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.


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


BenefitScroungingScum said...

Well, it would be if I'd left you the link ;)

R 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.

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