10 NEWS SYNERGY NEWS DECEMBER 2013
www.sor.org
Nurse/Non Medical Prescribing conference report
Hazel Boyce, review radiographer at Bristol Haematology & Oncology Centre, attended the Association of Nurse Prescribing conference in September, on behalf of the SoR. An excellent talk on ‘Making decisions better’ emphasised
how much we rely on past experiences and how these together with evidence based learning, help us make prescribing decisions. It is important to review evidence, but the speaker suggested a ‘Golden Hour’ – an hour a week spent looking at updates and information gathering from trusted valid sources. ‘Medicines management and use review’ looked at NHS
Trauma meeting focuses on facial injuries
The second trauma evening study session was held at Ninewells Hospital, Dundee, in October.
Entitled ‘facial trauma’,
the event was attended by over 60 members of staff from Fife, Tayside and Grampian. There were four excellent presentations. Dr Russell Duncan, consultant in emergency medicine at Ninewells, described the different injuries and histories that present to A&E with assault being the most common. He observed that patients seldom say ‘I’ve been in a fight’, but are more likely to say ‘I was jumped’! He went on to describe
how the patients are examined and how the clinician builds up a picture of the injuries sustained, followed by x-ray to confirm those findings before referring the patient on for more complex studies like CT and the maxilliary-facial surgeons.
Dr Duncan emphasised one point
to radiographers. Facial trauma in itself only becomes an urgent clinical priority if the airway is compromised or there is tethering of the rectus muscles of the eyes. In other cases, if the patient is uncooperative, then there is no urgency to x-ray them immediately. X-ray examinations of the face taken on uncooperative patients will nearly always be substandard and will need to be repeated a few hours later anyway. Consultant radiologist
John Brunton described the anatomy of the face in detail before showing different plain film and CT images of patients with injuries sustained, usually by assault. Dr Brunton described different injury types and how they showed on x-ray. Superintendent
radiographer Lynn Lyburn presented a quiz which complemented the talks given by the first two speakers. The fourth presentation
was given by maxiliary- facial surgeon, Douglas
Kennedy. Mr Kennedy described in detail, the types of injuries patients had in his department and the different approaches the surgeons use to access the different bones of the face, avoiding blood vessels and nerves. Some of the images he showed were particularly horrific, demonstrating significant trauma from accidents or practical jokes. Some patients had sustained severe blast injuries and burns to their faces. The organising team (Ewan Murray, Laura Nicolson, Paul Rudd and Denise Adam) would like to thank the speakers, Dundee University, Scottish Council for endorsing CPD Now accreditation and MIS Healthcare for its generous sponsorship. We are looking to produce our next event in 2014 and anyone who wishes to be kept informed should contact:
ewanmurray@nhs.net
Paul Rudd, Trauma Study Session
funding, commissioning vs. de-commissioning, cost benefit outcomes and how the bigger picture will impact on prescribing decisions now and in the future. The National Prescribing Framework and maintaining competence to prescribe was discussed. Using the framework to form the base for CPD will enable prescribers to revisit all aspects of their prescribing practice. All prescribers should follow the same framework so that patients receive the same safe level of care. Legal considerations for nurse prescribing was demonstrated with the use of case studies. Emphasis was given to acting within one’s scope of practice, accountability, negligence and code of conduct. A series of case study presentations followed including
prescribing within a cardiology clinic and the impact it had had on patient care (and how non medical prescribing has supported autonomous advanced practice). The development of NMP roles looked at nurse led
discharge and its benefits for patients. Service redesign plans must be centred on improving patient service and safety – most impact will be made in areas of high patient throughput and business cases should reflect these issues. An example of a business case was presented by a midwife NMP who set up a clinic to support pregnant women with diabetes. There is no routine involvement from medical staff – the service has proved to be very popular and patients are satisfied.
A Community Macmillan CNS NMP talked about some of the barriers to implementing NMP, and the need for clear shared protocols and procedures. She gave surprising statistics about the numbers of Macmillan nurses that are/not NMP. Of those that have not undergone the training 25% did not see it as part of their role. 40% expressed reluctance to undergo training. However, NMP has enabled rapid access to end of life symptom management and this has been of benefit to all. A consultant pharmacist and NMP looked at her role within
the multi-disciplinary team, making an interesting point. ‘There should never be competition between professions when prescribing, everyone has something to offer’. ‘The impact of NMP on patient care’ centred around audit.
To keep things simple, try to use existing data. Pose simple questions – What is happening? Who is involved? Does practice match agreed standards? The day closed with NMP moving forward and general changes expected in the NHS. Of note the introduction of electronic Pt records and electronic prescribing. For the full report, visit
bit.ly/1at6Gg3
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