Monday, 1 March 2010

BNF Indications

The British National Formulary (BNF) details the licensed indications for medications I prescribe.

Much of the time I prescribe outwith the licensed indications. Sometimes it's because the drug's not licensed for older adults. Sometimes it's because it's administed in a specific manner (e.g. crushed up). Usually it's because it's outwith licenced indications.

This shouldn't matter.

The marketting authorisation for a drug is there to ensure that the drug's got proven efficacy (i.e. for the named indications put forward by the drug company that the drug works better than placebo, so is an active drug, rather than some spurious snake oil linement whatnots). This then confines the drug company to marketting their product just for that indication. In theory, when drug reps come to talk to clinicians about their drugs they give us a summary of product characteristics and talk just about that.

They didn't they'd come and talk about all sorts of anecdotal nonsense which infuriated me sufficiently to report one to the ABPI and stopped seeing any more of 'em. I don't often have hissy fits but the Big Pharma nonsense pushed me rather too far. Ho hum.

What's peculiar is that the "Indications" for drugs seems to be taken, in some corners, as an irrelevant nonsense and inconvenient, artless work of fiction.

I have a lot of time for proper nurses and spend time each day sorting out liaison work in the acute hospital and RMNs grappling with difficult residents in EMI Nursing homes. When good nurses have tried everything sensible, medication often can have a role to play in assisting the staff deliver appropriate care.

What I find slightly more frustrating is when nursing colleagues from the acute Trust refer a patient to me so I can, "make them stay in bed," or I could, "prescribe something to stop them shouting," or better still, "give them something to stop them swearing."

The BNF does not do medication with indications to treat with a "stay in bed" pill or a "use the quiet voice" pill or indeed a "nice language only" pill.

No matter how hard we look, they don't have a licenced indication for, "Stop Mrs Smith ripping out peoples' venflons, biting and scratching nurses and hurling drip stands around the ward!"

Treating a behavioural problem with a chemical solution isn't ideal, but heck, often it won't even work. Not uncommonly it can make things worse. So why do I have oodles of requests for medication to de-escalate behavioural disturbance? Because ward staff feel they've no other viable choice before them. As my nursing colleagues eloquently assert, if wards are understaffed, then caring nurses can't deliver excellent person centred care.

4 comments:

BenefitScroungingScum said...

This blog is beautifully written by a lady who's caring for her sons on the ASD and her MiL who now has Alzheimers. The author thinks Alzheimers should also be a spectrum disorder. Well worth a read

BendyGirl

BenefitScroungingScum said...

Well, it would be if I'd left you the link ;)
http://sandwichedgenes.blogspot.com/
BG

Becca said...

Dear LC
I'm a nursing home survivor - 9 months ‘inside’ which I think was mostly the local authority hoping I'd die before they had to do any expensive adaptions or expensiver social care - and got to know a couple of elderly residents at the home who after reading what you wrote I am totally and utterly convinced are having their BPSD gravely mismanaged and general social and emotional needs completely neglected.

Are you aware of any possible courses of action to try and help my former comrades and/or try and get a closer eye kept on general standards at this place? There was a CSCI inspection while I was there but it was really feeble and overlooked some extremely serious issues.

otr214426 said...

INTERNATIONAL CONCEPT OF WORK FROM HOME
Work from home theory is fast gaining popularity because of the freedom and flexibility that comes with it. Since one is not bound by fixed working hours, they can schedule their work at the time when they feel most productive and convenient to them. Women & Men benefit a lot from this concept of work since they can balance their home and work perfectly. People mostly find that in this situation, their productivity is higher and stress levels lower. Those who like isolation and a tranquil work environment also tend to prefer this way of working. Today, with the kind of communication networks available, millions of people worldwide are considering this option.

Women & Men who want to be independent but cannot afford to leave their responsibilities at home aside will benefit a lot from this concept of work. It makes it easier to maintain a healthy balance between home and work. The family doesn't get neglected and you can get your work done too. You can thus effectively juggle home responsibilities with your career. Working from home is definitely a viable option but it also needs a lot of hard work and discipline. You have to make a time schedule for yourself and stick to it. There will be a time frame of course for any job you take up and you have to fulfill that project within that time frame.

There are many things that can be done working from home. A few of them is listed below that will give you a general idea about the benefits of this concept.

Baby-sitting
This is the most common and highly preferred job that Women & Men like doing. Since in today's competitive world both the parents have to work they need a secure place to leave behind their children who will take care of them and parents can also relax without being worried all the time. In this job you don't require any degree or qualifications. You only have to know how to take care of children. Parents are happy to pay handsome salary and you can also earn a lot without putting too much of an effort.

Nursery
For those who have a garden or an open space at your disposal and are also interested in gardening can go for this method of earning money. If given proper time and efforts nursery business can flourish very well and you will earn handsomely. But just as all jobs establishing it will be a bit difficult but the end results are outstanding.

Freelance
Freelance can be in different wings. Either you can be a freelance reporter or a freelance photographer. You can also do designing or be in the advertising field doing project on your own. Being independent and working independently will depend on your field of work and the availability of its worth in the market. If you like doing jewellery designing you can do that at home totally independently. You can also work on freelancing as a marketing executive working from home. Wanna know more, email us on workfromhome.otr214426@gmail.com and we will send you information on how you can actually work as a marketing freelancer.


Internet related work
This is a very vast field and here sky is the limit. All you need is a computer and Internet facility. Whatever field you are into work at home is perfect match in the software field. You can match your time according to your convenience and complete whatever projects you get. To learn more about how to work from home, contact us today on workfromhome.otr214426@gmail.comand our team will get you started on some excellent work from home projects.


Diet food
Since now a days Women & Men are more conscious of the food that they eat hence they prefer to have homemade low cal food and if you can start supplying low cal food to various offices then it will be a very good source of income and not too much of efforts. You can hire a few ladies who will help you out and this can be a good business.

Thus think over this concept and go ahead.