Rheumatology nurse specialists and corticosteroid prescribing – does it conform to eular guidelines
1Rheumatology, Luton & Dunstable University Hospital, Luton, United Kingdom
Background: The rheumatology nurse specialist (RNS) plays a central role in the multi-professional rheumatology team. Delivering corticosteroid (CS) therapy to patients is an area where there is little understanding of RNSs confidence in managing them.
Objectives: Considering CSs are a cornerstone of treating rheumatic diseases where RNSs are invariably involved, we undertook a pilot survey to understand the present climate of RNSs prescribing of corticosteroids in their practice.
Methods: A focus group discussion was held at South West regional meeting to ascertain the minimum level of understanding required to successfully deliver CS therapy to patients. It was centred on EULAR recommendations. Nine items were identified based on three main themes – safe prescribing, optimal dosing and prevention of complications. A questionnaire was created based on this discussion and all participants of the meeting were surveyed.
Results: There are 21 centres providing rheumatology services in the South West England. All were represented in 30 participants of the survey. Median age of the nursing establishment was 48 years (mean 47 year, range 27–60 years). Only 6/30 (20%) were nurse prescribers.
14 (47%) did not feel comfortable advising patients on adjusting their CS dose. Only four (13%) had any patient group directive in place at their trust to enable them to amend CS dose for non-medical prescribers. 11 (36%) considered CS to be disease modifying therapy in inflammatory arthritis. 17 (56%) employed CS therapy as part of early arthritis management protocol. 4/30 (13%) considered prednisolone equivalent dose of ≥10 mg/day safe in long term and seven (23%) would be happy to utilise 120 mg IM depomedrone monthly as necessary. 10 (33%) were unaware of therapeutic co-intervention for CS related osteoporosis risk and 21 (70%) were not employing any fracture risk stratification tools.
Conclusions: This pioneering initiative highlights a wide variation in the prescription standards of a key job provision. Very few units have independent nurse prescribers. Others lack patient group directive to at least enable non-medical prescribers i.e. RNSs to safely amend CS therapy prescribed by a rheumatologist. Less than a quarter of those surveyed actually consider CSs to have any disease-modifying role. Rather worryingly, some do not even recognise the safe long-term CS dose and willing to offer high doses periodically. Though most know the concomitant therapeutic options to mitigate against osteoporosis, few are actually assessing fracture risk thereby unlikely to offer the appropriate interventions.
In conclusion, there is wide variation in the service provision of RNSs. This can potentially have a negative impact on effort to promote safer use of CSs in the management of inflammatory rheumatic diseases. There is a need for improving training standards to help deliver good quality rheumatology professionals of the future and ensure safe and effective drug interventions.
Disclosure of Interest: None declared
Citation: Ann Rheum Dis, volume 77, supplement Suppl, year 2018, page A1813
Session: HPR Professional education, training and competencies