1. Non Medical Prescribing – Making a Difference Karen Selwood Advanced Nurse Practitioner

2. ANP’s in paediatric oncology 2 ANP’s in the late 1990’s Role development over the last 10 years Moved to a new unit 2 more ANP’s – wider service

3. Prescribing before the V300 Group protocols –Written instruction for the supply and/ or administration of medicines in an identified clinical situation.

4. PATIENT GROUP DIRECTION FOR NURSE PRESCRIBING OF ANTIBIOTICS IN ONCOLOGY 11.2.1 AIMS OF TREATMENT To treat neutropenic pyrexia following chemotherapy 11.2.2 POLICY & PROCEDURE STATEMENT The policy and procedures on the nurse or HCP administration of drugs according to prescribing exemptions are followed. 11.2.3 ADDITIONAL CRITERIA FOR ROLE EXPANSION Oncology ANP or clinician 11.2.4 DRUGS Piperacillin, Netilmicin, Ceftazidime, Amikacin, Teicoplanin. 11.2.5 EXCEPTIONS See guidelines relating to infection control in oncology. Patients allergic to one of the drugs or who have shown a previous ADR. 11.2.6 CONTRAINDICATIONS, PRECAUTIONS OR SPECIAL CONSIDERATIONS Consider previous anti-infective therapy, renal function adverse reactions, and aminoglycoside levels. 11.2.7 ASSESSMENT & ADMINISTRATION PROCEDURES Refer to guidelines on the use of anti-infectives in oncology. Document administration on the patient's nursing and medical notes. 11.2.8 FOLLOW UP All children will be assessed within 24 hours by a doctor. 11.2.9 DRUG DETAILS Administration and side effects - see guidelines. 11.2.10 REFERENCES Guidelines on the use of anti-infectives in oncology

5. Prescribing before the V300 Group protocols –Written instruction for the supply and/ or administration of medicines in an identified clinical situation. Transcription on admission/ discharge

6. V300 Issues –Adult orientated –Practical aspects from paediatric perspective A means to an end!

7. Prescribing in paediatrics Within scope of practice –Licensed medicines –Off label use Limitations of an Independent prescriber –The use of unlicensed medicines –Controlled drugs

8. Now in practice Independent Prescriber Clinical management plans –Partnership between independent/ supplementary prescriber –Can prescribe all medicines –Written care plan –Needs a diagnosis –Shared records

9. Name of Patient:Patient medication sensitivities/allergies: Patient identification AH No: Date of birth: Independent Prescriber(s): Dr. M. Caswell, Dr. R. Keenan, Dr. H. McDowell, Dr. B. Pizer, Dr L Howell Supplementary Prescriber(s) Monica Hopkins, Michelle Wright Karen Selwood, Caroline Langford Condition(s) to be treated: Leukaemia Aim of treatment Treatment of malignancy and relief of potential and actual side effects

10. Medicines that may be prescribed by SP: Indication Treatment of malignancy Preparation Chemotherapy/ steroids Dose schedule As per current protocol Specific indications for referral back to the IP Intolerance of treatment Prevention and treatment of nausea and/ or vomiting AntiemeticsAs per antiemetic guidelines/ medicines for children/ BNF Uncontrolled nausea/ vomiting Prevention and treatment of infections Antibiotics/ antifungals/ antivirals, antiseptic products. As per infective guidelines/ chemotherapy protocol Septic shock, unremitting fever or infectious signs Dehydration, fluid overload, abnormal electrolyte results, administration of drugs and fluid resuscitation Fluid and electrolytesAs per medicines for children / guidelines Severe dehydration, unresponsive blood chemistry, unremitting hypovolaemia GIT problemsLaxatives, drugs for mouthcare, diarrhoea, gastritis. As per guidelinesUnresponsive to initial treatments The relief of pain and discomfort Analgesia including controlled drugs where appropriate As per pain pathway/ medicines for children Uncontrolled or increasing pain Prevention and treatment of malnutrition Nutritional supplements/ TPN As per nutritional guidance and patient notes Persistent weight loss Maintenance of central venous line patency Heparin flushes, urokinaseAs per CVL guidelinesPersistent CVL blockage Treatment and prevention of thrombus Anticoagulation therapyAs per warfarin/heparin guidelines Persistent coagulopathy Prevention and treatment of allergic reactions. Antihistamines, corticosteroids As per anaphylaxis guidelines/ antihistamine guidelines Unresponsive to initial treatment The prevention and treatment of skin breakdown or trauma. Promotion of wound healing. Emollients, bacteriocidals, antiseptic and wound care dressings As per skin care guidelines – wound management, dermatological and radiotherapy Poor wound healing, deteriorating skin integrity

11. Now in practice Cover all areas of oncology unit Nurse led day care Leukaemia clinics Advantages for families –Holistic approach to care –Seen in more timely manner –See small team who know the child and their history

12. Issues for the future Controlled drugs –Awaiting changes in legislation Unlicensed medicines

13. Thank you for listening Any Questions? Karen.selwood@alderhey.nhs.uk