF in May 2006.
But use of medicines requiring complex clinical judgment, including antibiotics and antidepressants, has increased far more rapidly. Use of ciprofloxacin is up 218%, paroxetine by 262% and rosiglitazone by 245%, according to the latest data, for May this year.
The figures came as an editorial in the BMJ called for prescribing to be built into advanced nurse training to deal with concerns over training quality.
There are now 10,000 independent or supplementary nurse prescribers in the UK, three-quarters in primary care, but training courses consist of only 26 days of theory and 12 days of mentored practice.
Professor Hugh McGavock, visiting professor of prescribing science at the University of Ulster and a former member of the Committee on Safety of Medicines, said he had ‘serious concerns’ over the issue.

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‘Nurses’ knowledge of diagnosis is pathetically poor. It takes medical students five years to be competent at differential diagnoses. Only a country with not enough doctors would go down this cheapy line.’
He identified particular concerns over nurses’ use of the cardiac drugs amiodarone and digoxin, plus antibiotics, antivirals, calcium channel blockers and ACE inhibitors.
Professor Tony Avery, an author of the BMJ editorial who is conducting a review of nurse prescribing for the Department of Health, said the data raised some concerns, particularly over use of antibiotics.
Professor Avery, head of primary care at the University of Nottingham and a GP in the city, said: ‘We also found large increases in antibiotic prescribing and if they’re not offset by decreases elsewhere, that’s worrying. But it’s still less than 1% of community prescribing.’
Dr George Rae, a member of the GPC prescribing subcommittee and a GP in Whitley Bay, Tyneside, expressed concerns over antidepressant prescribing and called for a full audit.




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Joined: April 1st, 2004, 4:56 pm

August 23rd, 2007, 3:27 pm #2

new data showing an explosion in nurse prescriptions for antidepressants, anti-biotics and cardiac medication.
Nurse independent prescribers are taking full advantage of their access to the entire drug formulary, with use of some medicines leaping by more than 200% in the year since prescribing regulations were changed.
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Joined: April 1st, 2004, 4:56 pm

August 23rd, 2007, 3:28 pm #3


Among the growing number of drugs prescribed by nurses are many whose use requires high-level clinical skills, such as venlafaxine, rosiglitazone, rimonabant and amiodarone.
The figures, obtained by Pulse under the Freedom of Information Act, reveal that overall numbers of nurse scripts have leapt by 49% in the year since independent prescribers were handed access to the entire BNF in May 2006.
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August 23rd, 2007, 3:30 pm #4


There are now 10,000 independent or supplementary nurse prescribers in the UK, three-quarters in primary care, but training courses consist of only 26 days of theory and 12 days of mentored practice.
Professor Hugh McGavock, visiting professor of prescribing science at the University of Ulster and a former member of the Committee on Safety of Medicines, said he had ‘serious concerns’ over the issue.

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August 23rd, 2007, 3:42 pm #5

Huge explosion in nurse prescribing
&nbsp;

http://www.pulsetoday.co.uk/story.asp?sectioncode=35&storycode=4114218&c=2

<P class=date>23 Aug 07

<DIV class=byline>
<SPAN>By <STRONG>Richard Hoey</STRONG> </SPAN>
</DIV>
<DIV class=standfirst>
The full extent of the UK’s nurse prescribing revolution is exposed by new data showing an explosion in nurse prescriptions for antidepressants, anti-biotics and cardiac medication.
</DIV>
Nurse independent prescribers are taking full advantage of their access to the entire drug formulary, with use of some medicines leaping by more than 200% in the year since prescribing regulations were changed.
Among the growing number of drugs prescribed by nurses are many whose use requires high-level clinical skills, such as venlafaxine, rosiglitazone, rimonabant and amiodarone.
The figures, obtained by Pulse under the Freedom of Information Act, reveal that overall numbers of nurse scripts have leapt by 49% in the year since independent prescribers were handed access to the entire BNF in May 2006.
But use of medicines requiring complex clinical judgment, including antibiotics and antidepressants, has increased far more rapidly. Use of ciprofloxacin is up 218%, paroxetine by 262% and rosiglitazone by 245%, according to the latest data, for May this year.
The figures came as an editorial in the BMJ called for prescribing to be built into advanced nurse training to deal with concerns over training quality.
There are now 10,000 independent or supplementary nurse prescribers in the UK, three-quarters in primary care, but training courses consist of only 26 days of theory and 12 days of mentored practice.
Professor Hugh McGavock, visiting professor of prescribing science at the University of Ulster and a former member of the Committee on Safety of Medicines, said he had ‘serious concerns’ over the issue.

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‘Nurses’ knowledge of diagnosis is pathetically poor. It takes medical students five years to be competent at differential diagnoses. Only a country with not enough doctors would go down this cheapy line.’
He identified particular concerns over nurses’ use of the cardiac drugs amiodarone and digoxin, plus antibiotics, antivirals, calcium channel blockers and ACE inhibitors.
Professor Tony Avery, an author of the BMJ editorial who is conducting a review of nurse prescribing for the Department of Health, said the data raised some concerns, particularly over use of antibiotics.
Professor Avery, head of primary care at the University of Nottingham and a GP in the city, said: ‘We also found large increases in antibiotic prescribing and if they’re not offset by decreases elsewhere, that’s worrying. But it’s still less than 1% of community prescribing.’
Dr George Rae, a member of the GPC prescribing subcommittee and a GP in Whitley Bay, Tyneside, expressed concerns over antidepressant prescribing and called for a full audit.







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Joined: April 1st, 2004, 4:56 pm

August 23rd, 2007, 3:44 pm #6

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Last edited by Ch_Isp_Morse on August 23rd, 2007, 3:46 pm, edited 1 time in total.
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August 23rd, 2007, 3:47 pm #7

Last edited by Ch_Isp_Morse on August 23rd, 2007, 3:48 pm, edited 1 time in total.
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Joined: April 1st, 2004, 4:56 pm

August 23rd, 2007, 3:55 pm #8

Huge explosion in nurse prescribing
&nbsp;

http://www.pulsetoday.co.uk/story.asp?s ... 114218&c=2

<P class=date>23 Aug 07

<DIV class=byline>
<SPAN>By <STRONG>Richard Hoey</STRONG> </SPAN>
</DIV>
<DIV class=standfirst>
The full extent of the UK’s nurse prescribing revolution is exposed by new data showing an explosion in nurse prescriptions for antidepressants, anti-biotics and cardiac medication.
</DIV>
Nurse independent prescribers are taking full advantage of their access to the entire drug formulary, with use of some medicines leaping by more than 200% in the year since prescribing regulations were changed.
Among the growing number of drugs prescribed by nurses are many whose use requires high-level clinical skills, such as venlafaxine, rosiglitazone, rimonabant and amiodarone.
The figures, obtained by Pulse under the Freedom of Information Act, reveal that overall numbers of nurse scripts have leapt by 49% in the year since independent prescribers were handed access to the entire BNF in May 2006.
But use of medicines requiring complex clinical judgment, including antibiotics and antidepressants, has increased far more rapidly. Use of ciprofloxacin is up 218%, paroxetine by 262% and rosiglitazone by 245%, according to the latest data, for May this year.
The figures came as an editorial in the BMJ called for prescribing to be built into advanced nurse training to deal with concerns over training quality.
There are now 10,000 independent or supplementary nurse prescribers in the UK, three-quarters in primary care, but training courses consist of only 26 days of theory and 12 days of mentored practice.
Professor Hugh McGavock, visiting professor of prescribing science at the University of Ulster and a former member of the Committee on Safety of Medicines, said he had ‘serious concerns’ over the issue.

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‘Nurses’ knowledge of diagnosis is pathetically poor. It takes medical students five years to be competent at differential diagnoses. Only a country with not enough doctors would go down this cheapy line.’
He identified particular concerns over nurses’ use of the cardiac drugs amiodarone and digoxin, plus antibiotics, antivirals, calcium channel blockers and ACE inhibitors.
Professor Tony Avery, an author of the BMJ editorial who is conducting a review of nurse prescribing for the Department of Health, said the data raised some concerns, particularly over use of antibiotics.
Professor Avery, head of primary care at the University of Nottingham and a GP in the city, said: ‘We also found large increases in antibiotic prescribing and if they’re not offset by decreases elsewhere, that’s worrying. But it’s still less than 1% of community prescribing.’
Dr George Rae, a member of the GPC prescribing subcommittee and a GP in Whitley Bay, Tyneside, expressed concerns over antidepressant prescribing and called for a full audit.



<FONT face=Arial size=2>
<P align=left>&nbsp;

<P align=left>&nbsp;

<P align=left>http://www.wales.nhs.uk/sites3/Document ... 26NICE.pdf

<P align=left>Status: APPROVED </FONT><FONT face=Arial,Bold size=2>Page 1 of 2 </FONT><FONT face=Arial size=2>Issue Date: May 2006

<P align=left>Approved by: GPMTC 3</FONT><FONT face=Arial size=1>rd </FONT><FONT face=Arial size=2>May 2006 Review Date: December 2008
</FONT><FONT face=Arial,Bold size=6>
<P align=left>Venlafaxine and NICE Guidance on Depression

<P align=left>Advice for Gwent GPs
</FONT><FONT face=Arial size=3>
<P align=left>The recommendations below should also apply to use of the use of the modified release

<P align=left>preparation of venlafaxine (Efexor XL) for generalised anxiety disorder.
</FONT><FONT face=Arial,Bold size=4>
<P align=left>New Initiation of Venlafaxine
</FONT><FONT face=Arial size=3>
<P align=left>In December 2004 NICE released clinical guidelines in the </FONT><FONT face=Arial,Italic size=3>Management of depression in primary

<P align=left>and secondary care
</FONT><FONT face=Arial size=3>(CG 023) – available at: </FONT><FONT face=Arial color=#0000ff size=3>http://www.nice.org.uk/page.aspx?o=cg023</FONT><FONT face=Arial size=3>.

<P align=left>This reminds prescribers that venlafaxine is contraindicated in:
</FONT><FONT face=Arial,Bold size=3>
<P align=left>1.
</FONT><FONT face=Arial size=3>patients with heart disease e.g. cardiac failure, coronary artery disease, EGG

<P align=left>abnormalities (including pre-existing QT interval prolongation – prescribers should

<P align=left>be aware of other co-prescribed drugs that cause QT interval prolongation</FONT><FONT face=Arial size=1>1</FONT><FONT face=Arial size=3>)
</FONT><FONT face=Arial,Bold size=3>
<P align=left>2.
</FONT><FONT face=Arial size=3>patients with electrolyte imbalance
</FONT><FONT face=Arial,Bold size=3>
<P align=left>3.
</FONT><FONT face=Arial size=3>patients who are hypertensive.

<P align=left>NICE states “</FONT><FONT face=Arial,BoldItalic size=3>venlafaxine should only be initiated by specialist mental health practitioners,

<P align=left>including GPs with a Special Interest in Mental Health
</FONT><FONT face=Arial,Italic size=1>2</FONT><FONT face=Arial,Italic size=3>.</FONT><FONT face=Arial size=3>”

<P align=left>GPs may prescribe venlafaxine, where appropriate, following written or telephone discussion with

<P align=left>a psychiatrist about a specific case.

<P align=left>NICE also states “</FONT><FONT face=Arial,BoldItalic size=3>venlafaxine should be considered for patients whose depression has

<P align=left>failed to respond to two adequate trials of other antidepressants. Consideration should be

<P align=left>given to increasing the dose up to BNF limits</FONT><FONT face=Arial,BoldItalic size=1>3 </FONT><FONT face=Arial,BoldItalic size=3>if required, provided patients can tolerate

<P align=left>the side effects.
</FONT><FONT face=Arial size=3>”

<P align=left>Before initiating venlafaxine an ECG, </FONT><FONT face=Arial,Italic size=3>electrolytes </FONT><FONT face=Arial size=3>and blood pressure measurement should be

<P align=left>undertaken and practitioners should take into account:
</FONT><FONT face=SymbolMT size=3>
<P align=left>• </FONT><FONT face=Arial size=3>The increased likelihood of patients stopping treatment because of side effects, compared

<P align=left>with equally effective SSRIs.
</FONT><FONT face=SymbolMT size=3>
<P align=left>• </FONT><FONT face=Arial size=3>Venlafaxine’s higher propensity for discontinuation/withdrawal symptoms if stopped

<P align=left>abruptly, its toxicity in overdose and its higher cost.

<P align=left>The ECG should be undertaken to establish the corrected QT interval (QTc – see below). GPs

<P align=left>without specialist facilities should request that venlafaxine be initiated by Secondary Care.
</FONT><FONT face=Arial size=1>
<P align=left>1 </FONT><FONT face=Arial size=2>A </FONT><FONT face=Arial,Italic size=2>New England Journal of Medicine </FONT><FONT face=Arial size=2>editorial (Barbara A </FONT><FONT face=Arial,Italic size=2>et al</FONT><FONT face=Arial size=2>. </FONT><FONT face=Arial,Italic size=2>N Engl J Med </FONT><FONT face=Arial size=2>2004;351:1053-1056) on

<P align=left>drugs and the QT interval mentions the following: </FONT><FONT face=Arial,Bold size=2>disopyramide, procainamide, sotalol,

<P align=left>amiodarone, TCAs, SSRIs, haloperidol, macrolides, quinolones, tamoxifen, azole

<P align=left>antifungals, terbinafine, diltiazem and verapamil
</FONT><FONT face=Arial size=2>. A comprehensive list of drugs that can cause

<P align=left>QT interval prolongation is available at: </FONT><FONT face=Arial color=#0000ff size=2>http://www.torsades.org</FONT><FONT face=Arial size=2>. For many of these drugs, the risk
</FONT><FONT face=Arial,Italic size=2>
<P align=left>is thought to be minimal
</FONT><FONT face=Arial size=2>in patients with no other risk factors but combinations increase the risk.
</FONT><FONT face=Arial size=1>
<P align=left>2 </FONT><FONT face=Arial size=2>As defined by Dept. of Health and </FONT><FONT face=Arial,Italic size=2>R.C.G.P. </FONT><FONT face=Arial size=2>guidance on the appointment of GPs with a special interest in

<P align=left>Mental Health (see: </FONT><FONT face=Arial color=#0000ff size=2>http://www.gpwsi.org.uk/guidance/index.html</FONT><FONT face=Arial size=2>).
</FONT><FONT face=Arial size=1>
<P align=left>3 </FONT><FONT face=Arial size=2>The </FONT><FONT face=Arial,Italic size=2>BNF </FONT><FONT face=Arial size=2>states: </FONT><FONT face=Arial,Italic size=2>Depression, initially 75mg daily in 2 divided doses increased if necessary after at least 3-

<P align=left>4 weeks to 150mg daily in 2 divided doses; severely depressed or hospitalised patients, increased

<P align=left>further if necessary in steps of up to 75mg every 2-3 days to max. 375mg then gradually reduced
</FONT><FONT face=Arial size=2>.

<P align=left>Status: APPROVED </FONT><FONT face=Arial,Bold size=2>Page 2 of 2 </FONT><FONT face=Arial size=2>Issue Date: May 2006

<P align=left>Approved by: GPMTC 3</FONT><FONT face=Arial size=1>rd </FONT><FONT face=Arial size=2>May 2006 Review Date: December 2008
</FONT><FONT face=Arial,Bold size=4>
<P align=left>Patients currently taking Venlafaxine
</FONT><FONT face=Arial size=3>
<P align=left>All patients already taking venlafaxine should have their treatment reviewed.

<P align=left>Patients should be reviewed at their next routine appointment for heart disease, hypertension

<P align=left>and electrolyte imbalance. Risk factors for these (e.g. a family history of heart disease; those on

<P align=left>very high doses of venlafaxine; and those co-prescribed other drugs that prolong the QT

<P align=left>interval</FONT><FONT face=Arial size=1>1</FONT><FONT face=Arial size=3>) should also be reviewed.
</FONT><FONT face=SymbolMT size=3>
<P align=left>&#9829; </FONT><FONT face=Arial size=3>If there are any </FONT><FONT face=Arial,Bold size=3>clinical signs of heart disease </FONT><FONT face=Arial size=3>venlafaxine should be discontinued by

<P align=left>gradually tapering the dose down over a period of several weeks or months, according to

<P align=left>the patient's needs. If the original prescriber was in Secondary Care contact them for

<P align=left>advice.
</FONT><FONT face=SymbolMT size=3>
<P align=left>&#9829; </FONT><FONT face=Arial size=3>For those with </FONT><FONT face=Arial,Bold size=3>cardiac risk factors </FONT><FONT face=Arial size=3>an EGG should be carried out. If the corrected QT

<P align=left>interval</FONT><FONT face=Arial size=1>4 </FONT><FONT face=Arial size=3>(QTc) > 440msec (men) or > 470msec (women)</FONT><FONT face=Arial size=1>5 </FONT><FONT face=Arial size=3>alternative antidepressant

<P align=left>treatment should be considered. If the original prescriber was in Secondary Care contact

<P align=left>them for advice.
</FONT><FONT face=SymbolMT size=3>
<P align=left>&#9829; </FONT><FONT face=Arial size=3>Patients currently prescribed venlafaxine benefiting from treatment and with </FONT><FONT face=Arial,Bold size=3>no

<P align=left>contraindications
</FONT><FONT face=Arial size=3>can continue treatment with continued regular monitoring (and due

<P align=left>regard for NICE guidance on continuing treatment).
</FONT><FONT face=Arial,Bold size=4>
<P align=left>Continued monitoring
</FONT><FONT face=Arial size=3>
<P align=left>Once reviewed, patients continuing to be prescribed venlafaxine should have BP, and if

<P align=left>appropriate U&Es, checked 6 monthly and be regularly monitored for clinical signs of

<P align=left>heart disease (particularly those on higher doses). An urgent ECG should be arranged if

<P align=left>patients become symptomatic for arrhythmias.
</FONT><FONT face=Arial size=1>
<P align=left>4 </FONT><FONT face=Arial size=2>QTc (msec) = QT (msec) divided by the square root of RR (sec)
</FONT><FONT face=Arial size=1>
<P align=left>5 </FONT><FONT face=Arial size=2>Taylor D, Paton C, Kerwin Robert. </FONT><FONT face=Arial,Italic size=2>The Maudsley Prescribing Guidelines </FONT><FONT face=Arial size=2>2005-2006. 8</FONT><FONT face=Arial size=1>th </FONT><FONT face=Arial size=2>Edition
</FONT>
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Joined: April 1st, 2004, 4:56 pm

August 23rd, 2007, 3:57 pm #9

<P align=left>NICE states “<FONT face=Arial,BoldItalic size=3>venlafaxine should only be initiated by specialist mental health practitioners,

<P align=left>including GPs with a Special Interest in Mental Health
</FONT><FONT face=Arial,Italic size=1>2</FONT><FONT face=Arial,Italic size=3>.</FONT><FONT face=Arial size=3>”

<P align=left>GPs may prescribe venlafaxine, where appropriate, following written or telephone discussion with

<P align=left>a psychiatrist about a specific case.

<P align=left>NICE also states “</FONT><FONT face=Arial,BoldItalic size=3>venlafaxine should be considered for patients whose depression has

<P align=left>failed to respond to two adequate trials of other antidepressants. Consideration should be

<P align=left>given to increasing the dose up to BNF limits</FONT><FONT face=Arial,BoldItalic size=1>3 </FONT><FONT face=Arial,BoldItalic size=3>if required, provided patients can tolerate

<P align=left>the side effects.
</FONT><FONT face=Arial size=3>”
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Joined: April 1st, 2004, 4:56 pm

August 23rd, 2007, 3:59 pm #10


There are now 10,000 independent or supplementary nurse prescribers in the UK, three-quarters in primary care, but training courses consist of only 26 days of theory and 12 days of mentored practice.
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