Extended formulary nurse prescribing--another saliva substitute roadblock.

United Kingdom family physicians, General Practitioners (GPs), are allowed to prescribe from a Department of Health-approved list of non-medicines (the 'ACBS' list) which includes a majority of proprietary saliva substitutes. Independent nurse prescribing, introduced in 2001, has improved patient access to effective remedies for a wide range of common medical problems. Further qualified 'extended formulary nurse prescribers' have access to a limited range of prescription medicines, and all non-prescription medicines that GPs may currently prescribe. Despite their specified role in the management of oral complications encountered in palliative care, a similar anomaly in NHS rules that prevents dental practitioners from prescribing ACBS listed saliva substitutes also prevents nurses from prescribing them. Sadly, patients are suffering poorer access to simple and effective remedies to conditions such as xerostomia - a condition that has recognised impact on their quality of life.

Difficulties in dental prescribing of saliva substitutes for xerostomia.

The value of salivary substitutes for many elderly patients is indicated by a simple web search which found 2,470 references, with references to prescribing across the globe. To contain the public expense, prescribing medicaments within the National Health Service in England is limited to approved lists. The only salivary substitute currently prescribable by dentists has not been produced for 18 months. It is argued that: the prescription of this symptomatic therapy should be based on potential benefit for the xerostomic patient and not, as now, primarily on the pathological aetiology of the oral dryness. Secondly, that the professional caring for that oral problem--the dentist, is best placed to manage the prescribing as part of the overall management of the patient, independent of any reference to the patients physician that may be appropriate as part of the overall management of the patient.

The emergency drugs box--time for action?

Many GDPs are confused about which emergency drugs they should stock. There is a lack of uniform advice on this topic. Most recommended lists of emergency drugs contain superfluous medications which GDPs would never be expected to use. This paper rationalises the content of the emergency drugs box and provides clear, standardised guidance. A list of ten essential emergency drugs is presented, all of which can be administered by simple routes. Every GDP should be trained and competent to use these essential emergency drugs.

A dental school formulary.

A drug formulary can provide a readily accessible source of drug information that will complement traditional sources and enable students and faculty to make better use of them. This article presents the formal and types of information included in the University of Southern California Dental School formulary. Experiences with this formulary are discussed and recommendations for improvement are made. The formulary can be readily introduced in any dental school and would be beneficial to all dental schools, with or without their own pharmacies.