Nurse prescribing model proposed for rheumatology patients

An extended scope of practice model proposed for nurses will allow them to prescribe for rheumatology patients to free up doctors’ time for more complex patients.

The “prescribing in partnership” model released for consultation by the Nursing and Midwifery Board of Australia states that nurse prescribers will help ensure more timely care for patients and relieve clinic waiting times in an overburdened health system.

It aims to extend the scope of practice for nurse prescribing beyond existing models for nurse practitioners and rural nurses, who account for only 1% of the nursing workforce

In a public consultation paper, the Nursing Board outlines how the “prescribing in partnership” model will allow eligible registered nurses to be endorsed to prescribe scheduled medicines “within their level of competence and scope of practice”.

Under the model, an endorsed nurse will be a member of a multidisciplinary team and will prescribe in collaboration with a ‘partner prescriber’ – either a doctor or nurse practitioner.

The board stresses that nurse prescribing model will only operate in healthcare settings where appropriate governance arrangements are in place. Suitable settings will likely include acute and aged care, primary care and community health, but not for nurses working solo in private practice.

One example of nurse prescribing suggested in the consultation paper is for a patient with severe pain associated with osteoarthritis living in an aged care facility who has run out of pain medication and whose GP can’t be contacted.

“After assessing the resident and ensuring the residents’ pain continues to be well controlled, the RN writes the necessary ongoing prescriptions in accordance with facility guidelines on prescribing in partnership.

“The resident is able to receive uninterrupted and appropriate pain control until the GP is next scheduled to visit, immediately after the long weekend. The RN notifies the GP of the repeat prescriptions and on the GPs next visit discusses the ongoing management of the resident’s pain.”

Another example cited in the consultation paper is of a registered nurse prescribing and adjusting medications for patients attending an outpatient clinic.

“The RN monitors the person in the outpatient clinic on a monthly basis, and undertakes prescribing relating directly to their long-term health condition. On a routine patient visit, the RN conducts an assessment to determine whether the person’s long-term health condition is stable and titrates medicines in accordance with the health service’s governance framework.

“The RN regularly discusses the client’s health status with the partner prescriber and escalates care when any changes are identified in the patient’s health status. The partner prescriber now sees the patient in collaboration with the RN every two months, instead of monthly. This allows the partner prescriber to concentrate on more complex cases as well as helping to increase clinic efficiency by decreasing patient waiting times to be seen and assessed.”

The model makes sense, argues the Board, given that registered nurses make up the largest pool of regulated health professionals in the country and already work multidisciplinary teams, administer, supply and titrate medicines and play a “considerable role in the assessment, diagnosis, management and evaluation of care”.

To be eligible, registered nurses will need a minimum of two years’ full-time post-registration nursing experience and have to undertake additional education. Nurse prescribers will also have to practice for the first three months under the direct or indirect supervision of a “partner prescriber” and pass an evaluation.

The [Board] believes that prescribing in partnership as demonstrated by examples such as these will support improved timely access to medicines for consumers and also meet safety and quality standards,” it concludes.

The public consultation closes September 21.

Read the full proposal here

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