Transcript No Slide Title

Supporting Medication Management
and Prescriptive Authority
An Overview of Regulation and
Professional Guidance
Kathleen Walsh
Project Officer
An Bord Altranais and the National Council
Background and Timeline for
Prescriptive Authority
1998
Commission on Nursing
2000
Scope of Practice
2001-2005 Review of Nurses & Midwives in the Prescribing
& Administration of Medicinal Products
2006
DoHC Public Consultation
Irish Medicines Board (Miscellaneous Provisions) Act
Resource & Implementation Group of DoHC/HSE
2007
Medicines Regulations, SI 200 and 201
Nurses Rules
Creation of a dual framework
for nurse/midwife prescribing
Medicines
Legislation
Department of
Health & Children
Professional
Regulation
An Bord Altranais
Medicines Legislation
Irish Medicines Board (Miscellaneous Provisions)
Act 2006, Commencement Order, 2007
Medicinal Products (Prescription & Control of
Supply) Amendment Regulations 2007
Misuse of Drugs (Amendment) Regulations 2007
These Regulations require:
• Nurse is employed by a health service
provider
• The medication is normally given in the
usual course of health service in the setting
where the nurse is employed
• Prescription is issued in the usual course of
the health service
• Personal Identification Number of An Bord
Altranais must be written on the prescription
Medicines Regulations also allow
for:
• Health service provider/employer to impose
conditions
• If the conditions are not satisfied a person
can refuse to supply the drug
And
• An Bord Altranais to carry out its functions
as per the Nurses Act, 1985
This allows for the Board to mandate professional
regulations and provide for guidance
Role of the Nursing Board in
regulating prescriptive authority
Education
Clinical
governance
Registration
Competence
Nurses Rules 2007 establish
Registration & Professional Regulation
RNP
Registered Nurse Prescriber
 Division of the Register for Nurse Prescribers
• Candidate Registration is required
 Registration linked to other factors
• Completion of education programme
• Collaborative Practice Agreement
• Public access for checking the registration
(e.g. community pharmacists)
Education for Prescribers
Requirements & Standards
Minimum entry requirements:
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Registered on another division
3 years recent post registration clinical experience
within the past 5 years with 1 FT year experience in
the specific area of practice.
Possess the competencies recognised at Level 8 of
NQAI framework
Evidence of further education
Competent in information technology literacy
Education Requirements & Standards
Competencies for Prescriptive Authority provide
the foundation for prescribing
Indicative Content
 Professional Accountability & Responsibility
 Legal & Ethical Aspects
 Pharmacology & Pharmacotherapeutics
 Principles of the Prescribing Process
 Collaboration/Referral with Other Health
Care Professionals
Provision of Professional Guidance
for Practice & Clinical Governance
Decision-Making Framework
Practice Standards
Collaborative Practice Agreement
Collaborative Practice Agreement
(CPA)
Provides guidelines to the nurse/midwife,
medical practitioner & health service provider
for development of the individual CPA
Details the RNP’s scope of practice including
medication approval
Requires the review & approval of the employer
& medical practitioner working with nurse
prescriber
Components of the CPA
Audit
Restrictions
Medication
RNP
details
CPA
Signoff
by HSP
Clinical
Sites
Pts &
Conditions
Doctor
details
Commitment to CPD required by RNP
Practice Standards for
Nurses & Midwives with Prescriptive
Authority
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Overview
Medicines Legislation & Professional Regulation
Objectives
Practice Standards with rationale & competencies
References
Appendices
• Competencies
• Schedule 8 MDAs
Practice Standards Objectives
• Professional guidance for prescriptive authority and
medication management
• Demonstrate the key competencies and practice
elements associated with this authority & related
principles to ensure safe, competent, effective and
ethical practice
• Appropriate mechanisms of clinical & selfgovernance are in place relating to SOP
• Outline a regulatory framework for the continuum of
prescribing authority/practices
• Assurance of the public of the competence &
professional accountability of the RNP
• Support the twin track approach to regulation
Practice Standards
1 Prescription Writing
2 Prescribing for Self, Family &
significant others
6 Separation of responsibilities
for prescribing, dispensing and
supplying
7 Influence of outside interests
3 Repeat Prescribing
4 Prescribing of unlicensed
medications
5 Prescribing by verbal,
telephone, email or fax
8 Communication &
Documentation
9 Continuing Professional
Development & Competency
Linking registration, education &
clinical governance with continued
competence
Initial entry:
• Completion of education programme
• Attainment of competencies as detailed in the
Requirements & Standards
• Commitment to CPD – noted in CPA
Specific project to devise the structures and processes for
Continued Competency as a Prescriber:
• Consideration of international standards & best
practice & constructing a model that fits for the Irish
system
• Consultative activities are a key component
• Evolving process through this first phase
Supporting Medication
Management for the profession
Recent developments
Medication Management
Background
1990 – First publication on the
administration of medications
2003 Revision introduced the concept of
medication management
2005 Review recommendations & actions
for revision of Board guidance for
OTCs & medication protocols
2007 Legislation for nurse prescribing
7 revisions to date reflecting changes in
legislation, health care policy & advances in nursing
& midwifery practice
Structure of Guidance Document
Sections 1- 4
1. Medication Management General
Principles and Responsibilities
2. Cycle of Medication Management
3. Safety in Medication Management
4. Medication Protocol and framework
template
Each medication subject written as a
standard with supporting guidance
The New Look
Safety in medication management
Section 3
New topics
Expanded content
Crushing medications
Adverse event reporting
Immunisations
Conscious sedation
Haemovigilance
Unlicensed/off-label
medications
Medication errors &
near misses
And more...
Supply & administration using
protocols
Finishing Touches
References & Appendices
 Legislation & national guidelines
 An Bord Altranais publications
 Schedules of MDAs 1-5 & 8
 Glossary of terms
 Irish Medicines Board adverse event
reaction report form
 Useful contact addresses
Supporting Medication Management
& Prescriptive Authority
Project Implementation Work 2007-2008
 Orientation of the profession to E-learning
programme Guide to Medication Management
 Dissemination & communication of the Board’s
regulatory framework & professional guidance
for prescribing
• Monitoring & evaluation
 Collaboration with key stakeholders for current
implementation strategy & for future evaluation
Thank you
Further information:
Kathleen Walsh, Project Officer
[email protected] 01 639 8502