Medicines management in the community: An HF specialist nurse prescriber's experience

Abstract

Heart failure (HF) is a complex clinical syndrome of signs and symptoms resulting from structural or functional impairment of the heart to effectively deliver oxygen to meet the body's metabolic demands. It is associated with considerable mortality and morbidity and an uncertain disease trajectory. A significant part of the multifaceted care delivered by a community HF specialist nurse involves medicines management in relation to improving prognosis and managing symptoms. The prescribing process involves complex clinical and organisational decision-making to achieve safe and effective outcomes for patients. As part of, often small, HF specialist nurse services that work collaboratively with other health-care teams, their challenges can be less well understood within wider health and commissioning services. This practice-centred case study describes the profile of patients on a community HF specialist nurse's caseload and the nature and process of prescribing decisions made over a 3-month period and their subsequent effects on the prescribing practice, interdisciplinary working and related patient outcomes.