Should Pcn Prescribe Drugs_dato' Seri Dr t Devaraj

7/31/2019 Should Pcn Prescribe Drugs_dato' Seri Dr t Devaraj

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SHOULD PCNS PRESCRIBE

DRUGS IN A HOSPICE HOME

PROGRAMME?

Dato Seri Dr T Devaraj

Penang Hospice Society


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DRUGS IN MODERN MEDICINE 1

Essential component management disease,symptoms, complications

Drug Control AuthorityRegistration

Safety, efficacy, GMP Classification drugsOver the counter (OTC ) or also known as

non-scheduled poisons (NP) accessible topublic

Need prescription by doctor (Group B)more potentregulated


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DRUGS IN MODERN MEDICINE 2

CLASSIFICATION

MIMS - Malaysian Poison Classification

Group AGroup B - doctor ,dentist, vet

Group C - sell, entry Prescription Book

NP - Non-scheduled poisons or OTC


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DRUGS IN MINISTRY OF HEALTH

Ministry of HealthDrug Formulary 2008

Guidance on Prescribing

A+ - Consultant / Specialist for specificindication

A - Consultant / Specialist

A/KK - -do- / Family Physician Specialist

B - Medical Officer

C - Paramedical staff

C+ - Paramedical staff doing midwifery


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IAHPC LIST OF ESSENTIAL MEDICINESFOR PALLIATIVE CARE 2006

Medications for most common symptoms in P C

Pain: mild, moderate, severe

bone, neuropathic, visceral

dyspnea fatigue

terminal respiratory congestion

dry mouth depression

hiccups delirium

anorexia cachexia insomnia

constipation terminal restlessness

diarrhea sweating

nausea vomiting

List of drugs: Pall Med 2006; 20:647-651


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NURSE PRESCRIBERS -

SCENARIO IN MALAYSIA

Rx drugsHospitals NoClinics - Spt / GP NoMOH clinics Yes - MOH group C


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MOH GROUP C DRUGS

Drugs listed as C for use by paramedicalstaff cover all disciplines except respiratory,psychiatry, drugs affecting immune

response, haematology/oncology,rheumatologydiagnostic

MOH group C drugs applicable in PC are

antacids, laxatives, paracetamol, Bcomplex, ferrous fumarate, nystatin andsome creams


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DUNIA DI SANA SINI

PHS - paracetamol, laxatives, vitamins HCA Spore - PCNS have to consult doctor Australia

one service PCN does not carry any drugs /consult Drbut PCNs can increase dose paracetamol / laxatives

another service PCNs cannot prescribe but canrecommend OTC drugs has a N Practitioner in PC Rx opioids, anti emetics

India - illegal for nurse to prescribe and same in PC UK - 20,00 nurses and 1500 pharmacists qualified as

independent prescribers and can prescribe controlled

drugs (23.4.12) Africa some states PCNs allowed to prescribe opioids USA has Nurse Practitioners


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MAKING SENSE OF

DIFFERING PRACTICE Practice stems from the local health care

situation

Factors - morbidity needs, kinds of health

professionals available and other resources forhealth care, health systems, country size

Other factors socio-economic, costs of healthcare, quality of care

Task shifting - Malaysia has long history of para

-medics delivering health care

1 Malaysia clinics have re ignited controversyover task shifting


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WMA ON TASK SHIFTING

FROM MEDICAL PROFESSIONIn healthcare, the term Task Shifting is used todescribe a situation where a task normallyperformed by a physician is transferred to a healthprofession with a different or lower level ofeducation and training, or to a person specificallytrained to perform a limited task only, without aformal health education. Task shifting occurs bothin countries facing shortages of physicians andthose not facing a shortages.

Although task shifting may be useful in certainsituations, and may sometimes improve the levelof patient care, it carries with it significant risks. .

Berita MMA Jan 2010


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SPECIALIST NURSING PRACTICE

SOME DEFINITIONS OF EXPERT NURSES advanced practice nurse (APN) nurse practitioner (NP) clinical nurse specialist (CNS)

nurse consultant (NC)

Think point:multidisciplinary collaborative care betweendoctors and allied health professionals is

better optioncontinuity of care, patient safety, good care

the priority


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MEDICATIONS WHAT PCNSENCOUNTER AT INITIAL VISIT

None

Taking on own OTC or even group BOn medications from doctor / doctors

Medications can be group C or group B

Varied sources of medications

Medication needs can change over time


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DRUG USE IN HHP SOMEOBSERVATIONS ON PCNS ROLE

Ideal - PCNs consult doctor each time Q practicality, necessity Class of drugsGroup B - only by doctor

Group C - selected items for urgent useby PCNs

Modifications of drugs in use - have standinginstructions consult doctor

Think point:with no formal training yet of even PCNs moving

on to APNs or NPs can only be a pipe dream


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Thank you

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Should Pcn Prescribe Drugs_dato' Seri Dr t Devaraj