tip off
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What do nurses know about medicines, anyway?

Are nurses qualified to provide the general public with information about medicines?

Pharmacy consultant Ron Batagol doesn’t think so. He’s hopping mad that a nurse will be at the other end of the line for those calling the National Prescribing Service’s Medicines Line.

He writes:

“With the all-pervasive and very effective influence of the nursing lobbies in the highest echelons of health system decision-making, why are we so surprised that a national therapeutic advisory organization for consumers (the National Prescribing Service) chooses to use nurses instead of pharmacists to provide drug information to consumers?

After all, the “powers-that be” decided long ago that nurses, after some extra post-graduate study, are qualified to diagnose and also prescribe medications to patients to save them having to find a doctor.

Never mind that doctors spend years of dedicated study, under expert medical tutelage in both the art and science of differential diagnosis, and that pharmacists are acknowledged as experts in the therapeutic use of medications, having spent 5 years, plus post-graduate practice, studying and interpreting the chemistry, applied pharmacology and pharmacokinetics of drugs.

But, then again – if it’s OK for clinical consultations, why not go a step further and set nurses up to perform the role of a drug information pharmacist!

Now, don’t you just love the throwaway lines of the NPS justifying the new arrangements? “Registered nurses will answer calls in line with national nursing standards. More complex medicines-related questions will be triaged and referred to a health professional or an NPS medicines-information pharmacist.”

And even better:  “Many questions to medicines lines are about what the information on a label or medicine pack means and things that can be answered by reading the consumer medicine information leaflet.”

In reality, of course, it is ludicrous to think that you can “triage” these sorts of issues to a nurse or anyone else who does not have a pharmacist’s professionally-acquired understanding of how drugs work, and knowledge of the potential interactions, side-effects and optimum usage requirements. I’m also intrigued as to how “ being “in line with national nursing standards” is relevant in this context!

Indeed, as one who had, at various times, over a period of 30 years, been involved in setting up, and running Drug Information Centres for professional clients and consumers, as well as chairing professional specialty practice committees and seminars on drug information, let me say that it is the initial discussions with the caller that, if effectively handled, elicit the most valuable and, for the client, the most useful, exchange of information, that will set the framework for more detailed consideration and problem solving of specific medication-related issues.

And as to suggesting that “many questions related to “reading the consumer medicine information leaflet”, it is precisely the attempted decoding and deciphering of the convoluted gobbledygook of the consumer medicines information that brings many a consumer to phone a medicines advice line for expert advice and interpretation from a pharmacist.

Quite frankly, it’s a nonsense, and an insult to everyone’s intelligence to see the NPS using nothing more than clever spin to justify the dumbing down of a valuable national medication information line for consumers.”

• This post is also being published at the internet discussion group for pharmacists, AusPharmList.

Croakey wonder what others think about these matters?

(I must admit to having a wry smile about pharmacists aligning with doctors on this issue; I could have sworn they were at loggerheads just a moment ago… )

Meanwhile, the NPS website tells us that it collaborates with healthdirect Australia to deliver the Medicines Line, a telephone service providing consumers with information on prescription, over-the-counter and complementary (herbal/’natural’/vitamin/mineral) medicines.

It says: “When you call 1300 MEDICINE you will speak with an experienced registered nurse. Your question may be answered on the spot, or you may be referred to your GP or pharmacist, or to another health professional. If you have a complex enquiry you may be put through to a NPS pharmacist. In addition to receiving information, callers will be encouraged to discuss the information with their own doctor or pharmacist, who are be best placed to help interpret the medicines information. This telephone service is not for emergencies, medical advice or second opinions. Information provided by Medicines Line does not replace advice from a doctor or pharmacist.”

I will also seek a direct response from the NPS; will keep you posted…

Update, 9  July. Here is the response from the NPS  acting CEO, Karen Kaye:

“We are concerned the facts of this issue have become clouded: pharmacists are still pivotal in providing information to consumers who call Medicines Line.

Our decision to use healthdirect Australia to triage calls through to Medicines Line was based on giving consumers the best possible access to medicine information. Under the previous model, calls to Medicines Line could not be answered outside business hours.

With the new model, questions which can be appropriately handled by the experienced registered nurse answering the call will be answered on the spot. If the query falls outside their strict remit, the call will be triaged to an NPS medicine information pharmacist or the caller will be advised to contact their local pharmacist or doctor.

Registered nurses have an important role in managing a range of triage services which currently support health functions in this country, and providing health-related information in communities.

Pharmacists remain a critical element to the Medicines Line model and the new model does not in any way undermine their expertise. Rather, it provides further opportunities for referral to pharmacists where appropriate.

We encourage anyone who has questions about the new model to contact us directly or their professional organisation.”

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  • 1
    JamesH
    Posted July 9, 2010 at 4:50 pm | Permalink

    Another day, another outraged rent-seeking parasite.

  • 2
    Pete
    Posted July 11, 2010 at 5:59 pm | Permalink

    “Doctors spend years of dedicated study, under expert medical tutelage in both the art and science of differential diagnosis”

    Can someone please double-check that med students aren’t skipping these classes? My experience with GP’s is that their knowledge of differential diagnosis AND pharmacology is appalling. I have personally witnessed GP’s prescribing dangerous medicines, not checking for contra-indications, not checking that it is OK for the patient to take that drug, not even understanding the very basics of pharmacokinetics….

    I would always hope that a Pharmacologist would have this knowledge – but then in all the cases I just mentioned above, the dispensing pharmacist has never been the check-and-balance and have dished out the incorrect medication anyway!

    So what’s the big deal if someone with some training jump into this racket? Maybe these kinds of mistakes will be avoided with another fresh set of eyes….

    Just like with Midwives/Obstetricians – this is nothing but a turf-war!

  • 3
    raymond1
    Posted July 12, 2010 at 9:52 am | Permalink

    I don’t see a problem with a nurse traiging the calls and referring as necessary. As long as their “strict remit” is indeed strict. A registered nurse really doesn’t have much training in pharmacology at all (that’s not a core nursing duty).
    It would be inappropriate for a nurse to advise in detail on medicines.
    Although the message was a bit strong in tone, I thing he was just making that point.

    The idea that some have that nurses can do everything in the health system – be a nurse as well as a doctor and pharmacist is folly.

    And ‘Pete’ – your “GP’s are rubbish” diatribe was as just as ridiculous as most of the turf war issues you refer to. Mistakes are made with medicines at many points, from prescribing to despensing to adminstering and can involve doctors (pre-vocational, specialist and gp), nurses or pharmacists…..

  • 4
    ron batagol
    Posted July 12, 2010 at 10:27 am | Permalink

    ron batagol Says:
    July 12th, 2010 at 10:19 am
    Firstly, I must emphasise that my concerns in my article on this issue should not be seen as being either about turf wars or demeaning the important roles that nurses play in the health system. It is neither of those things! . Nurses have special expertise in patient observation, and monitoring of vital signs and changing levels of health status, plus a host of other specialised and varied functions such as wound care, stomal therapy, bowel management, special nutrition, fluid balance etc. They also monitor and titrate the giving of parenteral nutrition , blood replacement, and a whole range of other bedside procedures. They also set up and manage various health care plans for patients. And, again, they do these things better than anyone else!

    However, the best way I can summarise my concerns over the issue of NPS replacing pharmacists with nurses on their Medicines Line , is to repeat the caution expressed by an international expert on health systems and the various roles of health professionals, Prof.Des Gorman, of Auckland School of Medicine, when speaking on ABCs Life Matters in June 2009. Prof.Gorman said :“Role substitution makes sense only if the skills are transferable”. In this case, clearly they are not!

    This has direct relevance to NPS stating that “many questions can be answered by “reading the consumer medicine information(CMI). leaflet”, which is why I stated that “it is precisely the attempted decoding and deciphering of the convoluted “gobbledygook” in the CMI, which brings many a consumer to seek out the expertise of a pharmacist for clarification, and, often indeed, reassurance, about their medicines.” This is in fact even more important with a dedicated National medicines advice line, where, by its very nature, there are, potentially, queries which will require expert drug information advice, or at least pharmacist expertise, , to obtain relevant information from the caller and then accessing and interpreting appropriate databases and specialised texts, which is obviously well outside the scope of information contained in a standard CMI. As I indicated, in these cases, this will occur at the initial contact point with the caller.

    This process will be relevant and applicable to patient queries on medication use outside approved indications, mismatches between CMIs and also expert clinical consensus recommendations that doctors, in this day and age, preferentially rely upon. Also, underlying medical conditions affecting drug absorption, metabolism and excretion, which, again, may be a major area of concern in the clinical context. These are areas which the specific training and expertise of a pharmacist is geared up to advise upon. Should these calls now be handled initially by a nurse instead? I don’t think so!

    However, I guess the criticisms that I have expressed about this issue are symptomatic of a wider concern that I and others have over the moves in the past year for Governments to find a “quick fix”for the shortage of doctors by attempting to upskill nurses to take on the roles of doctors in diagnosis and prescribing. Again, I refer to that Prof.Gorman Life Matters interview, which, in fact, addressed the issue of more effective utilisation of health professionals and allowing them to enhance better health outcome, by contributing their special skills and expertise to the system in a collaborative way , rather than competitively substituting or replacing each other’s roles.

    But, it’s not all gloom and doom. The new move to give nurses a greater role in GPs surgeries with Practice Incentives Progammes is obviously a good thing. Similarly we now have well-researched templates for pharmacists to become more involved in selecting and advising doctors on drugs and their utilisation, which in major teaching hospitals at least, are starting to bear fruit as part of the plan where pharmacists and other health professional collaborate with doctors to develop comprehensive discharge, including medication management, plans. One can only hope that.over time, when the overall primary health care plans are fully developed and bedded down, there will be a more seamless transition and interaction between high-level institutional care and community care to the benefit of better overall patient care.

  • 5
    loretta
    Posted July 12, 2010 at 10:28 pm | Permalink

    As a cancer patient, herbal remedies were recommended to me. As a scientist I phones the AME hotline (several times), I talked to phamacologists – they were amazing.
    Nurses are wonderful people and are fantastic at patient care etc – but I would not like to take advice on interactions with pharmaceutic drugs and herbal remedies with them – as a consumer I think we have lost one of the most valuable resources in the expertise of those pharmacologists.

    It’s false economy and I won’t be using or recommending that help line again.
    What were the NPS thinking???
    What next? – an Indian call centre?

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