Competence in both theory and practice will need to be demonstrated for successful completion of the course.
If a student interrupts their studies whilst undertaking this module, they must complete the module in no more than two years from the identified start of the module. If a student has not completed all the assessments within the above time they must undertake the whole programme again, including all assessments, to ensure competence is maintained(NMC 2006: 13).
Assessment strategies will test knowledge, decision-making and the application of theory to practice in the following ways:
ASSESSMENT OF THEORY (50%)
1. Written Final Examination:
This will take place at the end of the module, under formal examination conditions lasting 1½ hours in total, consisting of:
Twenty MCQ/short-answer questions paper (1½ hour) testing knowledge and application to prescribing practice. (Pass mark 80%)
2. Numerical assessment, including drug calculations within the context of prescribing practice.
Students must achieve 100% pass mark.
ASSESSMENT OF PRACTICE (50%)
3. Practice Assessment
The competency statements in the practice assessment document (issued separately) have been adapted from the National Prescribing Centre publication entitled Maintaining Competency in Prescribing: an outline framework to help nurse prescribers (NPC 2003) and the NMC practice standards
The purpose of the practice assessment document is to:
• Enable you and your DMP to chart your continuous assessment and progress throughout the period of supervised practice
• Record the assessment of your competence and safety in the practice of nurse independent / supplementary prescribing
• Provide evidence of your ability to base your practice on the underlying theoretical components of the module.
You will be judged against safe, competent and proficient criteria identified in the attached practice assessment document.
Prescribing practice will be assessed by your approved DMP who is currently working in the same field as you.
Assessment of practice will be conducted by the DMP through the use of clinical supervision, observation and discussion in practice. An experienced non-medical prescriber trainee buddy (NMPTB) will be identified who can work alongside you and your DMP to provide support and guidance as appropriate.
The DMP must approve as legally correct and countersign three practice prescriptions written on the UNIS prescription template, for patients you have been assessed on in practice. These are to be submitted with the portfolio as validated evidence.
For each patient assessment the medical assessor must sign against each criterion whether he/she assesses you as safe or unsafe.
All competencies must be passed as safe
If a student is referred as unsafe in any of the competencies of the Practice Assessment document, an action plan must be agreed with the DMP, student and tutor.
The completed Practice Assessment form is to be submitted within the Practice Portfolio.
4. Portfolio of Practice Evidence
The principle behind using portfolios to assess practice in this programme is to capture the richness and sophistication of skilled healthcare practice. The portfolio structure reflects this principle, and is designed to enable you to achieve the competencies required. The different sections within the portfolio each have a purpose to your thinking in the practice experience. Portfolio guidelines, issued separately, contain a step-by-step guide to the different components of the portfolio, and how they contribute to assessment of practice.
5. OBJECTIVE STRUCTURED CLINICAL EXAMINATION (OSCE)
6. Date of final OSCE in Practice: TBC with DMP and Personal Tutor. This must occur before the final submission date
A systematic and detailed examination of practice within a simulated learning environment. Students must achieve a pass.
|The module aims to:
• Prepare nurses, midwives and specialist community public health nurses to independently prescribe safely appropriately and cost-effectively licensed drugs from the British National Formulary and to act as supplementary prescribers.
• Professionally develop students in the higher education context of lifelong learning
|The module provides opportunities for students to develop and demonstrate knowledge and understanding, qualities, skills and other attributes to enable them to independently prescribe from the British National Formulary, for any medical condition within their competence, including some controlled drugs.
The learning outcomes below are identified in Standards of Proficiency for Nurse and Midwife Prescribers (NMC 2006:18) and are inherent in the four principle areas, knowledge, skills and competencies required to underpin prescribing practice outlined in Annex 2 (NMC 2006:56).
On completion of the module a student will be able to:
Knowledge and Understanding:
• Understand and apply the relevant legislation to the practice of nurse / midwife prescribing.
• Understand the influences that can impact on prescribing practice
• Demonstrate an understanding of the ethical dimensions of prescribing
• Demonstrate an understanding of the roles and relationships of others involved in prescribing, supplying and administering medicines.
• Critically appraise, use sources of information / advice and decision support systems in prescribing practice
• Understand and apply knowledge of drug actions in prescribing practice.
• Assess and consult with patients / clients and parents / carers
• Undertake a thorough history, including medication history and current medication (including over-the-counter, alternative and complementary health therapies) to inform diagnosis
• Prescribe safely, appropriately and cost effectively
• Practise within a framework of professional accountability and responsibility
• Develop a clinical management plan within legislative requirements. (Supplementary Prescribing only)
Key Transferable Skills:
• Demonstrate an awareness of the need for cross-disciplinary working
• Use clinical supervision to critically analyse and evaluate their ongoing performance as independent nurse prescribers
• Make a contribution to their portfolio as lifelong learners.
|The content is presented within eight themes related to prescribing:
1) Consultation, decision making and therapy, including referral
• Models of consultation
• Accurate assessment, history taking, communication and consultation with patients/clients and their parents/carers
• Concepts of working diagnosis or best formulation
• Development of a management plan and /or clinical management plan
• Confirmation of diagnosis/differential diagnosis-further examination, investigation, referral for diagnosis
• Prescribe, not to prescribe, non-drug treatment or referral for treatment
• Numeracy and drug calculations
• Stopping medication prescribed by others
• Medicines review.
2) Influences on, and psychology of, prescribing
• Patient/client demand ,and preference vs. patient/client need − knowing when to say “no”
• External influences, e.g. companies or colleagues
• Patient/client partnership in medicine taking, including awareness of cultural and ethnic needs
• Concordance as opposed to compliance
• Achieving shared understanding and negotiating a plan of action.
3) Prescribing in a team context
• Rationale, adherence to and deviation from, national and local guidelines, local formularies, protocols, policies, decision support systems and formulae
• Understanding the role and functions of other team members
• Documentation, with particular reference to communication between members, including electronic prescribing
• Auditing, monitoring and evaluating prescribing practice
• Interface between multiple prescribers and management of potential conflict
• Budgets and cost effectiveness
• Dispensing practice issues.
4) Clinical pharmacology, including the effects of co-morbidity
• Pharmacology, including pharmaco-dynamics, pharmaco-kinetics, pharmaco-therapeutics
• Anatomy and physiology as applied to prescribing practice and community practitioner formulary
• Basic principles of drugs to be prescribed, e.g. absorption, distribution, metabolism and excretion, including adverse drug reactions(ADR)
• Interactions and reactions
• Patient/client compliance, concordance and drug response
• Impact of physiological state on drug responses and safety, for example, in elderly people, neonates, children and young people, pregnant or breast feeding women
• Pharmaco-therapeutics related to controlled drugs
• Using the BNF systems approach; Commonly prescribed drugs will be covered with particular emphasis on the cardiovascular, respiratory, gastro-intestinal, nervous and endocrine systems plus management of infection
5) Evidence-based practice and clinical governance in relation to nurse prescribing
• Rationale, adherence to and deviation from national and local guidelines, protocols; policies, decision support systems and formulae
• Continuing professional development − role of self and role of the organisation
• Management of change
• Risk assessment and management, including safe storage, handling and disposal
• Clinical supervision
• Reflective practice / peer review; critical appraisal skills
• Auditing practice and scrutinising data, systems monitoring; identify and report adverse drug reactions and near misses
• Prescribing controlled drugs; prescribing and administering; prescribing and dispensing.
6) Legal, policy and ethical aspects
• Sound understanding of legislation that impacts on prescribing practice
• Legal basis for practice liability and indemnity
• Legal implications of advice to self-medicate, including the use of alternative therapies, complementary therapy and over-the-counter (OTC) medicines
• Safe-keeping of prescription pads, action if lost, writing prescriptions and record keeping
• Awareness and reporting of fraud (recommendations from the Shipman Inquiry, Fourth Report)
• Drug licensing
• Yellow card reporting to the Committee of Safety on Medicines (CSM) and reporting patient/client safety incidents to the National Patient Safety Agency (NPSA)
• Prescribing in the policy context; manufacturer’s guidance relating to literature, licensing and off-label
• Ethical basis of intervention; informed consent, with particular reference to client groups in learning disability ,mental health, critically ill people and emergency situations
• Legal implications and their application to supplementary prescribing.
7) Professional accountability and responsibility
• The NMC Code of Professional Conduct; standards for conduct, performance and ethics
• NMC standards for prescribing practice
• Ethical recommendations from the Shipman Inquiry, Fourth Report; accountability and responsibility for assessment, diagnosis and prescribing
• Maintaining professional knowledge and competence in relation to prescribing
• Accountability and responsibility to the employer.
8) Prescribing in the public health context
• Duty to patient/clients and society
• Policies regarding the use of antibiotics and vaccines
• Inappropriate use of medication, including misuse, under-use and over-use
• Inappropriate prescribing including over-prescribing and under-prescribing
• Access to health care provisions and medicines
• Prescribing in its broadest sense, e.g. exercise.
|Methods of Teaching/Learning
|The module will be delivered on a part-time basis over twenty four weeks. The 27 days for theory will include a day set for induction, including university registration and introduction to study skills. The content will be delivered under 8 major themes:
Consultation, decision making and therapy, including referral; Influences on ,and psychology of, prescribing; Prescribing in a team context; Clinical pharmacology, including the effects of co-morbidity; 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.
Over the six month period, students will normally spend the equivalent of half a day per week in practice (twelve days or 90 hrs) supervised by designated medical practitioners, who will also participate as assessors in the assessment process. Students will be expected to complete a Supervised Practice Log to record the activities during the 90 hours of practice. Such assessors will be fully informed and prepared for their roles before the start of the course. A pack will be prepared and circulated to assessors.
Contact hours: 162 hours (27 x 6 hours in the university setting)
90 hours (12 x 7.5 hours in the practice setting)
48 hours (self-directed study)
Total: 300 hours
|Additional reading lists will be produced on each theme.
Courtney M, Griffiths M. 2004 Independent and Supplementary prescribing − An essential guide. Greenwich Medical Media Ltd, London
Dale MM and Haylett DG 2004 Pharmacology Condensed Churchill Livingstone Edinburgh (ISBN 0443070490)
Downie, G., Mackenzie, J., Williams, A. 2004 Pharmacology and Medicines Management for Nurses (3rd edition) Churchill Livingstone, Edinburgh
Downie G, Mackenzie J, Williams A 2006 Calculating Drug Doses Safely − A Handbook for Nurses and Midwives Churchill Livingstone. London
Edmunds, J. 2006 Introduction to Clinical Pharmacology (5th edition). Mosby, London
Department of Health. 2005 Supplementary prescribing by Nurses, Pharmacists, Chiropodists, Podiatrists, Physiotherapists and Radiographers within the NHS in England DOH, London
(Available on www.dh.gov.uk/gateway Ref 4941)
Department of Health 2006 (April) Improving Patients’ Access to Medicines: A guide to Implementing Nurse and Pharmacist Independent Prescribing within the NHS in England, DOH. London (available on www.dh.gov.uk/gateway Ref 6429)
Department of Health 2006 (July) Medicine Matters − A guide to mechanisms for the prescribing, supply and administration of medicines London: DOH (available www.dh.gov.uk/gateway Ref 6773)
Dimond, B., 2005 Legal Aspects of Nursing Pearson Education
Galbraith A, Bullock S, Manias E, Hunt B, Richards A. 2007 Fundamentals of Pharmacology: A Textbook for Nurses and Health Professionals. (2nd edition). Addison Wesley Longman Ltd, Edinburgh. ISBN 0582 404673
Neal, M.J., 2005 Medical Pharmacology at a Glance .Blackwell Publishing Ltd Oxford
ISBN -13: 978-1-4-51-3360-9
Nursing and Midwifery Council 2006 Standards of proficiency for nurse and midwife prescribers NMC London
Clinical Pharmacology Made Incredibly Easy 2005 Lippincott Williams and Wilkins Philadelphia (ISBN 1 58255-293-2)
Humphries, J., Green, J. 2002 Nurse Prescribing 2nd edition. Macmillan Hants
Johns, C., 2004 Becoming a Reflective Practitioner (2nd edition). Blackwell Science Ltd, Oxford
Jones, M. 2001 Nurse Prescribing Politics to Practice Bailliere Tindall, London
Manson, A. L., 2005 Crash Course − Cell Biology and Genetics Mosby, London (ISBN 0723432481)
National Prescribing Centre (March 2003) Maintaining Competency in Prescribing − An outline framework to help nurse supplementary prescribers. NPC Liverpool) available on (www.npc.co.uk/nurseprescribing)
National Prescribing Centre September 2003. A resource to help health care professionals to understand the framework and opportunities. NPC Liverpool (also on the NPC website)
Nursing and Midwifery Council 2004. The NMC Code of Professional Conduct: Standards for Conduct, Performance and Ethics. NMC London
Nursing and Midwifery Council 2007(October) Standards for medicine management NMC London
Rang, H. P., Dale M M, Ritter J M, Moore P K 2007 Pharmacology (6th edition) Churchill Livingstone, Edinburgh
Rutter, P. 2004 Community Pharmacy − Symptoms, Diagnosis and Treatment Churchill Livingstone, London (ISBN 0 4430 7362 7)
Tortora, G J, Grabowski S R 2005 Principles of Anatomy and Physiology John Wiley & Sons London
The Electronic Medicines Compendium and Medicines Guides
Clinical Management Plan Library online
Encourages individuals to submit their CMPs for sharing with others
Department of Health (DH)
Nurse prescribing and supplementary prescribing sections
A collection of guidelines from various authors – NICE, prodigy, SIGN and expert groups. Though a commercial publication, registration is free and company sponsored guidelines are not included.
Home Office Form for applying for handwriting exemption for CD prescriptions
Needed by those working in substance misuse; to be able to use electronically produced controlled drug instalments prescriptions (FP10MDA-SS).
For PGDs etc and private sector issues
National Electronic Library for Medicines (NELM) formally Druginfozone
Extending prescribing section has resources, training material, national document links
National Prescribing Centre (NPC)
For events & resources for supplementary prescribing
Nurse Practitioner website
Useful as has lots of CMPs
Nurse Prescriber website
This has a very useful discussion group and also useful updates on legal changes etc.
Patient Group Directions website
For all PGD issues
Prescription Pricing Authority (PPA)
This is a useful website for prescribers. For example, it gives information on types of prescriptions that are available
PRODIGY is a source of clinical knowledge, based on the best available evidence, about the common conditions and symptoms managed by primary healthcare professionals.
Royal Pharmaceutical Society of GB (RPSGB)
Useful for clinical governance framework, links to University courses, pharmacist register
SIGN (Scottish intercollegiate guideline network)
Guidelines, based on best available evidence, for many common conditions
NICE (National Institute for Health and Clinical Excellence)
Healthcarerepublic (Website for Primary Care)
Other sites of interest:
Government website, which is updated daily. Go to the Department of Health and click on What’s New. We suggest that you become a regular visitor to this site, as you will see changing policy, issues regarding health, prescribing, policy etc.
This is a useful site with guidelines, evidence and more.
Good for clinical guidelines. Other background information available.
Prodigy – good prescribing info for anyone. Worth a look!
A good resource for antibiotic use and misuse. American, and some of the names of medicines are different, but useful background reading
National Institute for Clinical Excellence. Latest on, amongst other things, drug evaluations, what can be prescribed on the NHS and what can’t.
NHS Direct site. Has some useful info from the patient’s perspective.
Bandolier, evidence based medicine. A useful resource
The Scottish Intercollegiate Guidelines Network – clinical guidelines at a glance
The Centre for research and Dissemination, sponsored by the Government. Good reviews for evidence based practice.
National Electronic Library for Health. Brings together a number of other sites with news and issues, evidence-based.
Medicines Control Agency, the licensing body for UK medicines. Learn about new medicines, the licensing process, current issues
The Medicines and Healthcare Products Regulatory Agency
National Prescribing Centre. There is a Nurse Prescribing page on this site which has useful information for prescribing nurses/pharmacists. Other info on the site is of great use.
Prescription pricing authority. Background interest and PACT information
Website for pharmacists. Has a good news page on what new drugs are expected, what drugs are out of patent and what’ happening in general. Some parts of the website are off limits, but useful all the same.
Website for patients.
This is an interesting website with video cams of bacteria dividing and lots of interesting info on bacteria.
|29TH JULY 2010