Carolyn Scott, Nurse Practitioner in West Yorkshire, has won the Nursing in Practice Mental Health Award 2009, sponsored by Papyrus Prevention of Young Suicide.
This project was based at a GP surgery with the highest benzodiazepine and "z" drug (BZD) prescribing levels in the primary care trust. Figures were standing at more than twice the national and local average.
Carolyn is a nurse practitioner at the surgery, based in a distinct rural community, a large part of which is composed of ex-council houses and high-rise flats. It is acknowledged as having the highest levels of multiple deprivations in the town with raised levels of unemployment; mental health problems; substance misuse; alcoholism; teenage pregnancy; child abuse; smoking and single-parent families.
The initial drive for the project was an observation made whilst carrying out routine medication reviews. According to competent prescribing practice, patients are invited to regular (at least annual) medication reviews, with the timing dependent on individual need. It was noted by that:
• All of the patients reviewed over 15 months on long-term BZDs did not want to stop them and offered valid and explicit reasons for their continued use. • Although aware that long-term BZD use is not appropriate, there was a lack of information and personal experience to negotiate otherwise. • A practice protocol for help in prescribing BZDs was not in existence. • Having reviewed all their other medication there is often very little time for a full discussion around BZD use.
The aim was to implement and encourage an innovative approach to BZD prescribing which required the full support of the multidisciplinary team.
From February to April 2008 practitioners were prepared by a series of interactive educational meetings.
Each identified patient's notes were checked to see if they should be excluded from the withdrawal programme for example, epileptics; people with severe mental health problems; palliative care patients.
Two months after the intervention, there are were only 19 patients on repeat prescription at the surgery as opposed to 79; showing a reduction of 75%.