The Introduction Of Nurse Prescribing Into An Intellectual Disability Service

Ciara O'Keeffe, Registered Nurse Prescriber 2

Overview

 Background  Implementation framework  Education programme  Collaborative practice agreement  Benefits and challenges  Future developments Ciara O'Keeffe, Registered Nurse Prescriber 3

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 4

Regulations

 Education  Registration  Clinical competence  Clinical governance Ciara O'Keeffe, Registered Nurse Prescriber 5

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 6

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 7  To Identify clinical governance structures within a service to support appropriate and safe prescribing practice Ciara O'Keeffe, Registered Nurse Prescriber

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 8 Ciara O'Keeffe, Registered Nurse Prescriber

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 9

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 10 Ciara O'Keeffe, Registered Nurse Prescriber

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.

11 Ciara O'Keeffe, Registered Nurse Prescriber

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 12 Ciara O'Keeffe, Registered Nurse Prescriber

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 13

Benefits of Nurse Prescribing in an ID service

 Appropriate and safe 14  Convenience and greater accessability  Cost effective  Appropriate clinical decision Ciara O'Keeffe, Registered Nurse Prescriber

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 15 Ciara O'Keeffe, Registered Nurse Prescriber

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 16 Ciara O'Keeffe, Registered Nurse Prescriber

Moving Forward..

 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 17

Conclusion

 Positive move forward for Nurses  Allows nurses to put pharmacological knowledge and experience into practice  Expansion of role of the RNID 18 Ciara O'Keeffe, Registered Nurse Prescriber