Transcript The Introduction Of Nurse Prescribing Into An Intellectual

The Introduction Of Nurse
Prescribing Into An
Intellectual Disability
Service
Ciara O'Keeffe, Registered Nurse Prescriber
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Overview
 Background
 Implementation framework
 Education programme
 Collaborative practice agreement
 Benefits and challenges
 Future developments
Ciara O'Keeffe, Registered Nurse Prescriber
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Background
 Report; “ Review of Nurses and Midwives in the
Prescribing and Administrating of Medicinal Products”
2005
 Report recommended that prescriptive authority be
extended to nurses and midwives, subject to regulations
Ciara O'Keeffe, Registered Nurse Prescriber
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Regulations
 Education
 Registration
 Clinical competence
 Clinical governance
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law
 Acts needed to be amended to include Nurses with
Prescriptive authority
 Irish Medicines Board ( Miscellaneous Provision) act 2006
 Misuse of Drugs ( Amendment) Regulations 2007
 Medicinal Products (Prescription and Control of Supply ) (
Amendment ) Regulations 2007
 Nurses Rules 2007
Ciara O'Keeffe, Registered Nurse Prescriber
Implementation of Prescribing
Initiative
 Group established in May 2007, Role Of group:
 To Develop & Implement a plan for the roll out of nurse
and midwife prescribing
 To Identify clinical governance structures within a
service to support appropriate and safe prescribing
practice
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Education
 Commenced programme an April 2008
 Education programme currently delivered by RCSI and UCC
 Programme runs over six month period
 Included 168 hours of theory within college and 96 hours
clinical Practice
 Core Modules – Professional Accountability, Pharmacology and
Systemic Assessment and Evaluation in Patient Care
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Organisational Requirements
 Site declaration form
 Named Doctor to mentor the Nurse candidate throughout the
education programme period
 Prescribing site co-ordinator
 Collaborative practice agreement
 Local drugs and Therapeutics committee
 Audit tool for prescribing practice
 Nurse prescribing policy
Ciara O'Keeffe, Registered Nurse Prescriber
Experience of nurse prescriber
candidate
 Chose to focus on dual diagnosis of Intellectual
disability and Mental Health
 Medical mentor assigned, Consultant Psychiatrist
 Clinical Placement both within Intellectual disability
and Mental Health services
 Placement with on site Pharmacist
 Three practical case studies with mentor
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Collaborative Practice Agreement
 Document which needs to be submitted to An Bord
Altranais prior to becoming a registered Nurse
Prescriber.
 Reviewed annually, new medications can be added
 Acts as scope of practice for RNP
 Includes information on patient population,
Collaborating medical personnel, Medications the RNP is
authorized to prescribe and audit systems in place.
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Prescribing in Practice
 Attend mental health reviews
 Reducing medication as opposed to writing new prescriptions
 Rewriting kardex systems due to patient population
 Referral system with collaborating consultants
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Audit of Prescribing practice
 Information sharing with collaborating consultant
 Regular review meetings with clinicians
 Database system, ( Health Service Executive )
 Clinical notes
Ciara O'Keeffe, Registered Nurse Prescriber
Benefits of Nurse Prescribing in
an ID service
 Appropriate and safe
 Convenience and greater accessability
 Cost effective
 Appropriate clinical decision
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Challenges of Introducing Nurse
Prescribing,
 Concern of some service providers re return of the
medical model
 Lack of availability of suitably qualified nurses
 GMS prescriptions
 Time constraints on Registered Nurse Prescribers
 Concerns of GP and other medical personnel
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Nurse Prescribing Within
Daughter’s of Charity
 First RNP in Intellectual Disability Services working in
Daughters Of Charity
 Currently prescribing for population with dual diagnosis
of ID and Mental health
 Initiative welcomed by organisation, supported by
C.E.O., Clinical Director, Director of Nursing and
Pharmacy Department
 Clear risk management structures in place Re
prescribing practices
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Moving Forward..
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 Initiative very much in its infancy in intellectual
Disability sector
 Five more nurse prescribers undertaking the education
programme
 Requires large number of RNP’s to provide an effective
service
Ciara O'Keeffe, Registered Nurse Prescriber
Conclusion
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 Positive move forward for Nurses
 Allows nurses to put pharmacological knowledge and
experience into practice
 Expansion of role of the RNID
Ciara O'Keeffe, Registered Nurse Prescriber