Nurse prescribers in epilepsy management: A concept in evolution.

Dear Sir,

I would like to discuss the contentious issue of supplementary nurse prescribing for the management of epilepsy.

The concept of nurse prescribing has evolved to address numerous issues; for example, in Sweden, nurse prescribing was introduced in the early 1990's to reduce the work-load of doctors and further ensure that care in the community was provided by an appropriate mix of health-care professionals.[1] Contrastingly, in Canada and several states in Australia, support for nurse prescribing has been in rural areas, where there is shortage of doctors.

Here in UK, the primary legislation permitting nurses to prescribe a limited range of drugs was passed in 1992 (Medicinal products. Prescribing by nurses act 1992) following which, there was the introduction of nurse-independent prescribing in 2002 (DoH 2002) and nurse supplementary prescribing in 2003 (DoH 2003).[2]

Currently, there are 28,000 nurses registered in the UK as independent prescribers, of these, 4000 are listed as supplementary nurse prescribers; this enables nurses to prescribe a large proportion of appropriate drugs listed in the British National Formulary for chronic diseases, following an appropriately developed management plan.

A lack of able practitioners for the management of epilepsy results in uncontrolled status epilepticus, adverse drug reactions and other associated morbidities, thus, supplementary nurse prescribing is clearly an important and necessary development in the management of epilepsy. Currently, as I understand, there are relevant courses to achieve these competencies. I am certainly supportive of supplementary prescribers’ role for nurses in the management of epilepsy, as this would reduce the need for appointments at hospital clinics and increase patient choice with regards to access to medicines. In addition to this, such an intervention would also have a massive benefit on developing countries, where resources are slightly more limited. Despite these benefits, the training and the implementation has to be closely evaluated over time; it has been shown that fewer than 50% of epilepsy-specialist nurses have relevant post-graduate qualifications.[3]

In my practice, in different hospitals across the UK, I have worked with advanced nurse practitioners and specialist nurses in various specialities in pediatrics. I believe that there is a lot of anxiety and lack of confidence among nurses who take up this role, despite extensive training. This may be attributed to lack of training in advanced pharmacology or physiology during their early years of training. I believe that there is certainly a role for nurse prescribers in the management of epilepsy, but this has to be taken up after appropriate qualification in epilepsy and supported closely by a specialist physician.