1. The Hidden Benefits of Nurse Prescribing
in Care of the Older Person
Daragh Rodger, Lorraine McNamee, Winah Quijano,
Christine Scanlon, Donna Mitchell, Charina Hogan, Maree
Barry, Gabriel Germino, Elena Deveney.
St Mary’s Campus Phoenix Park & SeanChara Community
Unit, Dublin
Background: A recent review of nurse prescribing activity in care of the older person identified the outcome didn’t
always indicate the need for a prescription and therefore is not captured on the Nurse and Midwife Prescribing Data
Collection System. This was also alluded to in the National Evaluation of the Role of the Nurse and Midwife
Prescribing Initiative (2009). The uncaptured activity is not seen as a negative by our Registered Nurse Prescribers
but a hidden benefit of their role.
3. Promotion of best practice
through staff education
The role of the RNP has also
resulted in improved practices
with the assistance of the Drugs
and Therapeutics committee
(DTC). DTC’s were set up initially
to provide a platform for
Registered Nurse and Midwife
Prescribers. Through reviewing
drug prescription sheets in a more
informed and critical manner,
RNP’s have found a number of
positive outcomes which are not
reflected in the database.
 Reduction in polypharmacy and
the risk of drug interactions.
 Improved use of prescribed
medications
 Improved medication
prescribing, management and
administration through staff
education
 Reduction in the risk of
medication errors.
These interventions have a
positive impact on the quality of
life of the patients and residents
in our care but are not recordable
on the Nurse and Midwife
Prescribing Data Collection
System.
1. Increased compliance of pre
prescribed medication through
education
As a nurse prescriber the assessment
process and physical examination of
the patient provides a wealth of
information.
 Relationship is formed which
encourages openness and honesty
 Diagnosis and discussion of plan of
care
 Need for a medication to be
prescribed
 Revelation medication has been
prescribed previously by GP but not
taken
 Opportunity to educate on the
effectiveness of the medication
 Monitor the ongoing progress and
effect of the medication
 Promotes compliance
 Patients needs are met
Many scenarios occur similar to this
and are not captured on the Nurse and
Midwife Prescribing Data Collection
System. There is no national record of
this valuable intervention.
2. Proactive approach to
antibiotic therapy
In a quarterly local audit the
total number of resident
assessments was n=15. The
number of prescriptions
ordered was n= 3. This
highlights that n= 12 residents
received comprehensive
nursing assessment and
physical examination by the
RNP which is not captured on
the Nurse and Midwife
Prescribing Data Collection
System. The majority of
assessments were for
perceived respiratory tract
infections and eye infections.
However following nursing
assessment and the absence of
infection perceived antibiotic
treatment was not required.
The RNP submits this data to
the prescribing site coordinator
for auditing purposes.
Conclusion: This initiative highlights the benefits of the assessment
process by RNP’s and how the time and documentation afforded to
this practice is not always captured on the Nurse and Midwife
Prescribing Data Collection System. It identifies the skills and
expertise of the RNP in the development of best practise in the
clinical area through staff education. It reinforces the use of local
audit trails to capture effective nurse prescriber activity for future
care of older persons.
Reference:
Drennan J., Naughton C.,
Allen D., Hyde A., Felle P.,
O’Boyle, K., Treacy P., Butler
M. (2009) Independent
Evaluation of the Nurse and
Midwife Prescribing Initiative.
University College Dublin,
Dublin.