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Pregabalin and gabapentin will become controlled drugs in April

Doctors will now need to physically sign prescriptions, rather than electronic copies being accepted by pharmacists.

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Gabapentin
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Gabapentinoids, like gabapentin and pregabalin, are to become controlled drugs.

Prescription drugs pregabalin and gabapentin are to be reclassified as class C controlled substances from next April, the government has announced. Medications may also be known by their brand names; lyrica and neurontin.

The move comes after experts have highlighted rising numbers of fatalities linked to the drugs. The change means it will be illegal to possess pregabalin and gabapentin without a prescription and it will be illegal to supply or sell them to others.

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The drugs, which are used to treat nerve pain, epilepsy and anxiety, can bring about an elevated mood in users but can also have serious side effects, particularly when used in combination with other drugs.

In 2016, the Advisory Council on the Misuse of Drugs (ACMD) raised concerns over medicinal misuse, illegal diversion of the drugs and addiction, and recommended that pregabalin and gabapentin should be controlled as class C Drugs under the Misuse of Drugs Act.

Stronger controls will be put into place.

Regulations implementing the change in law to control the drugs will be laid in Parliament later today.

Minister for Crime, Safeguarding and Vulnerability Victoria Atkins said: “Any death related to the misuse of drugs is a tragedy. We accepted expert advice and will now change the law to help prevent misuse of pregabalin and gabapentin and addiction to them.

“While drug misuse is lower now than it was 10 years ago, we remain committed to reducing it and the harm it causes.

“That is why we have published a comprehensive strategy to tackle the illicit drug trade, protect the most vulnerable and help those with drug dependency to recover and turn their lives around.”

The law change will mean the drugs are still available for legitimate use on prescription, but there will be stronger controls in place to ensure accountability and minimise the chances of pregabalin and gabapentin falling into the wrong hands or being stockpiled by patients.

Doctors will now need to physically sign prescriptions, rather than electronic copies being accepted by pharmacists. In addition, pharmacists must dispense the drugs within 28 days of the prescription being written.

Clinical Care

Hourly rounding ‘may not be the best way for nurses to deliver care’, finds study

Hourly rounding places an emphasis on ‘tick box’ care.

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Nurse with patient in bed

Hourly rounding made a minor contribution, if at all, to the way nurses engage with patients.

A new report by researchers at King’s College London has found that the widespread practice of hourly or intentional rounding, may not be the best way for nurses to deliver care to patients.

The report also found that rounding makes a minor contribution, if at all, to the way nurses engage with patients.

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Hourly or intentional rounding involves standardised regular checks with individual patients at set intervals and was introduced in hospitals in England in 2013, with 97% of NHS acute Trusts in England implementing it in some way.

The majority of NHS trusts adopted the ‘4Ps’ (Position, Pain, Personal needs, Placement of items) model of rounding.

The research was commissioned and funded by the National Institute for Health Research (NIHR) and was led by Professor Ruth Harris in the Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care.

Hourly rounding places an emphasis on ‘tick box’ care.

The NIHR report – Intentional rounding in hospital wards to improve regular interaction and engagement between nurses and patients: a realist evaluation – is the first study of its kind in the world.

The study found that rounding placed an emphasis on transactional ‘tick box’ care delivery, rather than individualised care. However, patients were found to value their interactions with nursing staff, which the study argues could be delivered during other care activities and rather than through intentional rounding.

The report also found that rounding was implemented without consultation, careful planning and piloting in the interests of political expediency following the Francis Inquiry Report into care failures in the NHS.

Ruth Harris, Professor of Health Care for Older Adults at King’s College London, said; “Checking patients regularly to make sure that they are OK is really important but intentional rounding tends to prompt nurses to focus on completion of the rounding documentation rather than on the relational aspects of care delivery.

“Few frontline nursing staff or senior nursing staff felt intentional rounding improved either the quality or the frequency of their interactions with patients and their family.”

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Clinical Updates

Nurses’ ‘worry’ better than most early warning scores, finds study

Nurses were asked to grade patients between ‘no concern’ and ‘extreme concern’. 

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Observations

A sense of worry can provide important information for the detection of acute physiological deterioration.

Nurses’ worry has a “higher accuracy” than most published early warning scores (EWS) at predicting if a patient is becoming more unwell, according to a recent study.

The study looked at 31,159 patient-shifts for 3185 patients during 3551 hospitalisations across two surgical and two medical wards. Researchers compared if the nurses were worried about a patients potential for deterioration using ‘the Worry Factor’ with early warning score indicators.

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Nurses were asked to grade each patient between “no concern” and “extreme concern”.

The Worry Score

Out of 492 potential deterioration events identified, researchers found that when nurses had an increasing worry factor the patient was more likely to require emergency medical treatment – 7 cardiac arrest calls, 86 medical emergency calls and 76 transfers to the intensive care unit.

The study also revealed that accuracy rates were significantly higher in nurses with over a year of experience.

The researchers concluded that “nurses’ pattern recognition and sense of worry can provide important information for the detection of acute physiological deterioration” and was often more reliable than traditional early warning systems.

They also noted that the worry score could be used alone or easily incorporated into existing EWS to potentially improve their performance.

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