Key areas of interest for paramedics in 2018

My Post (11)The most substantial development concerning paramedics this year is prescribing. Proposals to introduce independent paramedic prescribing were made to the Commission on Human Medicines (CHM) in 2015. However, the CHM did not support the proposals at that time. The College of Paramedics and NHS England went back to the CHM in July 2017 with case studies and an implementation plan to try and get further discussion. The following December the CHM decided to support independent prescribing by paramedics. It will now recommend implementation by making a submission to government ministers.

There is still a lot of work to be done and this is likely to be the key area for development of the profession in 2018. Legislation changes need to be made to enact the recommendation. Universities will have to develop their prescribing programmes and the Health and Care Professions Council (HCPC) will need to update its Standards for Prescribing. While it is unlikely there will be any paramedic prescribers until 2019 at the earliest, this marks a key progression in the development of the profession.

In September 2017, the HCPC began consulting on the threshold level of qualification for entry to the register for paramedics. The current level is outlined in the HCPC Standards of Education and Training at ‘equivalent to Certificate of Higher Education for paramedics’. However, the Paramedic Evidence Based Education Project (PEEP) report recommended the level to the paramedic register be raised to BSc (Hons) degree by 2019.
The consultation document proposes the level of qualification should be amended, due to the changing nature and complexity of the role of paramedics, and it illustrates the ongoing diversity in current qualifications across the UK. Any resultant change would not affect existing registered paramedics or students who are part way through pre-registration education and training programmes. The consultation closed on 15 December, with the outcome expected early this year.

Clinical practice

The UK Ambulance Services Clinical Practice Guidelines, last published in 2016, published supplementary guidelines last year. Although there will not be a new version of the guidelines this year, ongoing updates continue to be published online.

The National Institute for Health and Care Excellence (NICE) is updating its Quality Standard on Trauma. This quality standard covers assessment and management of trauma (complex fractures, non-complex fractures, major trauma and spinal injury) in adults, young people and children. It does not cover hip fracture or head injury as these topics are covered in a separate Quality Standard. The draft quality standard was open for consultation from 7 November to 5 December. The final Quality Standard is expected to be published on 29 March 2018.

Initial results from the AIRWAYS-2 trial are likely to be seen in spring 2018. This randomised trial is comparing the clinical and cost effectiveness of the i-gel supraglottic airway device with tracheal intubation in the initial airway management of patients suffering an out of hospital cardiac arrest.

At the time of writing, the final publication of the College of Paramedics’ position statement on paramedic intubation is still impending. Work began in May 2017 on the statement, with a group meeting in July to discuss and develop a first draft. This statement was reviewed and amended by several key clinical groups before being released to the membership and wider stakeholder organisations for comment. Consultation ran in September 2017, with final publication imminent.

Service delivery

NHS England and NHS Improvement have called on all A&E Delivery Boards to implement measures to reduce the impact of ambulance handover delays. They have outlined key principles concerning actions to be embedded as part of normal working practice, and actions to be taken should ambulances begin to queue.

Among the principles, they state acute trusts must always accept the handover of patients within 15 minutes of an ambulance arriving at the emergency department; that leaving patients waiting in ambulances or in corridors supervised by ambulance personnel is inappropriate; and that the patient is the responsibility of the emergency department from the moment that the ambulance arrives, regardless of the exact location of the patient. It will be interesting to see if the implementation of these measures will have an impact on reducing ambulance handover delays in 2018.

Ongoing feedback on the roll out of the Ambulance Response Programme (ARP) will continue throughout the year. The ARP saw changes to the triage of calls, known as dispatch on disposition, to allow more time for call handlers in cases that are not deemed as immediately life-threatening. Additionally, new call categories were introduced to better reflect the wide range of needs patients have when they dial 999. It is likely there will be national updates on the effectiveness of the ARP, hopefully with benefits of the change being seen, in 2018.

The NHS was promised £1.6 billion for 2018/19 and £900 million for 2019/20 in the autumn budget. While this is certainly welcome relief, it is still a far cry from the £4 billion health experts said the NHS needed. It is believed £1 billion of the cash pot for 2018/19 will be used to improve performance against the 18-week target for elective treatment and £600 million to help hospitals meet the 4-hour target in A&E.

Conclusions

These are just a few of the elements that will affect paramedics this year. Other areas not mentioned include the Assaults on Emergency Workers (Offences) Bill 2017–19, development of the nursing associate role, the national programme to support allied health professionals to return to practice, and the final report of the Asthma Audit Development Project. There are many challenges facing the NHS in the coming year, but with the upcoming developments in the profession, paramedics will find themselves in a key position to alleviate many of these pressures.

Taken from Journal of Paramedic Practice, published January 2018.

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Jeremy Hunt’s plans to reduce prescribing and medication errors

Adobe Spark (2)A new initiative aimed at reducing prescribing and medication errors across the NHS has been announced by Health Secretary Jeremy Hunt.

Hunt said medication-related errors are responsible for 5–8% of hospital admissions. This is due to 1 in 12 prescriptions involving mistakes relating to dosage, course length or type of medication. With just under  150 prescriptions handed out in primary care every second, Hunt has called the potential for errors ‘huge’.

Writing in the Health Service Journal, he said:

‘Up to 1 in 12 prescriptions may include a mistake and whilst we’re lucky most don’t cause harm to patients, there is more we can do to tackle the problem and make the NHS safer…That’s why I’ve launched a new scheme working with the NHS to reduce these errors and protect patients.’

According to Hunt, the scheme will explore a number of areas where he believes the NHS ‘can do better’. This includes improving the way that technology, such as electronic prescribing, is used, to ensure prescriptions are processed more efficiently; re-evaluating the way that patients are informed and educated about their medicines, to look along the pathway from prescribing to administration and monitoring; supporting 7-day clinical pharmacy services, where possible, in acute hospitals; and providing pharmacist support for care homes and GPs.

Hunt also said the programme will look at how the transfer of information about medicines when patients move between care settings might be improved, as it is during these transition points when things can often go wrong.

According to the Department of Health, the programme is likely to be launched later this year or early next year. It is aimed at helping the NHS meet the World Health Organization’s global patient safety challenge, which hopes to reduce severe avoidable medication-related harm by 50% globally in the next 5 years. An expert group is being put together to help scope the programme and establish how to improve patient safety.

Speaking at the Royal Pharmaceutical Society Annual Conference, Steve Brine MP, Parliamentary Under Secretary of State (Public Health and Primary Care), confirmed how Jeremy Hunt will be working with the Chief Pharmaceutical Officer, Keith Ridge, to tackle the challenge of prescribing and medication errors:

‘Studies currently indicate that up to 8% of prescriptions have a mistake in dosage level, course length or medication type—a risk which the WHO identifies as a leading cause of injury and avoidable harm in healthcare systems across
the world.’

How might this affect nurses?

While the initiative is likely to predominantly affect GPs, it will also have an impact on the 70 000 qualified nurse and midwife prescribers. The Nursing and Midwifery Council (NMC) recently launched a consultation on proposals for nurses and midwives to prescribe earlier in their careers.

The proposals, if implemented, would enable nurses and midwives to gain prescribing practice experience as soon as they qualify. They would, therefore, do the prescribing training as part of their degree so that they have more of an understanding when they graduate.

It is unclear how this may affect patient safety or the number of medication errors carried out by nurses. Nurse Prescribing contacted the NMC, but as their proposals are only in the consultation phase, they said they were unable to comment at this time.

Deborah Robertson, Senior Lecturer and Programme Leader in Non-medical Prescribing at the University of Chester highlighted how nurse prescribers are very aware of the risk of prescription errors, and that best practice is needed to ensure errors are minimised:

‘Nurse prescribers are already very conscious of the risk of prescription errors and in prescribing education—we spend a good deal of time ensuring that they know the legalities of prescription writing as well as the need for best practice advice to ensure the minimisation of errors.’

‘We always reiterate the benefits of team working in prescribing practice and establishing good relationships between prescribers and dispensing pharmacists to ensure prescribing errors are picked up in a timely manner and how to avoid confrontation. This also highlights the need for ongoing continuing professional development in all areas of prescribing practice.’

Taken from Nurse Prescribing, published November 2017.

Prescribing for paramedics?

This month, the Journal of Paramedic Practice contains an article from the College of Paramedics on the recent ministerial approval for the commencement of preparatory work to take paramedic independent prescribing proposals forward to public consultation.

In it, it outlines the work of the Allied Health Professions (AHP) Medicines Project, a joint initiative by NHS England and the Department of Health, which aims to extend prescribing, supply and administration of medicines to allied health professions.

The concept of independent prescribing for paramedics is not a new one—the Department of Health’s (DH) ambulance review Taking Healthcare to the Patient: Transforming NHS Ambulance Services (DH, 2005) recommended that prescribing for paramedics should be actively explored. Since then, the College of Paramedics have been actively campaigning to review the current legislation around non-medical independent prescribing and the case for paramedic independent prescribers.

Under current medicines legislation, paramedics are able to supply and administer a range of medicines, on their own initiative, as part of their normal professional practice for the immediate and necessary treatment of sick or injured persons (DH, 2010). However, it is not currently possible for paramedics to write a prescription for a patient. This is largely because in an emergency situation, it would be unlikely that paramedics would need to write a prescription. Instead, their priority would be to stabilise, treat and transport the patient as necessary. However, the need for paramedics to provide a broader range of treatment in both emergency and urgent (non-emergency) settings has become increasingly apparent.

Paramedics are treating more patients at their homes, thus avoiding the need for many patients to visit A&E. Additionally, paramedics who have undertaken further training, such as emergency care practitioners (ECPs), often work independently in these two types of settings.

The Department of Health’s vision for urgent and emergency care is that ‘patients are provided with 24/7 services which are integrated together, so that patients get the right care wherever they access the health system’ (DH, 2010). The ambulance service plays a key role in allowing for this integration due to the flexibility of the roles that are undertaken by ECPs and other advanced practitioners in delivering care to patients at home and in the community.

The benefit of prescribing for paramedics is clear: not only would it support better integration of urgent and emergency care services, it would enable patients to avoid having to make an additional visit to another healthcare provider. The work that the College of Paramedics is undertaking with NHS England, the Association of Ambulance Chief Executives and Health Education England, therefore, is integral if this is to become a reality.

References

Department of Health (2005) Taking Healthcare to the Patient: Transforming NHS Ambulance Services. DH, London

Department of Health (2010) Proposals to introduce prescribing responsibilities for paramedics: Stakeholder engagement. DH, London

Taken from Journal of Paramedic Practice, published 5 September 2014