Mistakes predicted if nurses prescribe

Patient safety is under threat from law changes that will allow nurses to prescribe drugs, senior Christchurch doctors claim in an attack described as a public warning.

Two specialists yesterday published a scathing article in the New Zealand Medical Journal, saying the law changes risked serious damage to medical teamwork and would have "unforeseen consequences on standards of safety and competence".

The report's co-author, clinical pharmacologist Professor Evan Begg, last night said the article was a "public warning" on the consequences of the new law, which will come into effect on December 5.

Begg said he and his co-author, rheumatologist Peter Moller, had published the warning because they wanted their concerns on record "when things go wrong".

"Even under current practising conditions with doctors, people make mistakes. We all make mistakes – people who are trained less will make more mistakes," Begg said.

"Would you like to go to Australia in an aeroplane piloted by one of the flight crew who had some extra training?"

Begg said he and Moller had been asked for their opinion several times as the new law was debated, but no heed was taken of their concerns.

Asked if he believed the changes would threaten patient safety, he replied: "Absolutely."

The Nursing Council, however, says it can not see any evidence to support the doctors' claims, while the Nurses Organisation says any fears are unfounded.

In September, the Cabinet approved the right for nurse practitioners who had met requirements set by the Nursing Council to prescribe a range of prescription medicines and controlled substances.

New Zealand Medical Association (NZMA) chairman Dr Ross Boswell previously described the move as "loony", and an article in the latest issue of the association's journal, the New Zealand Medical Journal, has continued the attack.

Begg and Moller's article questions whether nurse practitioners – who would be restricted to administering drugs to when they had knowledge and skills in a certain area – would have the training to prescribe with the same degree of safety and competence as a doctor.

"We (doctors) are dealing with a complexity of interactions with other disorders, other drugs and side-effects on various systems which are wider than a nominated area of practice. Thus the knowledge base required is thorough and comprehensive," the article said.

The doctors rubbished statements that expanding nurse-prescribing was desirable because it would extend nurses' skills, saying that placed the interests of patients "second to a major experiment on behalf of a sectional interest".

Nursing Council chairwoman Annette Huntington said there was a large body of international evidence which clearly supported the view that nurse practitioners were safe.

To prescribe, nurses would need four years experience in their speciality area over and above their general nursing experience and to have undertaken a clinically focused master's degree.

They would then have go through a registration process which would probably include doctors on the panel.

"We're working very collaboratively with our medical colleagues in relation to registering nurse practitioners," Huntington said.

Nurses Organisation chief executive Geoff Annals said the risk of error among nurse practitioners was no greater than for medical practitioners.

"There is evidence that current health services are not available to many people when they are most needed. Extending the responsibility for prescribing to specified nurse practitioners will lead to more prompt treatment through rapid access to medicines."

Health Minister Pete Hodgson said a suggestion, made in the article, of a political will to radically alter healthcare was "spurious nonsense", and that the first New Zealand report considering nurse prescribing dated back to 1994.

"I can imagine that if you look forward into the future we will get better flexibility, especially in rural areas ... where access to medical assistance is hard to come by."

"The benefits are not just to keep up with the world but to make sure you have a health system with appropriate flexibility," Hodgson said.

He said there were about 3000 nurse practitioners in Britain and more than that in the United States, and New Zealand – if anything – was behind the times in introducing the change in this country.

However, plans to extend nurses' prescribing powers in Britain to include any licensed drug have proven controversial. Yesterday, the British Medical Association said such plans were irresponsible and dangerous.

By MIKE HOULAHAN and AMANDA WARREN

Article from www.stuff.co.nz