In New Zealand (NZ) prescribing of medicines has resided with medical or nurse practitioners. In 2011 the Medicines Act changed enabling Registered Nurses (RN) practising as Diabetes Nurse Specialists (DNS) to prescribe diabetes and related medications under medical supervision. The NZ Society for the Study of Diabetes (NZSSD) tested safety and effectiveness of twelve DNSs prescribing over six months (with a further six months follow up) in four demonstration sites with external evaluation, previously presented, demonstrating safety and effectiveness. In 2013 the NZSSD led a national managed roll out of DNS prescribing with nurses from primary and secondary care settings.
Fifteen DNSs with the required clinical and academic preparation undertook a prescribing practicum and were then registered to prescribe by the Nursing Council of NZ. Clinical data including HbA1c, BP, lipids, creatinine, and eGFR were collected to assess safety and effectiveness. Additionally nurses, supervisors and patients were surveyed to ascertain satisfaction with the extended role.
During the managed roll out 2582 prescribing decisions were made, with 857 prescriptions for 1392 patients. Of these patients 52% were male, mean age was 50 years and ethnicity included NZ European (50%), Maori (14%), Pacific island (20%), Indian (9%) and other (7%). Most had between 1-13 co-morbidities most commonly hypertension (59%), dyslipidaemia (60%) and ischaemic heart disease (16%), demonstrating a complex population. Clinical measures remained stable, with improvements in HbA1c and total cholesterol. Survey data showed satisfaction with the role.
Prescribing by DNSs continues to be safe and effective with benefits to patients, nurses and doctors. It provides a mechanism for safe, efficient and accessible diabetes care and service delivery, with particular benefits in rural areas. From 1 May 2014, the Nursing Council of NZ is accepting applications for RN prescribing in diabetes care across New Zealand.