Hello folks,
I'm (hopefully) about to start the course in Sept - but my work area seems different to most of you. I'm in a harm min service and not a treatment service and so will be intending to prescribe in support of primary care stuff (antibiotics for phlebitis, ? Depo provera and possibly eventually take home naloxone etc)

Anybody out there doing this sort of work or can you point me to someone who is?

Thanks

Bill Toy

Bill,
I am suprised there has been no response to this post, perhaps it is a unique role, (in which case you must write it up).

I know of a nurse practitioner who is a prescriber who works in the local homeless service. She works closely with shared care at the practice and has done the RCGP cert too. I will ask her if she is willing to get in touch. There may be a locAl homelesS service to you that does similar work but without the drug treatment element who could offer advice and useful experience. It is an area crying out for nurses now that drug workers have snaffled all the stuff we used to call our own.

Hello Jim and thanks for getting back to me - I was beginning to think I had upset everybody!!!!!

One of the reasons I have been sponsored to do this course is that I am providing a Primary Care role to our local homeless service that we are co-located with.

They also have hostels that not surprisingly take a a large number of drug and alcohol users and so the two services are very much linked, but they don't have nursing staff of their own, so the plan would be that I extend my role to provide them a medical service i/c initiating prescribing as required and by this route make contact with drug users who are not currently in contact with services.

I would very much like to talk to your colleague if she is willing to get in touch.

My e-mail is bill_toy@hotmail.com

Thanks
Bill

Bill,
sorry for some reason i'd overlooked this post. I do prescribe for the things you mentionned and one of our contracts along with Substance misuse is asylum seekers and the homeless.
So although we have many in treatment we also have many who are not ready but still need to access some treatment at some stage. I try to chip away and make sure people know treatment is available if and when they need it.
I think soon i'll have to set-up a clinic for leg ulcers

Hello Simon,

I will need to do some cramming before the course starts to get up to speed on latest regulations etc, but as I understand it pretty well the whole of the BNF is available for nurse prescribing now, so if agreed locally there should be no restrictions on me initiating antibiotics, analgesics, anti fungals and even depo contraceptives etc??

I dont see my role as prescribing Methadone as we are not a substitute treatment service.

If there are restrictions still on what nurses can prescribe then I will have to reconsider if its worth the effort!!!

But assuming that I will go ahead with it any "I wish I had known then what I know now" advice and tips from you pioneers??? Eg - mine is the p/t course - 22 taught days plus supervised practice and the -exam. How much private study hours do I need to allow for to comfortably keep on top.

Bill

Bill

Bill,
For most things the restrictions are what you can prescribe has to be within your scope of practice. Scope of practice is obviously different for everyone.
The course I did was over 3 months, one of my brothers is doing the course now over 6 months - a bit less pressure.
I've no idea how much time you need to study, but once you get the exam question, do it over and over and over, remember headings for each section and keep doing it.
I did not pass first time in fact half my course failed, the course leader 'Returned to practice'.
I'm sure you will be given good guidance on the course as to what is required.
You can always keep us up to date on here as to how things are going.
best wishes

Simon
ps hope you don't have to do the maths test!

I hope this comment is not taken out of context or misinterpreted. It is currently not true that "pretty well the whole BNF is available" for prescribing for doctors who have qualified after five years at Medical School. There are restrictions (none least from NICE) on many different classes of therapeutic interventions in the BNF. You may well argue that most of the newly qualified doctors shouldn't be prescribing either after recent comments from esteemed Professors of Therapeutics........... However the key to prescribing safely is if you are not sure or not used to a certain intervention then holdback and take advice. A consultant colleague of mine recently prescribed a drug that perhaps he should not have done. I've been in General Practice for 14 years and I'm still learning. As far as prescribing is concerned you never stop learning. I am certainly in favour of prescribing by nurses and have actively encouraged our Nurse Practitioner to take the course. James.

James,
I fully agree with you and would not take your post out of context or misinterpret it.
As my previous post it has to be within the persons scope of practice, whatever that means.
I can imagine most Nurses/Pharmacists and whoever else will be prescribers will probably only prescribe in a specialised area. In theory most of the BNF is available but most people will only prescribe from small parts of it.
I do prescribe some things for minor ailments/injuries if i'm comfortable with that.
I would imagine that the non-medical prescribers who will be doing so over broader areas will be the practice Nurses.
Where Bill is working, last year he couldn't have prescribed a lot of the things he might as they wouldn't have been on the list of conditions.
James,
You are 100% right and if I have a shred of doubt over anything I ask for advice. I think we all get a kind of 6th sense sort of nagging in our heads.
regards
Simon

I agree completely about the slow but steady development of confidence matched to knowledge and experience. As I approach the end of the training I am very aware of the huge gaps that exist in my competence in relation to the 'entire BNF'. It is one thing to recommend a drug to a prescriber, or say to oneself 'knew that's what they would give them' than to be doing the whole thing yourself alone. Assuming the exam is passed etc I will be able to prescribe by the end of the year.

All I can do is to try to keep abreast of developments in what I am currently competent to do (and it is a developing field) and remind myself that some of my knowledge is 35 years out of date and things may well have changed there too, so better ask first! (Now leg ulcers, wasn't that tincture of benzoin on gauze changed 4 times a day?)

Simon, James,

I agree completely with what you say and it is not my intention once (if) I get the ticket to set myself up as font of all knowledge regarding treatment. The scope of my practice will be specified and adhered to with agreement on any development (as I said earlier - I don't see my remit as prescribing substitute opiates, there are several very good treatment services locally who do that now).

On the otherhand, ours is often the first and sometimes only health service a drug user will access and unless I went through the process of getting PGDs signed for everything (and we all know what a pain that process is) the restrictions of not being able to give them a paracetamol for a headache let alone initiating antibiotics for phlebitis because that would be classed as 'prescribing' is frustrating.

I only wanted to be clear that if I did this course I would be free, within the scope of my practice, to prescribe what is necessary - with the guidance of my medical supervisor and I think you have both answered that - thanks.

Bill.

PS - Leg Ulcers - where does honey and leeches fit in?????

Thankyou for not taking my reservations out of context. I speak after being taught by several Ward Sisters the better way to do things as a housedog (as we were referred to and treated in the late 1980s). Nurse prescribing will work if treating within accepted boundaries and it will certainly help with access (essential) and cost saving (which nowadays IS the key to a service continuing to be resourced). James.

James,

We used to refer to baby Drs by the kinder term of Houseboys (or girls) - to remind them that their primary role was to make tea for us nurses. Not that they listened much - but then they got a kicking like it sounds as if you were treated!!!!

quote:

Originally posted by Bill:
PS - Leg Ulcers - where does honey and leeches fit in?????

Bill,
Indeed Honey dressings are back in and they are bloody expensive!

quote:

Originally posted by simon greasley:

quote:

Originally posted by Bill:
PS - Leg Ulcers - where does honey and leeches fit in?????

Bill,
Indeed Honey dressings are back in and they are bloody expensive!

I seem to recall being told:
Hydrogen Peroxide @ 20 volumes (having surrounded the wound with vasalene), rinsed with light saline, dried with O2 (mask taken off nearest bottle to provide source) & strawberry jam to finish (but not diabetic Jam).

Please bear in mind that I trained at the start of the last last quarter of the last century & the C/N who told me it was better than all this modern rubbish probebly trained the century before.

I seem to also recall that the ward sister who worked the 'opposite shift' decried this as bad practice . . . she swore by egg white instead of jam!!!

Malcolm,
Didn't diabetics get to have diabetic jam ?
I have some Gooseberry Jam in my fridge I made last year if anyone wants to do some other fruity sticky dressings.

I guess we should remind ourselves that there is a slim chance someone browsing this forum may take this as current practice guidance.

Why don't we start another thread as "reminisence therapy for middle aged nurses"?
BTW the BBC are making a series called "Casualty 1906" being made in my old training hospital, should be fascinating for you Malcolm (or are you already acting as technical advisor) (:-)

Student doing medicine round with Charge Nurse asks 'What's this drug for'. Charge Nurse looks around room points a finger and says 'It's for him'.