Transcript Nurse Prescribing in a Sexual Health Clinic

Nurse Prescribing in
a Sexual Health Clinic
Sandra Delamere
ANP (Sexual Health)
GUIDE Clinic
Background
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Legislation for nurse prescribing was passed
in 2007, following the Irish Medicines Board
(miscellaneous provisions) Act, 2006
 Allowed nurses in Ireland to independently
prescribe for the first time
 Nurse/Midwife must be registered by An Bord
Altranais as a nurse prescriber
 The Requirements & Standards of the
Education Programme for nurses/midwives
with prescriptive authority (2007) defines the
competencies that must be achieved by the
nurse/midwife at the end of the programme
The Specialist Service Nurse
Prescribers Agreement
Included a list of medications that the
nurse prescriber could prescribe, within
their scope of practice
 Medication list approved by the local
Pharmacy & Therapeutics
(P&T)committee in conjunction with the
RNP’s and the team of specialist
consultants
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GUIDE Clinic
Sexual Health Clinic – approx 26,000
attendances per year
 Majority uncomplicated cases of Gonorrhoea,
Chlamydia Trachomatis,Trichomonas
vaginalis, Bacterial Vaginalis, Genital Warts
with a large proportion of patients for routine
screening.
 Average of 15 patients seen daily by ANP
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Medications- Antibiotics
Azithromycin
 Metronidazole
 Cefixime
 Ciprofloxacin
 Ceftriaxone IM
 Erythromycin
 Doxycycline
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Medications - Antivirals
Acyclovir tablets
 Acyclovir cream
 Valacyclovir
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Medications - Antifungals
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Fluconazole
Clotrimazole 1% cream
Clotrimazole 1% + hydrocortisone 1% cream
Clotrimazole pessaries, 100mg, 200mgs, 500mg
Miconazole Nitrate cream 2%
Miconazole 2% + hydrocortisoneream 1% cream
Miconazole nitrate 2% powder
Miconazole nitrate pessaries
Econazole nitrate pessary
Medications - Analgesic
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Diclofenic sodium
Paracetamol
Instillagel®
Lidocaine 2.5% + Prilocaine 2.5% cream
Lidocaine 2%
Medications – Topical treatments
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Aqueous cream
 Emulsifying ointment
 Hydrocortisone cream 1%
 Hydrocortisone ointment 1%
 Caldescene powder
 Fucidic acid 2% + hydrocortisone cream 1%
 KY jelly lubricant
Medications - Vaccines
Engerix B
 Twinrix
 HbvaxPro
 Haverix
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Medications – wart preparations
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Podophyllotoxin
lotion and cream
 Imiquimod cream
Medications – Ano-rectal preps
Anusol suppositories ®
 Anusol Cream ®
 Anusol HC ointment ®
 Anusol HC suppositories ®
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Medications - Scabacides
Malathion 0.5%
 Permethrin 1%
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Preparation of Prepacks
 Each drug prepack contains a specified dose
in a specified amount, all properly measured
and sealed
 2 Pharmacists - prepare/check
 Follow written pharmacy protocol
Audit is essential in order to
support best practice in nurse
prescribing
Aims of Audit
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To ensure the RNP is prescribing safely and
effectively for clients within his/her agreed
scope of practice
 To audit RNP compliance with
a) Practice standards for nurse/midwives with
prescriptive authority (2007)
b) Legal documents related to nurse
prescribing
c) Collaborative practice agreement
Audit
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As well as HSE minimum data set, St
James’s proposed to run monthly
audits from each RNP using the audit
tool, developed locally for the purpose
Purpose of Audit
1.To ensure RNP is prescribing safely and effectively for clients
within his/her scope of practice
2. To audit RNP compliance with
- Practice standards for nurse/midwives with prescriptive
authority (2007)
- Legal documents related to nurse prescribing
- Collaborative practice agreement
Methods
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RNP report (summary of patients) issued to
the prescribing coordinator
5 random patients selected for audit
Relevant charts and audit tool provided to
collaborating physician/peer RNP
Data collected and submitted to prescribing
site coordinator
Audits reviewed by prescribing site
coordinator and report submitted to P&T
quarterly
Results
Conclusion
Audit of nurse prescribing is essential to
provide quality assurance to clients
attending the GUIDE Clinic
 Ensures the RNP prescribes in a safe
and effective manner in accordance
with legislation and An Bord Altranais
guidance documents
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Disadvantages of Nurse
Prescribing
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Time consuming writing out generic names
ie, - Clotrimazole instead of canesten
- Podophyllotoxin instead of warticon
- Clotrimazole 1%, Hydrocortisone 1%
instead of Canesten HC
 Lots of repetition, ie monthly audits, quarterly
reports, HSE minimum dataset.
 Time consuming with minimum dataset
Benefits of Nurse Prescribing
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Patient centred care
- convenient
- continuity of care
Holistic care
- allowing opportuniy for health promotion and
lifestyle advice
Autonomous Practitioner
- essential component for ANP role
- increased capacity at clinics
- opportunities for other nursing grades
Thank you