Transcript Nurse Prescribing - University of Wolverhampton

Nurse Prescribing
Extended independent and
supplementary prescribing
Session objectives
1.
2.
3.
4.
Know the requirements of NHS
prescriptions
Recognise tools to monitor and improve
prescribing
Identify sources of support and advice
Plan for the future
(1) NHS prescriptions
Prescribing decisions
Types of prescriptions
Legal requirements
Security/ safety issues
Prescribing decisions
Consider the patient
W
Who is it for?
W
What are the symptoms?
H
How long have the symptoms been
present?
A
Any action taken so far?
M
Any other Medicines?
Consider the choice of product
E
How Effective is the product?
A
How Appropriate is it for this patient?
S
How Safe is it?
E
Is the prescription cost-Effective?
NHS in-patient prescription
requirements
Patient details
First name + surname
Hospital number (NHS number)
Date of birth or age
Prescriber’s signature and date
Patient location (ward or department)
NHS out-patient & FP10
prescription requirements
Patient details
First name + surname
Date of birth or age
Prescriber’s signature and date
Contact telephone number
Prescription
Details
Formulary?
Guidelines?
Name of item
- generic for medicines
- brand/trade name for appliances
Form and strength
- important to avoid confusion
- check sizes in Drug Tariff
Directions for use (dose & frequency)
Prescription Details
Duration of treatment or review date
Quantity
Special containers
Patient/ calendar packs
Bank Holidays
Reduce waste…. Reduce waste…. Reduce waste
Allergies & adverse reactions
Identify risk
Consider anaphylaxis
Observe
Record in patient’s records
Report – “yellow cards”
Disposal of unwanted medicines
Fraud/security issues
•Indelible ink
•Blank space
•Multiple items
•Record keeping
•Storage
(2) Tools to monitor and
improve prescribing
Audit
Prescribing
Data e.g. PACT
Clinical audit
Quality improvement process that seeks to improve
patient care and outcomes through systematic review
of care against explicit criteria and the implementation
of change. Aspects of the structure, processes and
outcomes of care are selected and systematically
evaluated against explicit criteria. Where indicated,
changes are implemented at an individual, team or
service level and further monitoring is used to confirm
improvement in health-care delivery.
Audit design
(planning stage)
The Audit Cycle
Set design criteria and agree standards
(what should be happening)
Monitor progress
(was the change successful)
Collect data
(what is actually happening)
Implement changes
(making the changes)
Identify causes of nonachievement (decide on change)
Analyse audit data
(compare results)
AUDIT: Practical points
Is it realistic?
Is it a controversial
Is it a “real” problem?
subject?
Has it a measurable
Would changes be
activity?
welcomed by
Can standards be set?
everyone?
Can a change be
made?
Start small and build on
Is the effort required
success, rather than start
acceptable?
with the hardest problem!
AUDIT: set criteria and agree
standards
CRITERIA
Simple statement
Focus on key points –
clinically relevant,
clearly defined and
measurable
STANDARDS
Realistic
Attainable
Worthwhile
An audit standard will
focus on one aspect of
patient care; guidelines
cover all aspects of the
patient’s management.
AUDIT
Audit Commission
http://www.audit-commission
National Clinical Audit Support Programme
http://www.doh.gov.uk/ipu/ncasp/ncaspadv1.htm
Principles for Best Practice in Clinical Audit
http://www.nelh.nhs.uk/nice_bpca.asp
Getting better with evidence
http://www.doh.gov.uk/research/london/allappxs.pdf
Pharmacy
Doctor, nurse or
pharmacist
prescribes
Payments to
pharmacists
PACT
Monitoring - PACT data
Prescribing analysis
and cost information
Generic prescribing
Product range
Quantities
Checking formulary
compliance
Peer review
Prescribing by:
Dr CENTRE PAGES
Dr No: 123456
47 BRONCHODILATOR WAY
MYOCARDIAL INFARCTION
REFLUXSHIRE
NSA 1DS
Report to:
Dr CENTRE PAGES
Dr No: 123456
PACT
STANDARD REPORT
47 BRONCHODILATOR WAY
MYOCARDIAL INFARCTION
REFLUXSHIRE
NSA 1DS
BNF Version Number 38
QUARTER ENDING DEC 2000
For explanatory notes and practice details, please see back page
PRACTICE PRESCRIBING COSTS
Change from
last year (%)
£149,168
-1
HA equivalent
£149,623
12
National equivalent
£162,101
11
Your own costs
£49,329
0
Your Practice costs are below the HA equivalent by < 1%
October - December 2000
Your practice
Your Practice costs are below the national equivalent by 8%
See the coloured pages for information on Analgesics & NSAID Prescribing
®PACT is a registered trade mark of the Prescription Pricing Authority
1
© Copyright Prescription Pricing Authority 2001
Standard Report: Page 1
Shows practices prescribing costs
HA equivalent is actual figures for
Wolverhampton PCT, with a practice with
same demographics, so GP’s can compare
with their neighbours
National equivalent is calculated in the
same way
Own costs also present
YOUR PRACTICE COSTS BY BNF THERAPEUTIC GROUP
Page 2
Change from last year (%) (%) new
Practice
HA
drugs
£13,207
£19,054
£19,217
£26,488
£21,142
£18,354
£11,839
£19,290
£9,352
£9,742
-31
-4
13
16
-27
21
16
1
15
-9
6
2
-39
5
22
7
-4
-40
-4
2
Endocrine System
£18,023
£13,901
30
0
13
0
All other
£56,388
£42,794
32
7
10
21
Gastro-Intestinal System
Cardiovascular System
Respiratory System
Central Nervous System
Infections
October - December 2000
Comparison
with HA (%)
Practice costs
HA equivalent
2
THE TWENTY LEADING COST DRUGS IN YOUR PRACTICE
Drug
These drugs represent 37.6% of your total practice cost. G:generic form available
Total cost % practice Change from
(£)
total
last year (%)
1: Genotropin
2: Omeprazole
3: Havrix
4: Becotide G
5: Augmentin
6: Typhim Vi
7: Becodisks
8: Eprex
9: Beclometh Diprop (Inh)
10: Ranitidine HC1
9,150
6,025
5,076
2,982
2,981
2,745
2,549
2,543
2,498
2,277
6.1
4.0
3.4
2.0
2.0
1.8
1.7
1.7
1.7
1.5
-3
53
55
-44
-7
-24
-9
99
15,057
170
21
159
250
129
356
257
53
6
155
78
No of
items
Drug
11: Adalat G
12: Fluvirin
13: Proprietary Co Enternal Nutrit
14: Influenza (Merieux)
15: Mengivac
16: Amoxycillin
17: Recormon
18: Cyclosporin (Systemic)
19: Amlodipine Besyl
20: Ins Humulin 1 (Isop)
Total cost
(£)
2,190
2,138
1,877
1,867
1,786
1,758
1,580
1,475
1,272
1,248
% practice
total
1.5
1.4
1.3
1.3
1.2
1.2
1.1
1.0
0.9
0.8
Change from
last year (%)
17
0
-4
-2
39
303
-25
5
869
38
N. of
items
83
420
34
366
267
1,833
2
6
42
24
© Copyright Prescription Pricing Authority 2001
Standard Report: Page 2 - cost
Practice costs for top 6 therapeutic areas are
listed together with change and HA equivalent
New drugs are defined as those introduced
within 3 years and are black triangle drugs.
Top 20 leading cost drugs in practice also
included
Drugs that can be prescribed generically are
detailed
THE NUMBER OF ITEMS YOUR PRACTICE PRESCRIBES
Change from
last year (%)
Prescribed
generically (%)
Dispensed
generically (%)
Your practice
23,083
-4
45
43
HA equivalent
16,532
2
58
52
National equivalent
19,478
3
57
52
Your own prescribing
7,229
-2
42
40
The number of items your Practice prescribed is above the HA equivalent by 40%
The number of items your Practice prescribed is above the national equivalent by 19%
PRESCRIBING BY BNF THERAPEUTIC GROUP IN YOUR PRACTICE
No. of items prescribed
HA equivalent
Comparison
with HA (%)
Change from last year (%)
Practice
HA
Dispensed
generically (%)
1,413
1,207
17
15
7
25
Cardiovascular System
1,253
2,709
-54
22
9
51
Respiratory System
4,078
1,553
3,055
2,688
3,104
2,048
163
-17
-3
36
14
-6
4
55
52
-22
-11
80
Endocrine System
996
1,067
-7
2
8
55
All other
9,184
5,260
75
7
5
30
Central Nervous System
Infections
October - December 2000
Gastro-Intestinal System
3
© Copyright Prescription Pricing Authority 2001
Standard Report: Page 3 volume
The amount prescribed is not taken into
account – it is the number of prescriptions
If you always prescribe 28 day rather than
56 day repeats that will double your
volume.
The level of generic dispensing and
prescribing is also listed – some drugs will
only have one brand – eg sertraline
4
AVERAGE COST PER ITEM
Your practice
£6.46
3
HA equivalent
£9.05
9
National equivalent
£8.32
7
Your own average cost
£6.82
2
October - December 2000
Change from
last year (%)
The average cost of items prescribed by your Practice is below the HA equivalent by 29%
The average cost of items prescribed by your Practice is below the national equivalent by 22%
THE AVERAGE COST BY BNF THERAPEUTIC GROUP IN YOUR PRACTICE
Your practice
HA equivalent
Comparison
With HA (%)
Change from last year (%)
Practice
HA
Gastro-Intestinal System
£9.35
£15.79
-41
-16
6
Cardiovascular System
£15.34
£9.78
57
-1
7
Respiratory System
£5.18
£11.82
£3.88
£7.18
£3.01
£4.76
-56
10
9
-46
13
18
-37
-23
8
Endocrine System
£18.10
£13.03
39
-2
5
All other
£6.14
£8.14
-25
0
5
Central Nervous System
Infections
© Copyright Prescription Pricing Authority 2001
Standard Report
Page 4 - cost per item
Combines volume and cost information
Relies heavily on the length of repeat
prescriptions
75% of prescribing is repeat
Larger quantities = more cost = larger cost
per item
Standard PACT
Page 5
Line graphs for six top therapeutic areas,
compares cost for practice against HA
equivalent
Page 6 & 7
Practice’s top 40 BNF sections, compares
cost and volume against equivalent HA
Page 8
Practice details, total number of prescribing
units. Nurse prescribing information.
(3) Sources of support and
advice
Drug Tariff Online December 2003
Hospital
Community
Primary Care
www.npc.co.uk
www.ppa.nhs.uk
(4) Plan for the future
Job
description
Competency
DRUG
ALERTS
Medicines
policy
Clinical Governance
+
Na
Drug
industry
Prescription
pads
CPD
Liability
Supplementary prescribers (nurse or
pharmacist) are professionally
accountable for their own prescribing
decisions. In addition, employers would
remain vicariously liable for the actions
and decisions of their staff.
University of Wolverhampton
Extended independent and
supplementary prescribing course
Linda Forrester 2004