Frustration over legal barriers to a diabetes nurse specialist prescribing pilot is prompting exploration of alternative pathways.
The Clinical Training Agency board recently considered a proposed pilot of prescribing by diabetes nurse specialists put forward by the multidisciplinary New Zealand Society for the Study of Diabetes (NZSSD).
But CTA board member Helen Pocknall said the initial proposal was not achievable under the Medicines Act as the act did not allow registered nurses to prescribe.
Chief nurse Mark Jones said the pilot’s backers were still confident that it could use existing legislation around nurse prescribing to facilitate the project. Options being explored could include seeking designated prescribing status for the pilot nurses.
But he and Pocknall said long-term the bigger picture of reforming the Medicines Act to allow nurse prescribing needed to be addressed.
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.
Helen Snell, a diabetes nurse practitioner and NZSSD executive member, said the current standing order prescribing system was “cumbersome, challenging and time-consuming” for diabetes nurse specialists.
She said the country’s specialist diabetes services were predominantly delivered by a diabetes nurse specialist team working with a single diabetes physician or endocrinologist who has to sign off each nurse prescription within a set period.
Because of the nature of diabetes – with sick patients sometimes requiring hourly prescription changes to revise doses and stabilize blood sugars – a diabetes nurse specialist might be issuing 200 to 250 prescribing notes a week under standing orders. She said it was also nonsense that a diabetes nurse specialist needed to take up the time of a physician or NP to sign a prescription for simple urine testing strips. Pocknall said looking at mechanisms to allow prescribing diabetes nurse specialists had “quite far reaching ramifications” for other nurse specialist roles.
There were also other health professionals, like podiatrists, dieticians and pharmacists, who were keen to have some form of prescribing role. “Under current legislation it is very difficult for them to move ahead in that direction,” Pocknall said She said she told the minister at the recent board meeting that one of the single biggest differences that could be made to improving delivery of patient care was changing the current prescribing legislation.
