Transcript Document

Non Medical Prescribing – Making a Difference
Karen Selwood
Advanced Nurse Practitioner
ANP’s in paediatric oncology
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2 ANP’s in the late 1990’s
Role development over the last 10 years
Moved to a new unit
2 more ANP’s – wider service
Prescribing before the V300
• Group protocols
– Written instruction for the supply and/ or
administration of medicines in an identified
clinical situation.
PATIENT GROUP DIRECTION FOR NURSE PRESCRIBING OF ANTIBIOTICS IN ONCOLOGY
11.2.1 AIMS OF TREATMENT
To treat neutropenic pyrexia following chemotherapy
11.2.2 POLICY & PROCEDURE STATEMENT
The policy and procedures on the nurse or HCP administration of drugs according to prescribing exemptions are
followed.
11.2.3 ADDITIONAL CRITERIA FOR ROLE EXPANSION
Oncology ANP or clinician
11.2.4 DRUGS
Piperacillin, Netilmicin, Ceftazidime, Amikacin, Teicoplanin.
11.2.5 EXCEPTIONS
See guidelines relating to infection control in oncology. Patients allergic to one of the drugs or who have shown a
previous ADR.
11.2.6 CONTRAINDICATIONS, PRECAUTIONS OR SPECIAL CONSIDERATIONS
Consider previous anti-infective therapy, renal function adverse reactions, and aminoglycoside levels.
11.2.7 ASSESSMENT & ADMINISTRATION PROCEDURES
Refer to guidelines on the use of anti-infectives in oncology. Document administration on the patient's nursing and
medical notes.
11.2.8 FOLLOW UP
All children will be assessed within 24 hours by a doctor.
11.2.9 DRUG DETAILS
Administration and side effects - see guidelines.
11.2.10 REFERENCES
Guidelines on the use of anti-infectives in oncology
Prescribing before the V300
• Group protocols
– Written instruction for the supply and/ or
administration of medicines in an identified
clinical situation.
• Transcription on admission/ discharge
V300
• Issues
– Adult orientated
– Practical aspects from paediatric perspective
• A means to an end!
Prescribing in paediatrics
• Within scope of practice
– Licensed medicines
– Off label use
• Limitations of an Independent prescriber
– The use of unlicensed medicines
– Controlled drugs
Now in practice
• Independent Prescriber
• Clinical management plans
– Partnership between independent/
supplementary prescriber
– Can prescribe all medicines
– Written care plan
– Needs a diagnosis
– Shared records
Name of Patient:
Patient identification
AH No:
Patient medication
sensitivities/allergies:
Date of birth:
Independent Prescriber(s):
Dr. M. Caswell, Dr. R. Keenan, Dr. H.
McDowell, Dr. B. Pizer, Dr L Howell
Supplementary Prescriber(s)
Monica Hopkins, Michelle Wright
Karen Selwood, Caroline Langford
Condition(s) to be treated:
Leukaemia
Aim of treatment
Treatment of malignancy and relief of
potential and actual side effects
Medicines that may be prescribed by SP:
Indication
Treatment of malignancy
Preparation
Chemotherapy/ steroids
Dose schedule
As per current protocol
Specific indications for
referral back to the IP
Intolerance of treatment
Prevention and treatment
of nausea and/ or
vomiting
Antiemetics
As per antiemetic guidelines/
medicines for children/ BNF
Uncontrolled nausea/ vomiting
Prevention and treatment
of infections
Antibiotics/ antifungals/
antivirals, antiseptic
products.
As per infective guidelines/
chemotherapy protocol
Septic shock, unremitting fever
or infectious signs
Dehydration, fluid
overload, abnormal
electrolyte results,
administration of drugs
and fluid resuscitation
Fluid and electrolytes
As per medicines for children /
guidelines
Severe dehydration,
unresponsive blood chemistry,
unremitting hypovolaemia
GIT problems
Laxatives, drugs for
mouthcare, diarrhoea,
gastritis.
As per guidelines
Unresponsive to initial
treatments
The relief of pain and
discomfort
Analgesia including
controlled drugs where
appropriate
As per pain pathway/
medicines for children
Uncontrolled or increasing
pain
Prevention and treatment
of malnutrition
Nutritional supplements/
TPN
As per nutritional guidance
and patient notes
Persistent weight loss
Maintenance of central
venous line patency
Heparin flushes, urokinase
As per CVL guidelines
Persistent CVL blockage
Treatment and
prevention of thrombus
Anticoagulation therapy
As per warfarin/heparin
guidelines
Persistent coagulopathy
Prevention and treatment
of allergic reactions.
Antihistamines,
corticosteroids
As per anaphylaxis guidelines/
antihistamine guidelines
Unresponsive to initial
treatment
The prevention and
treatment of skin
breakdown or trauma.
Promotion of wound
healing.
Emollients, bacteriocidals,
antiseptic and wound care
dressings
As per skin care guidelines –
wound management,
dermatological and
radiotherapy
Poor wound healing,
deteriorating skin integrity
Now in practice
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Cover all areas of oncology unit
Nurse led day care
Leukaemia clinics
Advantages for families
– Holistic approach to care
– Seen in more timely manner
– See small team who know the child and their
history
Issues for the future
• Controlled drugs
– Awaiting changes in legislation
• Unlicensed medicines
Thank you for listening
Any Questions?
[email protected]