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News from todays Demonstrating & Improving Prescribing Competence & Practice: Implementing the National competency framework for all prescribers

Chair Dr Deborah Robertson, Consultant Editor, Nurse Prescribing, Senior Lecturer, University of Salford

Pre Event Abstract 
Prescribing Governance. The scope of the presentation is as follows: 

  • using the prescribing competency dimensions for prescribing governance in practice
  • using the framework as part of the NMC revalidation process
  • governance of non-medical prescribing roles
  • electronic prescribing systems and prescribing competence 
  • demonstrating prescribing governance
  • case studies and examples in practice, and the impact on patient care
    Full Powerpoint presentation

Supporting healthcare professionals to prescribe effectively: The National Competency Framework for all prescribers
Catherine Picton,
Lead author, A Competency Framework for All Prescribers, Consultant to Royal Pharmaceutical Society

Pre Event Abstract
When prescribed and used effectively medicines have the potential to significantly improve the quality of lives and improve patient outcomes. However the challenges associated with prescribing the right medicines and supporting patients to use them effectively should not be underestimated.
In 2012, a single prescribing competency framework was published by the National Prescribing Centre/National Institute for Health and Clinical Excellence (NICE) to support all prescribers to prescribe effectively. This framework was updated by the Royal Pharmaceutical Society with the backing of NICE and Health Education England, and in collaboration with all the prescribing professions UK wide. The updated single competency framework was published in July 2016, for use by all regulators, professional bodies, and prescribers across all prescribing professions.
This presentation will touch on key changes to the new framework and how the framework can be used to support new and existing prescribers.
Full powerpoint presentation

NMC Update: The May 2018 revised Prescribing Standards for Medicines Management: Adopting the RPS framework for all nurses and midwives
Ruth Wakeman
, Deputy Director of Education, Standards and Policy, Nursing and Midwifery Council

Pre Event Abstract 
In March 2016, the NMC’s Council agreed to progress our education strategic programme. This substantial programme of work consists of a number of key areas of change, designed to ensure that future nurses and midwives are trained to successfully meet the challenges of providing safe and effective care to a changing population demographic in an increasing diverse numbers of settings in the coming decades.
The education programme includes the development of new standards of proficiency for the future registered nurse and the future registered midwife; a new education framework and associated programme requirements that underpin safe and effective learning, including updated arrangements for learning in practice; an independent review of our quality assurance (QA) function; and a review of a number of other standards, including our Standards of Proficiency for Nurse and Midwife Prescribers, our Standards for Medicines Management and our Standards relating to Return to Practice programmes. It is our intention that this programme of work will be completed by March 2020.
The first phase of this work has now been completed, with a first tranche of new standards being approved by Council in March 2018. Following approval, May 2018 saw the publication of our new standards of proficiency for future nurse, our standards framework for nursing and midwifery education, our standards for student supervision and assessment, and our programme standards for NMC approved pre-registration nursing and prescribing programmes. These new standards come into effect from January 2019. At same time, the NMC has also agreed to the adoption of the Royal Pharmaceutical Society’s Competency Framework for all Prescribers and the withdrawal of our Standards for medicines management.
This presentation focuses on our new standards for nurse and midwife prescribers, looking at how they differ from our current standards, and the challenges and opportunities they will bring for students, practitioners, educators, employers and the NMC as a regulator. It covers subjects such as selection for, admission to and progression through prescribing programmes; the content, delivery and evaluation of prescribing programme curricula; learning that takes place in practice settings; how student prescribers are to be supervised and assessed during their programmes; and the qualification to be awarded to successful students and post-qualification practice.
It also looks at the new proficiencies for future prescribing practice, the reasons for withdrawal of the Standards for medicines management and what will replace them. It also considers whether an increase in the number of nurses and midwives prescribing will have an effect on the number of fitness to practise referrals to the NMC for prescribing misconduct, and explores why the NMC has taken the radical step of adopting a competency framework developed by another organisation as the benchmark for safe and effective prescribing practice.
Full powerpoint presentation

Self assessment, reflection and audit of prescribing practice against the ten competency dimensions
Sally Jarmain
, Non-Medical Prescribing Lead, Northern Devon Healthcare NHS Trust

Pre Event Abstract
This presentation looks at barriers to the implementation of Non-Medical Prescribing, based on a systematic review by Noblet et al (2017). These include personal/professional factors, education/support factors, system factors and financial factors. Ways of overcoming these barriers are discussed, for example peer supervision and organisational policies. The presentation also looks at methods for demonstrating competence using the ten competency dimensions, including audit, self-assessment and reflection.
Full Powerpoint presentation

Prescribing and Diagnostic Decision Making in a Clinic Setting
Linda Nazarko OBE
, Consultant Nurse Physical Healthcare, West London Mental Health NHS Trust

Pre Event Abstract
The UK is leading the way in advanced clinical practice. Currently Nurses, Physiotherapists, Pharmacists, Podiatrists, Optometrists, Dieticians, Radiographers and Paramedics are able to prescribe.
Internationally the clinical situation differs.  Nurse practitioners with MScs can prescribe in 21 states in US. In Canada, NZ, Spain, Netherlands there is limited prescribing. In the US pharmacists can prescribe in Florida, prescribing is otherwise limited in the US and not in place elsewhere.
Use of PGDs common place when there is a lack of prescribing authority
In the UK non-medical prescribers prescribe in differing clinical settings, these range from hospitals, community, walk in centres and clinics. Around 44,629 nurses, 3,845 pharmacists & 689 AHPs have NMP qualifications, 16% of nurses & pharmacists take 6/12 to issue first prescription and round 25%-50% don’t prescribe (Latter et al, 2010). 
Although 80% of diagnosis can be made on the basis of history those with complex presentations and long term conditions may not have the ability to provide a relevant history and may find it difficult to articulate concerns. It is important that the NMP has the ability not just to take a history but to carry out physical examination, order and interpret tests when clinically appropriate. The hope and aspirations of the patient must remain central to all aspects of diagnosis, clinical decision making and prescribing. This presentation will use case histories to explore these themes.
The impact of non medical prescribing is poorly researched probably because it is relatively new and initially low numbers of prescriptions were issued. In 2010 only 1.5% of prescriptions were issued by nurses (Drennan et al, 2014).
Patients report greater flexibility and access to appointments, better continuity of care, and a perception of a more caring style of consultation (Courtenay et al., 2011, Stenner et al., 2011). They also report that they consider their conditions were controlled better, and that they had a greater understanding of their medicines (Latter et al. 2010). In a recent evaluation of pharmacist and nurse prescribing, there was discussion regarding nurses’ knowledge of pharmacology, and pharmacists’ ability to undertake physical examinations and to diagnose. It was felt that there was room for improvement in the history taking, assessment and diagnostic skills of NMPs, but concluded that overall NMPs were making clinically appropriate prescribing decisions (Latter et al., 2012).
Prescribing errors by doctors are common, particularly in hospitals.  A systematic literature review of medical prescribers by Lewis et al. (2009) suggests that 7% of medication orders, 2% of patient days and 50% of hospital admissions are affected by them. Ashcroft et al (2015) found that NMPS were safer than junior doctors however a very small number of NMPS were surveyed.
This presentation will conclude by affirming the value of nurses practicing at advanced level and the difference they make to patient care.
Full Powerpoint Presentation

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10 September 2018


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