Transcript Prescribing the future for community children`s nursing

Prescribing the future for
community children’s nursing
Penny Franklin
Lecturer/Non-medical Prescribing
Lead: the University of Plymouth
Aim: To provide an overview of the past and current
status of Non-medical Prescribing for community
children’s nursing
Learning Outcomes
At the end of the session participants will be
able to:
• understand the Non-medical Prescribing
Journey- where it has come from (brief
history);
• recognise different prescribing rights and
mechanisms;
• apply knowledge of prescribing to the
care of children in the community.
Brief History
•
•
•
•
Cumberledge Review 1986;
Nurse Prescribing 1994;
Crown Review 1998/9;
Extended Formulary Nurse Prescribing
2001;
• Supplementary Prescribing 2003;
• Nurse Independent and Supplementary
Prescribing 2006.
Who else is out there?
Other Prescribers/ not nurses
• Doctors and Dentists as Independent
Prescribers;
• Pharmacist Independent and
Supplementary Prescribers;
• Physiotherapists, radiographers;
• Podiatrists and speech therapists as
Supplementary Prescribers
Types of Non-medical Nurse
Prescribers
Nurse Independent prescribing -from the
Community Practitioners’ Formulary for
Nurse Prescribers (V100 and V150)
• V100 for nurses who hold a community specialist
practice qualification-part of SPQ preparation
• V150 for nurses without a community specialist practice
qualification for whom it would be appropriate to
prescribe from the Community Practitioners’ Formulary10 days of face to face learning and 10 days supervised
practice
Types of Non-medical Prescribers:
continued
• Nurse Independent and Supplementary
Prescribing (V300)
• 26 taught days at an accredited
educational institution plus 12 days of
supervised practice
(DH, Medicines Matters, 2006)
Nurse Independent Prescribing
• Licensed drugs from anywhere in the BNF
for Children.
• However many drugs are not licensed for
use in children....
Supplementary Prescribing
• Voluntary partnership
between
Supplementary
Prescriber and an
Independent
Doctor/Dentist
prescriber, with the
patients’/carers’
agreement and using
an agreed clinical
management plan. (DH,
2006)
Recent Developments
• Standards for Medicines ManagementNMC February 2008; Replaces guidelines
for the administration of medicine and
available as a CD-rom from 17th March
The Nursing and Midwifery Council standards of
proficiency for nurse and midwife prescribers’
(NMC, 2006)
• ‘Only nurses with relevant knowledge,
competence, skills and experience in nursing
children should prescribe for children. This is
particularly important in primary care (e.g. out of
hours, walk-in clinics and general practice
settings). Any one prescribing for a child in these
situations must be able to demonstrate
competence in prescribing for children and refer
to another prescriber when working outside their
level of expertise or level of competence.’
Only prescribe if clinically
competent (NMC, 2006)
• Prescribers must fully understand the
action of drugs in children and the differing
physiology of children and young people.
The NMC advises that registrants do not
prescribe unless they have specific
competence in children's nursing.
Additional Learning Outcome for
Nurse/midwife Independent Prescribing
programme.
• Participants on programme ‘must ensure
that they can take an appropriate history,
undertake a clinical assessment and make
an appropriate decision based on that
assessment to either diagnose or refer,
having considered the legal, cognitive,
emotional and physical differences
between children and adults.’ (NMC, 2006)
Additionally
• Registrants must demonstrate recognition
of the unique implications and
developmental context of the anatomical
and physiological differences between
neonates, children and young people.’
(NMC Standards pg 6).
Preceptorship
• For registered prescribers who are new to
prescribing for children+ if appropriate,
additional education in making and
assessment and diagnosis for children.
Responsibility
• It is the responsibility of the employer to
ensure that the registrant is able to apply
the prescribing principles to their own area
of practice (NMC Standards, page 6).
More to come
• Home Office Consultation on the
prescribing of controlled drugs by Nurse
and Pharmacist Independent Prescribersresults awaited.
• http://www.homeoffice.gov.uk/documents/cons2007-indpres
Prescribing for children in the
community
• Out of hours and minor injury-mainly Nurse
Independent prescribing
• General practice- minor illness/minor injury,
complex conditions
• Public Health- smoking cessation, etc
• Long term conditions and more complex
continuing care-Supplementary and or
Independent prescribing
Supplementary Prescribing (Clinical
management plans (CMPs))
• The CMP must be developed in
partnership between the independent
medical or dental prescriber and the
supplementary prescriber with the patient's
agreement. It must be individualised and
relate to specific medications for specific
conditions, and be determined by the
needs of the patient following diagnosis.
CMPs must take into account:
• The individual patient's unique medical
history;
• Their current health status;
• Any other conditions they may have;
• Any current medication they are taking;
whether prescribed or over the counter.
How does supplementary prescribing
support community children’s nursing?
• Confidence and competence-development
of expertise;
• Long term conditions;
• Clear framework for team prescribing;
• Controlled drugs which are not;
listed/indicated for Nurse Independent
Prescribers;
• Unlicensed medicines.
Childhood conditions
where independent and
Supplementary
Prescribing can work
Pain management
Heart conditions
Diabetes
Other metabolic
disorders
Skin conditions
Cystic fibrosis
Juvenile rheumatoid
arthritis,
Asthma,
Neonatal conditions,
Diabetes
Blood disorders
To find out more
• DH(2006) Medicines Matters: a guide to
mechanisms for the prescribing, supply
and administration of medicines.
• Association for nurse prescribinghttp://www.anp.org.uk/
[email protected]
References
• DHSS. (1986) Neighbourhood Nursing - A focus for care. Report of
the Community Nursing Review. HMSO, London.
• DoH. (1998) Review of Prescribing, Supply and Administration of
Medicines. A Report on the Supply and Administration of Medicines
under Group Protocol. Crown Copyright. London.
DoH. (1999) Review of prescribing, supply and administration of
medicines. Final report. Crown Copyright, London.
• DoH. (2000) Consultation on proposals to extend nurse prescribing.
• DoH. (2002) www.doh.gov.uk/supplementaryprescribing/index.htm
• DH, (2006) Medicines Matters: a guide to mechanisms for
prescribing, supply and administration of medicines. London. The
Stationery Office.
References (continued)
• Nursing and Midwifery Council (2006). Standards of
Proficiency for Nurse and Midwife Prescribers. London.
NMC
Nursing and Midwifery Council (2007) NMC Circular
22/2007. Prescribing for Children and Young People.
NMC. London.
• Nursing and Midwifery Council (2008) Standards for
Medicines Management:
• http://www.nmc-uk.org/Article.aspx?ArticleID=1658
accessed 09.03.08