Prescribing trial sought for diabetes nurses

1 March 2010

A trial of diabetes nurse specialists with prescribing rights is a step closer with a special regulation proposal now on the agenda. The fate of the proposed pilot hung in the balance late last year as ways forward appeared hampered by legislative barriers under the Medicines Act.

The pilot hopes to find an alternative to the “cumbersome” standing order system that requires a physician to sign off the 200-250 prescriptions issued a week by a diabetes nurse specialist.

Health Workforce New Zealand (HWNZ) board member Helen Pocknall said a project team was advised early this year that it could seek to gazette a regulation to allow approved diabetes nurse specialists to become designated prescribers of a limited formulary of drugs.

She said the team, of which she was a member, would put a formal proposal to the HWNZ board in March for a short-term regulatory approval to allow the prescribing pilot to go ahead.

If signed off by the board, it is estimated the proposed designated prescriber regulation for diabetes nurse specialists would go out for consultation and – if it wins the support of government – could be gazetted before June 30. Pocknall said once legislative barriers were removed, a pilot or demonstration project could be off the ground by September or October and could involve up to 12 diabetes nurse specialists over three to four sites.

Pocknall, who is the board member sponsoring the project, said the aim was for only a short-term regulation as ultimately HWNZ and nursing were seeking reform of the Medicines Act to allow wider prescribing by health professionals.

Nurse prescribing reforms were shelved in 2007 with the stalling of the controversial omnibus Therapeutic Products and Medicines Bill and while health minister Tony Ryall has indicated he will review the Medicines Act, it is not on the agenda in the immediate future.

Pocknall said pharmacists, dieticians and podiatrists were also seeking prescribing reform and the minister had got the message that the current legislation was one of the biggest barriers to health professionals offering “better, sooner, more convenient” health care. The diabetes nurse specialist proposal was initiated by the multi-disciplinary NZ Society for the Study of Diabetes (NZSSD) which presented it last year to the new Clinical Training Agency board (now known as HWNZ) as an innovation to be trialed.

A project team was set up and met in February to look at ways forward under the existing legislation which led to the latest proposal.

Society members and diabetes consultants Tim Cundy and Paul Drury are members of the HWNZ project team which also include NP Helen Snell, diabetes nurse specialists section chair Mary Meendering, acting chief nurse Christine Andrews and Clinical Training Agency head Tony Gibling, along with Helen Pocknall and Nursing Council legal advisor Clare Prendergast.