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Nurse Prescribing In Cardiac Rehabilitation

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Nurse Prescribing In Cardiac Rehabilitation Jacinta Caulfield CNS/RNP Cardiac Rehabilitation. St Columcilles Hospital. Introduction of Nurse Prescribing May 2007 The ... – PowerPoint PPT presentation

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Title: Nurse Prescribing In Cardiac Rehabilitation


1
Nurse Prescribing In Cardiac Rehabilitation
  • Jacinta Caulfield CNS/RNP
  • Cardiac Rehabilitation.
  • St Columcilles Hospital.

2
Introduction of Nurse Prescribing
  • May 2007 The medicinal products (prescription and
    Control of Supply Regulations and the Misuse of
    Drugs (amendment) regulations signed into law.
  • Specified the conditions for prescribing of
    medicinal products by Registered Nurse
    Prescribers.
  • Nurses rules 2007.

3
Conditions for prescriptive authority
  • Nurse/Midwife must be employed by a health
    service provider.
  • Medicinal product must be one used in the usual
    course of service.
  • The prescription is issued in the usual course of
    the healthcare setting.
  • Successful completion of education programme.
  • Work within scope of practice.

4
Education programme
  • Six month education programme.
  • Level 8 minor award.
  • Pharmacology exam.
  • Systematic assessment in patient care.
  • Osler exams/Case study.
  • Professional accountability
  • Reflective portfolio and CPA assignments.
  • Clinical time with Consultant Cardiologist.

5
Collaborative Practice Agreement(CPA)
  • A written agreement between the RNP, medical
    mentor and employer.
  • Prescribing site coordinator.
  • Contains the details of patient group and health
    care setting in which the RNP can prescribe.
  • Details medicinal products the RNP can prescribe.
  • Forwarded to An Bord Altranais annually.

6
Nurse Prescribing in Cardiac Rehabilitation
  • Successful completion of course in RCSI.
  • Drawing up of CPA.
  • Patient group and setting identified.
  • Medications identified.
  • Communication pathway with other healthcare
    professionals.
  • Introduction into CR (SCH) March 2009.

7
Caseload
  • Patients attending Phase III.
  • Formal assessment of Risk factors during week 5.
  • Cholesterol measurement.
  • Medications re evaluated with patient.
  • Titration of medications.
  • Complicated patients refer back to Cardiologist
    or GP as appropriate.

8
Patient assessment
  • Documentation of patients medical history.
  • Physical exam if required.
  • Recording of blood pressure.
  • Cholesterol measurement.
  • Documentation of risk factors (diabetes, smoking,
    alcohol, BMI)
  • Current medications
  • Allergies.
  • Exercise level.

9
Prescription writing
  • Legible
  • Include patients Name, Address, Date of Birth
    (triplicate).
  • Allergies.
  • Prescribe generically.
  • Dose and duration of therapy.
  • Signature and pin number of RNP.
  • Explanation of therapy to patient verbal and
    written.

10
Communication
  • Drug specific information. (Medicines.ie)
  • Treatment discussed with patient.
  • Individual medication record.
  • Information booklet (medication safety).
  • Nurse Prescribing leaflet.
  • Discharge summary to GP and Cardiologist.
  • Documentation of patient consultation with RNP.
  • Referral to other healthcare professional.

11
Role of prescribing in CR
  • Therapeutic relationship with patient.
  • Continuity in patient care.
  • Opportunity to assess adherence.
  • Information targeted to individual patients.
  • Affords patient opportunity to ask questions.
  • Lifestyle changes discussed.
  • Communication within CR team.
  • Communication with GP enhanced.

12
Case Study one
  • 79 year old female.
  • Cardiac history STEMI, medical management.
  • Risk factor assessment
  • - Blood pressure 110/70mmHg, no diabetes, non
    smoker, BMI 26 kg/m².
  • Cholesterol measurement
  • Total 2.81mmol/l HDL 1.10 mmol/l LDL 1.25mmol/l
    Trigs 1.02 mmol/l Glucose 5.10 mmol/l

13
.contd
  • Current medications
  • Nuseals aspirin 75mg od
  • Clopidogrel 75mg od
  • Bisoprolol 2.5mg od
  • Ramipril 2.5mg od
  • Atorvastatin 80mg od
  • Liver function test normal.
  • No over the counter drugs.
  • No known drug allergies.

14
contd
  • Plan reduce Atorvastatin to 40mg od.
  • Discussed with patient.
  • Written information.
  • Advised 6 monthly cholesterol and liver function
    check.
  • Lifestyle factors.
  • Documented in patients record card.

15
Documentation
  • Patient assessment documented and copy
    prescription kept.
  • All prescriptions input into HSE Nurse
    Prescribing data base.
  • Changes in medications documented in patients
    discharge summary sent to GP and cardiologist.

16
Special considerations
  • Prescribing for elderly patients.
  • Avoiding polypharmacy.
  • Compliance with medical therapy.
  • Level of literacy.
  • Alcohol consumption.
  • Over the counter medications/herbal.

17
Case study two
  • Male 63 years.
  • Cardiac history Cardiac arrest, medical
    management.
  • Current medications
  • Nuseals aspirin 75mg od.
  • Atorvastatin 80mg od
  • Micardis 20mg od
  • Lansoprazole 30mg od
  • No known drug allergies.

18
  • Current Smoker 40 cigarettes daily.
  • Blood pressure 130/80mmHg at rest.
  • Heart rate 110 bpm pre exercise.
  • Alcohol gt 30 units per week.
  • Cholesterol measurement
  • Total 3.53mmol/l HDL 1.26mmol/l Trigs 1.12mmol/l
    LDL 1.76 mmol/l.
  • Glucose 4.31 mmol/l.

19
  • Training heart rate 120-140 bpm
  • Blood pressure 140/90mmhg.
  • Dyspnoea on exertion.
  • Plan
  • Restart low dose beta blocker.
  • Atorvastatin reduced to 40mg od.

20
Patient consultation
  • Explain rationale for change of medication.
  • Advised re alcohol intake.
  • Smoking cessation offered.
  • Advised re side effects with beta blocker.
  • Written information given.
  • Follow up in Cardiology clinic. Follow up bloods
    - LFTs
  • GP contacted by phone.

21
National Independent Evaluation of Nurse
midwife prescribing initiative.(2009)
  • Barriers
  • Delays with Drugs Therapeutics
    Committees/Medical practitioner in agreeing CPA.
  • Prescribing of unlicensed medications.
  • Antibiotics.
  • RNP/RMP
  • gt 10 years experience.
  • Scope of practice.
  • Quality educational experience.
  • Increased workload.

22
Attitudes of patients
  • Highly satisfied with their care.
  • Comprehensive education and advice.
  • Self report intent to comply was high.
  • Reduction in waiting times.
  • Consultation with RNP time for the patient.

23
Support for prescribing role
  • Other Health professionals supportive.
  • Medical mentor
  • Nursing colleagues.
  • Pharmacy colleagues.
  • An Bord Altranais HSE.
  • Continuing professional development.

24
Conclusion
  • Positive impact on patient care.
  • Avoidance of delays in treatment.
  • Opportunity to enhance compliance.
  • Avoidance of visits to Cardiologist Clinic.
  • Patients at target for risk factor management.
  • Expanded role as CNS-enhanced knowledge.

25
Thank you
26
References
  • Drennan J., Naughton C., Allen D., Hyde A., Felle
    P., OBoyle K., Treacy P., Butler M. (2009)
    Independent Evaluation of the Nurse and Midwife
    Prescribing
  • Initiative. University College Dublin,
    Dublin.
  • Irish Society for Quality and Safety in
    Healthcare (ISQH) (2008). Lets Talk Medication
    Safety.
  • Collaborative Practice Agreement for Nurses and
    Midwives with Prescriptive Authority (December
    2007).
  • Practice Standards for Nurses and Midwives with
    Prescriptive Authority (July 2007).
  • Office of the Nursing Services Director. HSE
    (2008) Nurse and Midwife Prescribers-How they
    care for you.
  • WEBSITES
  • Medicines.ie
  • HSE.ie/nurseprescribing
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