Fife Prescribers Forum

Present:
Lorna Mackenzie
Jenni Jater
Ingrid Pitt
Kevin MacKenzie
Anne Henderson
Tricia Mackie
Janice Birrell
Dianne Snell
Jacquie Taylor
Christine Macdonald
Karen Moir
Lorna Stewart
Jill Logan
Colette Henderson
Eugene Benson-Takeda

Introduction and Welcome:
CH opened the meeting and thanked the sponsors for their support of the meeting.
Minutes:of previous meeting were accepted with no amendments.
T2DZone:
Eugene Benson spoke to the RCN accredited nurse education programme T2DZone. This programme is in CD format and provides case studies, it is RCN approved and can be used in practices for informal meetings; Eugene is available to come in to practices and discuss the programme if required. SIGN guidance is due out soon for diabetes. Holding an event was discussed and it was recognised in the group that there would be interest in this. Action-EB
Update from NMP Advisor:Legislation changed as of 21/12/2009 to enable NMPs to prescribe unlicensed medicines. We are awaiting changes to NMC standards to reflect this. At time of printing a circular has been released by the NMC to confirm this legislative change and enable nurse and midwife prescribers can prescribe unlicensed medicines providng:
Practice Standard 17 (17.1) of the Standards of proficiency for nurse and midwife prescribers (NMC, 2006) should be replaced with the following information;
You may prescribe an unlicensed medication as an independent nurse prescriber providing:

• You are satisfied an alternative, licensed medication would not meet the patient’s or client’s needs.

• You are satisfied there is a sufficient evidence base and/or experience to demonstrate the medication’s safety and efficacy for that particular patient or client.

• You are prepared to take responsibility for prescribing the unlicensed medicine and for overseeing the patient’s or client’s care, including monitoring and any follow up treatment.

• The patient or client agrees to the prescription in the knowledge that the medicine is unlicensed and understands the implications of this.

• The medication chosen and the reason for choosing it are documented in patient’s or client’s notes.
In addition as of 21/12/2009, the MHRA announced changes to medicines regulations to allow mixing of medicines prior to administration. These changes do not apply to the mixing of controlled drugs.
The changes are detailed below:
• Doctors and dentists - who can already mix medicines themselves – are now able to direct others to mix (other than a pharmacist under existing legislative provisions, or by a person holding a manufacturer’s licence).
• Nurse and Pharmacist Independent Prescribers can now mix medicines themselves and direct others to mix.
• Supplementary prescribers can now mix medicines and direct others to mix medicines only when this is part of a clinical management plan for an individual patient.
There have been no changes in legislation to enable prescribing of controlled drugs by pharmacist independent prescribers or to increase the range of controlled drugs that may be prescribed by nurse independent prescribers.
NHS Fife Strategy:
We are currently awaiting verification that NHS Fife guiding principles for furthering non medical prescribing in NHS Fife is complete. Once confirmed this will be circulated.
CPD Events:16th and 25th February there will be a Renal Impairment CPD event facilitated by local pharmacists and nurses working in this field.
11th March a Fife Formulary session is to be held, looking at the formulary why we need it, how to access and influence the development of it and a demonstration of the site.
14th May a session looking at unlicensed and off label prescribing will be held.
Other Meetings:
Operational division meeting for NMPs was cancelled recently
Respiratory task group meeting was also cancelled recently
MCN for addictions which includes FV and Tayside was also recently cancelled
Future Meetings:
A discussion was held around what we want this meeting to consist of, will we continue to do the same or should we invite speakers and how often should we hold the meeting.
SNPG meeting is 24th April at the Vine Church.
JT is going to meet with representatives from NES to discuss educational issues for paediatrics and asked if she could provide the website details, there were no objections from those present.
Meeting summary and close.
Next meeting arranged for Thursday 27th May 1830 at Dunnikier Hse Hotel

Present
Jacqui Taylor
Diane Snell
Colette Henderson
Gaynor Black
Lorna Mackenzie
Heather Watters
Janice Birrell
Lesley Colquhoun
Kerry Mavor
Tracy Murphy
Wendy McCormack
Mary Archibald
Karen Lee
Introduction and welcome: KL opened the meeting and welcomed everyone and thanked Pfizer, BI and Abbott for their financial sponsorship of the meeting.
Minutes of previous meeting – Minutes of previous meeting were viewed and accepted with no amendments
General update –Discussion around COPD management. If patient previously had 2 exacerbations and was started on steroid inhaler – should steroid inhaler be discontinued if they are now stable? Caroline Osborn can be contacted regarding information given at a meeting about this.
Podiatry practitioners now have prescription pads, but are awaiting management agreements.
Educational Meetings –
Discussion around new Fife Respiratory Steering Group being held at 6.30pm on the 10th November. Flyers to be sent to practices – Colette will assist with this. Aim to hold meeting 3 x per year. Venue To Be Arranged – will be chaired by Margaret Stevenson [charge nurse in ward 16] –forum to discuss any issue relating to respiratory care.
What’s on your mind – X – Ray requests podiatry practitioners have been told they need to complete the diagnostic module before they could make this request. Katherine Jamieson is the person to contact at VHK/QMH regarding this. Paediatrics are unique in that they can request renal ultrasound and micturating cystourethrograms.
Referrals to operational division seem to be generally well accepted. Advice given re caution to take on this responsibility as previously there were issues with referral pathways.
Update from Non Medical Prescribing Lead -
Controlled drugs – information to be sent out in prescriber newsletter.
Clinical supervision CPD event Nov/Dec. Delegates to bring cases studies along.
CPD - if anyone has any suggestions re specific topics, please contact Colette.
Any other business – Discussion around swine flu vaccination-whether Swine Flu vaccine is black triangle, training re swine flu, low percentage of NHS Staff accepting vaccine.
Next Meeting arranged for Wednesday 27th January at the Dunnikier House Hotel.
Meeting summary and close.

Dunnikier House Hotel
Kirkcaldy
Tuesday 7th April 2009

Present
Lindsay Pert
Olga Fielding
Michelle Horne
Heather Preston
Susan Chapman
Sheila Robertson
May Currie
Kecia McDougal
Nicky Credland
Lynne Coyne
Lorna Stewart
Aeltsje O
Susan Gallacher
Anne McKean
Jaquie Taylor
Lynn Pollock
Caroline Craig
Caroline Osborn
Janice Birrell
Ann Lawson
Colette Henderson
Christine Watson
Gaynor Black
Minutes of Previous Meeting
Minutes of previous meeting read and accepted by those present
Update on other Meetings
Operational Division – Jacqui Taylor informed group that last prescriber meeting was cancelled.
CHD study days including
– Keep Well Project. Discussion around inclusion criteria for project
- Diabetic MCN Meeting will be held on 28/4/09
COPD Study day : take home messages from meeting were
– Everyone should be using a pulse oximeter
– Everyone should be checking the calibration of spirometer
– Not sending sputum specimens during exacerbation
– Potential legislation around wrong diagnosis.
Diabetes UK : take home messages from meeting were
– New therapies
– New NICE Guidelines
– Oral therapies
– Clinical Governance with insulin management
Travel Update : feedback from meeting was
– Excellent meeting
– CD available for protocols
– Level of service offered
– Concern around deskilling of nurses not offering service
– GPs are paid 2% of global sum therefore should not be charging patients.
Update from NMP Advisor
– Colette’s contract is now permanent
– NMP Advisor for 20 hours per week.
– Next CPD Event on 14/5/09: topic supplementary prescribing. Flyers have already been sent & additional information to follow.
What’s on Your Mind?
Singulair
– Ann McKean asked if any other HCP were experiencing any problems with patient reaction on Singulair. Karen Lee raised ABPI compliance and completing a yellow card in instances like this. No other awareness in room to patient behavioural changes on Singulair.
Diabetes
– Nicky Credland asked if anyone has noted reduced control with non branded metformin with their patients.
COPD
– Caroline Osborn raised that an audit in practice looking at FEV1 <50% on steroid inhaler and discussion around patient risk / benefit of this practice – FEV1 does not always correlate with patient symptoms. Conclusion was to justify decision for treatment and question decision to remove steroid if that is action that was taken.
Operational Division Meetings
– Ann McKean asked about the possibility of having lunch time meetings or ? protected learning time meetings. Issue of pharma industry sponsored meetings not inviting op division nurses along – response was that often nurses don’t attend due to time constraints, but this is no reason why they should not be invited along.
– ADH nurse training/study days are funded by pharma industry
– Seems from op division that only medical staff are invited. ACTION : Education centre manager to be asked to add prescribers to list of HCP that she invited along to educational meetings in acute setting.
Funding for training / education
– Funding from Pharma industry
– RCN Grants
– GPs are given monies in global sum for training
Working with Pharma Industry
– If HCP are concerned with working closely with pharma industry there is guidance in the document “A Common Understanding” this offers guidance for working together, and a template for this.
– DoH – guidance / toolkit for NHS and pharmaceutical companies working together.

Professor Molly Courtenay
– Discussion around indemnity insurance
– MDDU / RCN
Handout / Study Discussed
Questions asked around repeat & acute prescriptions
ANP Website
– Educational Modules
– Linked to healthcare republic
– Weekly news section
– Journal
– Links
– Social networking forum
– Free to members
– Costs £25 to join
Professor Courtenay thanked for coming along and speaking at the meeting. Meeting closed.

Dunnikier House Hotel
Kirkcaldy
3rd February 2009
Attendees
Karen Lee Gwyneth Thom Gill Dennes
Lena Stewart May Currie Colette Henderson
Jaquie Taylor Susan Chapman
Anne McKean Karen Martin
Lorna Stewart Catriona Marshall
Apologies
Apologies were given from non medical prescribers unable to attend the meeting. Thanks to those who did this.

Introduction, welcome and thanks given to Allen & Hanburys and Boehringer Ingelheim for their financial support for the meeting

Minutes of previous meeting
Minutes of previous meeting were read by all in attendance and accepted.
Update on any other meetings attended
Clinical Standards NHS QIS – Gill Dennes on this group for COPD clinical standards. Planning standard for spring 2010

Asthma care group – schools very bad, kids have poor understanding of their problem. Research project happening in Glenrothes area – Anne McKean involved. P5 – P7 and teens, all schools contacted re this in Glenrothes area – response from only from 4 children.

Op Division Meetings – still held quarterly rotating between the Victoria Hospital and the Queen Margaret Hospital

Website update
Aware of problems, being addressed at the moment.
Fife Prescribing and Formulary Development Group – nurse Rx input update
Nurses who stated interest at last meeting are still waiting to find out if their time will be backfilled. Nurses are still interested though.
Update from NMP Advisor
Discussed CPD meetings and peer review events – feedback from all events is excellent. NMP Advisor post is ongoing until March 09. Waiting to find out if contract will be renewed.
Frequently asked questions document produced by Colette is to be published and circulated throughout NHS Fife.

Colette advised group that a nurse has been struck off the register for inappropriate prescribing.
Actions from previous meetings
Response from Anne Ritchie read out and circulated to group re spirometry in children and if there are any documented predicted values that could be used when carrying out this test. Anne advises that nurses in primary care should not be doing spirometry in children – Anne McKean paediatric nurse specialist felt that primary care nurses were well placed to carry out this test in primary care.

Gill Dennes is organising a spirometry meeting with Lena Stewart from A&H and will be including spirometry in children as a topic.

Susan Chapman advised group about a website that can be used to find predicted values of spirometry for children over 8 – www.spiroexpert.co.uk or .com
Can order paediatric mouthpieces for spirometer through stores.

Karen Lee has made contact with Molly Courtney and she would be pleased to come along to our next meeting on the 7th of April 2009.
What’s on your mind?
These points have been addressed as we have been going though each point in the agenda.
Date of next meeting
7th April 2009 at the Dunnikier House Hotel – buffet supper at 6.30pm with meeting starting at around 7pm. Molly Courtney will be a guest at this meeting and we will ask her to give us an overview of the national picture.
Any other business
Anne McKean brought up the fact that she has noticed that Singulair being used in paediatric patients has been causing changes in behaviour in some cases. Karen Lee and Lena Stewart both advised the group that if they felt that this was a side effect or an adverse effect from using this product then this was a yellow card event and should be reported as such.
Everyone thanked for attending the meeting and meeting closed

Dunnikier House Hotel
Kirkcaldy
29th October 2008

Present Apologies
Fiona Graham Jennifer Erskine Elaine Stark
Wendy McCormack May Currie Ruth Robins
Gaynor Black Alicia Nelson Dow Anne McEwen
Colette Henderson Sharon Kirk Shirley Fane
Michelle Horne John Campbell Lyne Coyne
Nicky Credland Jacki Taylor Gwyneth Thom
Lyndsey Pert Catriona Marshall Lesley Frew
Susan Chapman Sheila Robertson Ann Marie Gillespie
Susanneke Lucas Rhona Bishop Tracey Murphy
Grace Thompson Gill Dennes Lesley Colquhoun
Lorraine Summers June Lindsay Maureen Pheely
Heather Sheddon Irene Russell Lorna Stewart
Lena Stewart Karen Martin Lorna McKenzie
Janet Boylan Tessa Kidd
Karen Lee

Introduction and welcome and thanks given to Servier, Allen & Hanburys and Boehringer Ingelheim for their financial support for the evening meeting.

Minutes of previous meeting –
Minutes from the last meeting were read by all in attendance, and accepted.
Update on any other meetings
Nicky Credland updated group on Diabetic MCN meeting. Sharps policy is currently being updated. Will initially be for Dunfermline and West Fife CHP, with the intention of roll out to NHS Fife. Tessa Kidd has been writing policy – as sharps bins not prescribed for diabetic patients which means that there is a Health and Safety issue with sharps used by diabetics [sharps are put into general household rubbish]. It will be the responsibility of whoever prescribes the sharps to ensure that provision for safe disposal is provided. A new patient leaflet has been developed. 1 litre sharp bin to be prescribed. Each practice requires a SEPA certificate.
Wendy updated the group that there are now two AHP prescribers – namely Karen and Wendy – and Fiona is studying at the moment. Discussion about courses available at different universities. Also discussed Supplementary Prescribing course vs. the independent prescriber’s course.
Colette advised the group that the Fife Prescribers Website has been updated with new links & AHPs [recently qualified] details could be added to website.
All student prescribers will meet to discuss shadowing – Colette to organise.
Wendy discussed anecdotal evidence that patients are satisfied when CDM clinics are nurse led.
24th November – 9am to 4pm, Respiratory Meeting at Dean Park Hotel, Kirkcaldy. Looking at new asthma guidelines and will cover the topic of Spirometry in children.
17th November [evening] and 20th November [afternoon] Respiratory meetings being run by NHS Fife. Same programme being run twice. All non medical prescribers should have received an invitation to attend one of these meetings – can attend the one that suits them best.
Actions from previous meeting
Karen Lee has contacted Andy Robson [lung function department] at Edinburgh Royal Infirmary re Spirometry in Children. No response as yet. Also contacted Anne Ritchie re the same – again no response as yet. Karen has been asked to e mail the group when she has a response rather than wait until the next meeting to discuss it.
Karen is also waiting on dates for Molly Courtney to come to meeting. Group agreed that spring would be a good time for her to come to the meeting.
Discussed X Ray challenges again. Still no further forward with this. Course completed by many, but no guidance as when they can start referring as yet.
Fife Formulary – nurse Rx input
Question asked re would anyone like to attend the Fife Formulary Development Group meeting. Primary care representation is needed. The meeting lasts for about 2 hours, and is held every 6 – 8 weeks. Heather Sheddon, Michelle Horne, Gaynor Black, and Lorraine Summers are all interested – issues were raised about using their clinical time to attend a meeting. Colette will discuss with NHS Fife re if the practice could be reimbursed to allow them to attend before any decisions are made about who would be keen to attend.
What’s on your mind?
Barcodes on Prescriptions – question asked if this will be introduced for all NMPs. Yes was the answer – some systems e.g. emiss already have this on their system.
Emiss being introduced in some practices – St Andrews have just had it installed. Good points raised so far are BNF live on system, good patient information leaflets, emis templates can be changed – it also seems that the information that is input into system drills through all the various screens.
Heather enquired about paperless/paperlight practice when awaiting for notes. Same challenges faced in secondary care – concerns about awaiting notes and sending letters to surgery – this can take up to 2 weeks. Most concerning is issues with stopping drugs when in hospital and not clear when / if they need to be restarted.
Awaiting a possible system for everyone to access notes from primary and secondary care.
Update from NMP Advisor
Colette’s NPM frequently asked questions booklet is almost finalised.
Clinical Supervision events planned
1. Minor Ailments.
2. CMPs in practice Pod/Pharm/Nurses [Best Practice Guides]
3. Fife Formulary
4. Scenarios

CPD events planned
Pain Management meeting – planned for February next year
Wound Care / soft tissue injuries also planned for next year. Date TBC.
Date of next meeting
Date of next meeting set for Tuesday 3rd February 2009 at the Dunnikier House Hotel.
Meeting summary and close
Everyone thanked for attending the meeting, and the meeting was brought to a close.