Transcript Supplementary Prescribing

Extended and Supplementary
Prescribing
Supports modernisation
in the NHS
“Vision for Pharmacy”
 “More staff, working differently”
 NICE/CHAI
 Improving working lives
 Junior Hospital Doctors hours
 Working Time Directive
 Skill-mix
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Benefits of Supplementary
Prescribing
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Improved access
Improved patient choice
Greater flexibility for management of patients
Re-distribution of prescribing workload
Improved job satisfaction for supplementary
prescriber
Formalises some vicarious prescribing that
currently goes on
Latest DoH position
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"We need to fundamentally transform the NHS by giving and
extending choice. Nursing and midwifery has a central part to
play in this transformation because you are close to people you listen to them and they listen to you. Patients must play a
bigger role in their health care and your help is vital in helping
them to learn how to manage their condition."
Mr Reid also announced that independent nurse prescribing
would be expanded with the addition of a further 10 new medical
conditions and more than 30 additional medicines to the list,
which Extended Formulary nurse prescribers can prescribe.
These conditions include acute attacks of asthma and animal
and human bites. He also made clear that nurse prescribing
would be further extended next year to include emergency care.
John Reid CNOs Conference 14/11/03
Role of Extended and
Supplementary Prescribing
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Mode 1 and 2 prescribing
– Original legislation to allow health visitors and
district nurses to prescribe from limited list
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Extended prescribing for nurses
– Allows independent prescribing from wider range
of products, but still doesn’t include all products
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Supplementary prescribing
– Very few limits to drugs that can be prescribed,
but must be done in conjunction with independent
prescriber and clinical management plan
What is Supplementary
prescribing?
 “A
voluntary prescribing partnership
between the independent prescriber
and a supplementary prescriber, to
implement an agreed patient-specific
Clinical Management Plan with the
patient’s agreement”.
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The Supplementary Prescriber must be a Registered
Nurse, Registered Midwife or Registered Pharmacist.
Coming soon – optometrists, physiotherapists, other AHPs
Supplementary Prescribing
is not restricted SRx to specific clinical
conditions
 decision to introduce SRx arrangements
for a specific patient will depend on
agreement between the independent
and the supplementary prescriber, and
the patient
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Prescribing Partnerships
Voluntary
 Share responsibility
 Professionally accountable for own
decisions
 If responsibility moves from one
medical practitioner to another, the
supplementary needs to forge new
partnership
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Independent prescriber
responsible for:
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the initial clinical assessment of the patient
and the formulation of a diagnosis,
the development of a written clinical
management plan, in conjunction with the
supplementary prescriber, following diagnosis
ensuring the clinical management plan is kept
up-to-date
informing the supplementary prescriber of the
limits of responsibility delegated to that
supplementary prescriber
providing access to the patient’s record for
the supplementary prescriber.
Independent prescriber
responsible for:
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providing advice and support to the
supplementary prescriber as required
carrying out a review of patient’s progress at
appropriate intervals, depending on the nature
and stability of a patient’s condition, or at the
request of the supplementary prescriber, and
normally not longer than 1 year from the initial
assessment
resuming full responsibility for the patient’s care
at the request of the supplementary prescriber
Supplementary prescriber
responsible for:
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monitoring and assessing the patient’s progress
as set out in the clinical management plan, and
as appropriate to the medicines prescribed,
including the reporting of any adverse reactions
contributing to the clinical management plan
prescribing for the patient in accordance with
the agreed clinical management plan
changing the medicine prescribed, within the
limits set out in the clinical management plan, if
monitoring of the patient’s progress indicates
that this is clinically appropriate
Supplementary prescriber
responsible for:
accepting clinical responsibility and
professional accountability for their
prescribing decisions and practice
 working at all times within their clinical
competence and their professional Code of
Conduct, consulting the independent
prescriber as necessary and particularly if a
matter falls outside their own clinical
competence.
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Supplementary prescriber
responsible for:
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as soon as possible, and preferably
contemporaneously, recording clinically
relevant facts, including prescribing and
monitoring activity, in the patient’s medical
records.
referring prescribing responsibility back to the
independent prescriber if the agreed clinical
reviews are not carried out within the intervals
specified in the clinical management plan or if
monitoring of the patient’s progress indicates
that this is appropriate
Principles of SRx
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there should be benefit to patients and the
NHS
supplementary prescribing should support but
not replace multi-disciplinary care
patient safety should be paramount
prescribing and dispensing responsibilities
should, where possible, be separate in
keeping with the principles of patient safety
and governance.
How can SRx be used in
Practice?
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Ongoing management of long-term
conditions
– Asthma, diabetes , hypertension, mental health
– Heart Failure, COPD
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Management of out-patients
– HRT clinic, renal patients, HIV/AIDs, anti-coag.
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In-patient settings with predictable
pathways
– Nausea in oncology, post-operative pain
The clinical management plan
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MUST
– specify the range of medicines that may be
prescribed
– specify the range and circumstances within which
the supplementary prescriber can vary the
dosage, frequency and formulation of the specified
range of medicines as appropriate.
– when to refer back to the independent prescriber
– contain relevant warnings about any known
sensitivities of the patient to particular medicines
– Include arrangements for the notification of any
adverse drug reactions.
– Start date and review date (max 12 months)
Before starting
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The nurse or pharmacist must
– successfully complete the specified training
and preparation for SRx
– record their SRx competency on the relevant
professional register
– agree with their employer that SRx should be
included in their job description.
– make arrangements for Rx pads, prescribing
budget or other arrangements (e.g. patients’
prescription charts in hospitals)
Training and preparation - nurses
consultation, decision-making, therapy
and referral
 influences on and psychology of
prescribing
 prescribing in a team context
 clinical pharmacology including the
effects of co-morbidity and recognition of
potential adverse drug reactions
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Training and preparation - nurses
evidence-based practice and clinical
governance in relation to nurse
prescribing
 legal, policy and ethical aspects
 professional accountability and
responsibility
 prescribing in the public health context.
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Managed Entry System
Single system for SW WDCs for
application for training
 All applications go to one place
 Ensures appropriate practitioners are
applying and training will be used in
suitable situation
 Can help to form networks of
supplementary prescribers
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Process for Application
Decision that supplementary prescribing is necessary and appropriate
Fill in Application form and send to Project Team
Project Team consider applications and approve / advise where
necessary
Approved applicants apply to university
Applicant undertakes supplementary prescribing
training
Supplementary prescriber uses training. Project team provide
support and links to prescriber networks
www.prescribing.swest.nhs.uk
Points to Consider
Availability of mentors
 Backfill
 Candidate ability to undertake distance
learning study
 Whether qualification will be used after
training
 Whether there are other ways to fulfil
the role e.g. PGDs
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Course providers
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Pharmacists
– Bath
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Nurses
– Gloucestershire
– Bournemouth
– Plymouth
– Oxford Brookes
– Plymouth
Further Information
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All information can be found on the website
» www.prescribing.swest.nhs.uk
» National information at
www.doh.gov.uk/supplementaryprescribing
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Contacts
– Kim Hogan – Avon, Gloucestershire, Wiltshire
» [email protected]
– Alaster Rutherford – Devon and Cornwall
» [email protected]
– Danielle Gorman – Dorset and Somerset
» [email protected]