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Choosing a drug: 2
Having established that a prescription is really necessary and in the best interests of the patient, the nurse prescriber needs to decide exactly which drug to prescribe.
The EASE mnemonic may help (NPC 1999):
E - how Effective is the product?
A - is it Appropriate for this patient?
S - how Safe is it?
E - is the prescription cost-Effective?
Clinical effectiveness
Nurse prescribers have a responsibility to ensure they are up to date with the current guidance on the drugs in the Nurse Prescribers' Formulary. This means reading the latest literature published about the medications and conditions covered by the formulary. Nurse prescribers also need to be aware of the latest in evidence-based practice, national guidelines and current problems. When writing a prescription, they must consult a reliable up-to-date source of pharmaceutical information, such as the British National Formulary (BNF), Drug Tariff or Monthly Index of Medical Specialities (MIMS).
Some suggested sources of further information are:
* Drug and Therapeutics Bulletin: monthly bulletin on prescribing and drugs from the Consumers' Association. Tel: 0845 983 0082. www.which.net/health/dtb
* Effective Health Care: bi-monthly bulletins from the NHS Centre for Reviews and Dissemination. Tel: 020 7290 2927. www.york.ac.uk/inst/crd/ehcb.htm
* The Cochrane Library: regular CD-ROM and internet updates with reviews of healthcare papers. www. Update-software.com/cochrane/default.htm
* Clinical Evidence: monthly updates on treatments and therapies from BW Publishing. Tel: 020 7383 6270. www.clinicalevidence.com
* National Electronic Library for Health: portal to Clinical Evidence, NICE and CHI reports and guidance. www.nelh.nhs.uk
* National Prescribing Centre: bulletins and nurse prescribing information. Tel: 0151 794 8134. www.npc.co.uk
* Current Problems in Pharmacovigilence: monthly drug safety bulletin from the Committee on Safety of Medicines and Medicines Control Agency. Tel: 020 7273 0156. www.mca.gov.uk
Having established that the drug works, the next question is will it work with this patient and for these symptoms? To decide this, certain questions need to be answered:
* What is the therapeutic goal of the treatment?
* What is the patient's drug history? Include over-the-counter (OTC) medications, alternative therapies, prescriptions, adverse drug reactions and suspected drug allergies.
* Does the patient have any other illnesses? (Some concurrent conditions might put the patient at higher risk of certain adverse reactions.)
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