Prescribing the future for hospice at home

Categories: Care.

It is three o’clock in the morning. A cancer patient who is being cared for at home needs an urgent prescription, but faces a long wait for an out-of-hours doctor to call. It is a distressing situation for the patient and his family, and one that nurses working in the community seek to avoid.

At Rennie Grove Hospice Care, nurses prepare for emergencies by keeping ‘Just in Case’ medication in the patient’s home. And now they are improving hospice at home care still further by extending their skills and knowledge to qualify as non-medical prescribers. This enables them to bring effective relief to patients when they need it, at any time of day or night.

Rennie Grove currently has three specialist nurses who are qualified to prescribe medicines within their expertise of palliative care. One of the charity’s key goals is for all its senior staff – 13 clinical nurse specialists and 15 Band 6 nurses – to gain the qualification.

Sue Jarvie, Hospice at Home Locality Nurse Manager for the Dacorum, Overnight, and Grove House teams, explains: “The most important reason for our nurses to train as non-medical prescribers is that it brings huge benefits to patients.

“A nurse who is qualified to prescribe can provide quick and effective treatment, when the patient needs it, and will also be prescribing within her area of professional expertise. Our senior palliative care nurses have high levels of specialist knowledge and experience, which they use to prescribe the right treatment.

“Having more nurse prescribers also eases pressure on GPs and out-of-hours doctor services. Rennie Grove is not a standalone service but part of a network of health professionals. We work in close partnership with GPs and district nurses.”

Sue says the specialist knowledge of her nursing teams is particularly important as treatments and management for life-limiting illnesses continue to improve.

“The focus now is on survivorship,” she explains. “We see much more long-term disease, with patients being treated and discharged. Many people are able to live well until very near the end of life, but we also see patients with a complex range of symptoms, and this presents new challenges for our nurses. They have to be highly educated and there is a huge emphasis on continuing training and development.

“When I started as an Iain Rennie Hospice at Home nurse, 24 years ago, we didn’t see people surviving with cancer tumours in remission, or with secondary stages of the disease having had time to develop.

“Our nurses also have larger caseloads than in the past, and visits are managed differently. Rennie Grove also uses the skills of its many volunteers, who give respite care and train as bereavement visitors, services the nurses used to provide.”

Hospice at home nurses may not spend as much time with patients as in the past, but Sue says it is the quality of the time given and the responsive nature of the 24/7 service that is important.

“It’s much easier now for us to respond to patients rapidly because all nurses have mobile phones – whereas in days gone by we had one mobile phone between us! I think also – with the evolution of our out-of-hours service into a fully-fledged night team, patients feel more confident to call us at any time.

“But responsiveness isn’t just about the time we take to respond; it’s also about remaining as flexible as possible. One visit may only need ten minutes, but another might take two hours. We spend the time that the patient needs.”

As Sue suggests, another important change since the early days is the way Rennie Grove operates its night service. “The emphasis has always been on care being available 24 hours a day, but we now have a dedicated night staff,” says Sue. “The night service is used more and the team work in pairs so that attention can be given to family members at the same time as the patient.

“It is so important for patients and their families to know that we are there, whatever time of day or night. Being a family carer is a huge responsibility. Relatives have often said to me that even though they may never need to call us out at night, it is knowing that they can, that we are there if they need us, that makes such a difference.”

Thank you to Rennie Grove Hospice Care for sharing its experience of non-medical prescribing with ehospice. This is such an important aspect of care for hospice and palliative care providers, ensuring a fully responsive service which meets the needs of the patient and carers. Contact ehospice if you would like to share your own experience of implementing non-medical prescribing, or why not share your thoughts by commenting on this article (note that the comments function is currently only available on the desktop website).

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