References
Prescribing within clinical toxicology
Abstract
In 2020, the first clinical toxicology advanced nurse practitioner and independent prescriber post was introduced in the United Kingdom. This article discusses the remit of clinical toxicology and the integration of nurse prescribing into this service by following a patient journey from admission to discharge. The case study describes an acute paracetamol poisoning presentation following intentional self-harm. Paracetamol is widely available and safe in therapeutic dosages; however, it is the drug most commonly taken in intentional overdose and the toxic effect can result in hepatic failure and fatality. The nurse prescriber conducted a holistic consultation, assessed pharmacological management and instigated timely treatment. Current research on the benefits and disadvantages of paracetamol antidote regimes are discussed. Long-term physical and mental wellbeing following intentional overdose require interprofessional liaison with access to psychological support, arranged prior to patient discharge.
There has been an exponential and welcome growth in the number of healthcare professionals with an independent prescribing qualification in the United Kingdom (UK) since legislation was passed in 2006 (Stewart et al, 2017). The benefits of prescribing rights beyond traditional medical practitioners for service provision, patient-centred care and professional development are well documented (Graham-Clarke et al, 2019). However, within clinical toxicology services the independent nurse prescribing role is a recent introduction, with the first UK clinical toxicology advanced nurse practitioner (ANP) and prescriber training post realised in Edinburgh in 2020 (EdinClinTox, 2020). This article will outline the remit of the clinical toxicology nurse prescriber and the UK National Poisons Information Service (NPIS), before presenting this novel prescribing role in a case study of paracetamol (acetaminophen) poisoning.
Regional NHS poisoning treatment centres were first established in the 1960s following the Atkins and Hill reports, which highlighted significant concerns regarding poisoning management nationally (Good, 2014). This informal network of poisoning centres subsequently amalgamated to become the UK National Poisons Information Service. The NPIS service is currently based in four NHS teaching hospitals: Birmingham, Cardiff, Newcastle and Edinburgh, with links in London and York. Together, they provide information on suspected exposures or poisonings involving a vast range of substances, including pharmaceuticals, alternative medicines, drugs of abuse, organic compounds, household and industrial chemicals. Their remit includes NHS staff education on poisoning therapies; public health surveillance and clinical toxicology specialist research. The primary role of NPIS is to provide a 24-hour clinical toxicology information service to healthcare professionals, offering guidance on the management of poisoned patients. Most enquiries to the NPIS relate to paracetamol poisoning (NPIS, 2020).
Register now to continue reading
Thank you for visiting Journal of Prescribing Practice and reading some of our peer-reviewed resources for prescribing professionals. To read more, please register today. You’ll enjoy the following great benefits:
What's included
-
Limited access to our clinical or professional articles
-
New content and clinical newsletter updates each month