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Letter: Experience should count for something

Joan James

I read with interest the doctor’s comment outlined in ‘Is nurse prescribing a bad idea?’ (Vol 1, No 4, p102), in which ‘disappointment’ was expressed at the move to allow nurses to prescribe insulin. I recently had cause to visit a patient in a nursing home who was on twice-daily fixed mixture insulin injections and Peg feeds. His feeding regime had been changed several times and the nursing staff were concerned that his diabetes was not being well controlled. Knowing that the GP was visiting later that day, I left a note asking if the man could be changed to a basal/bolus regimen suggesting which insulins might be used and the doses I thought he would need.

On follow up a few days later I discovered that the soluble insulin had been prescribed but the intermediate night insulin had been changed to a fixed mixture which was totally inappropriate. The patient was put at risk of hypoglycaemia due to a double dose of soluble insulin being given in a short period of time. Two days later I received a telephone call to say that the patient had died. Did he have another CVA or was it a hypoglycaemic coma? 

I feel angry on two counts, one that the patient was put at risk and the other because I cannot openly question the competence of a GP.  So when the question is asked ‘Is nurse prescribing a bad idea?’ you know what my answer would be.

I acknowledge that nurses need training in pharmacology and the legal aspects of prescribing, but experience should count for something as well.

I read with interest the doctor’s comment outlined in ‘Is nurse prescribing a bad idea?’ (Vol 1, No 4, p102), in which ‘disappointment’ was expressed at the move to allow nurses to prescribe insulin. I recently had cause to visit a patient in a nursing home who was on twice-daily fixed mixture insulin injections and Peg feeds. His feeding regime had been changed several times and the nursing staff were concerned that his diabetes was not being well controlled. Knowing that the GP was visiting later that day, I left a note asking if the man could be changed to a basal/bolus regimen suggesting which insulins might be used and the doses I thought he would need.

On follow up a few days later I discovered that the soluble insulin had been prescribed but the intermediate night insulin had been changed to a fixed mixture which was totally inappropriate. The patient was put at risk of hypoglycaemia due to a double dose of soluble insulin being given in a short period of time. Two days later I received a telephone call to say that the patient had died. Did he have another CVA or was it a hypoglycaemic coma? 

I feel angry on two counts, one that the patient was put at risk and the other because I cannot openly question the competence of a GP.  So when the question is asked ‘Is nurse prescribing a bad idea?’ you know what my answer would be.

I acknowledge that nurses need training in pharmacology and the legal aspects of prescribing, but experience should count for something as well.

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