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News and Updates for todays Nurse Prescribing in End of Life Care

Marion RussellMarion Russell

Nurse/Non Medical Prescribing: National Update
Marion Russell,
Medicines Management Advisor & Board Member, Association for Prescribers
Pre Event Abstract 
The number of professions now able to register as non-medical prescribers is expanding as the demands made on the NHS and other Health Care providers continues to increase.
This brings with it the need to ensure that medicines are not only prescribed safely but those who undertake this task are capable and competent to do so.
The new NMC Code for nurses and midwives sets out quite clearly that patient safety is the registrant's responsibility.
This presentation seeks to link all of these facets together and help to set the scene for the conference.  
Marion speaking this morning said: 

  • We will never get it right, all we can do is make it better
  • In the past 20 years, and in the last 3 months, there have been significant advances in the function of the nurse
  • Prescribing is a huge thing to take on.  Marion asked the group how many of them trembled when asked to write their first prescription
  • NMC figures (Sept 2017), 77,067 nurse prescribers in the UK
  • In April 2018 prescribing rights were approved & granted for paramedics, and courses began September 2018
  • The NMC consultation ended in September 2017.  The standards for Medicines Management will be withdrawn in January 2019.  They will be replaced but are not yet written, maybe by end of January but we don’t know
  • The measurement of competence is variable & subjective
  • Standards for Prescribing Programme (May 2018) promotes inter-professional learning.  At last we are getting a link between nurses and pharmacists.
  • Huge change, any of you on the register can now be an assessor, don’t have to be a Dr, do you feel competent?

Full PowerPoint Presentation


Nurse/Non Medical Prescribing in end of life care
Catherine Malia,
Nurse Consultant, St Gemma’s Hospice
Pre Event Abstract
This session aims to explore how we have implemented non-medical prescribing within a Hospice setting. Catherine intends to share her practical experiences of using NMP in St Gemma’s Hospice in-patient unit to support the introduction of a new nurse-led initiative. She will highlight some of the many benefits we have identified in terms of patient experience, staff and service development. She will also share some of the challenges experienced and how we overcame them.
Catherine speaking today said:

  • There has been an £800 million saving by non-medical prescribing in hospices
  • Why are some NMPs not prescribing? 40% did not perceive a need for the qualification within their current role
  • There are challenges to qualified prescribers, support is very important
  • Huge increase in non-medical prescribers however only 1.1% of all palliative care drugs are prescribed by nurse prescribers
  • Catherine highlighted the benefits of non-medical prescribing within St Gemma’s Hospice, including improved oiate prescribing, have become more efficient, and many more
  • Catherine cited Ziegler et al 2015: Why are palliative care nurses not prescribing? Some said that there was no need, time constraints, will only do it for financial reward, lack of support

Full PowerPoint Presentation


Inpatient Pain Service influence on pain management at the End of Life
Inge Bateman,
Lead Clinical Nurse Specialist In-patient Pain Service, Western Sussex Hospitals NHS Foundation Trust
Pre Event Abstract:
Non-medical prescribing needs to be used in the context of safe delivery of care and therefor part of sound governance framework within your organisation. I will share my experiences both as a Non-medical Prescriber but also as a former Non-medical Prescribing Lead for the Trust. Concerns are frequently being raised in relation to deskilling other professionals by having clinical nurse specialists and in particular if they are Non-medical Prescribers as well. It is like everything a balancing act between delivering best care here and now and long-term benefits, which I believe are best achieved by having clinical nurse specialist that are prescribers but also understand the context of prescribing within a team approach. Maintaining competency and demonstrating this can be a challenge so I will share some of the experiences from our Trust. Collaborative working is vital and I will highlight some of the changes that we have found beneficial for delivering quality care to our patients. Our organisation is using the leadership model used at Virgina Mason Institute in developing our Patients First Programme, which in a few words means that we put patients first in everything we do. Through case based discussion I will cover the role of the Inpatient Pain Service and how this can complement the Palliative Care Team or support Hospice care.
Inge speaking at the conference today said:

  • You can do the prescribing course after being qualified for just a year, this worries me enormously
  • You need to work within your sphere of competency
  • Revalidation plays into our way of demonstrating our competency to prescribe
  • Working as an Inpatient palliative care team has really changed over last 25 years
  • Inge demonstrated a series of prescribing case studies


Ensuring competence and confidence in prescribing practice
Deborah Robertson,
Lecturer, University of Salford, Consultant Editor, Nurse Prescribing Journal
Pre Event Abstract
The scope of the presentation is as follows:

  • Improving non-medical prescribing practice
  • Implementing the competency framework
  • Ensuring you have the history-taking, clinical assessment and diagnosis skills to prescribe appropriately and effectively
  • Keeping your prescribing knowledge up-to-date: accessing education, training and resources
  • Difficult Issues: Pharmacology and prescribing decision making for cancer and non-cancer palliative care, understanding comorbidity issues and drug interactions.

The presentation will explore the key areas of prescribing competence and confidence. We will explore the current issues and how, by improving and supporting Non-Medical Prescribing in this area we can address some of these issues.
Deborah speaking this afternoon said:

  • Nurses are caring, courageous, competent
  • A competency framework is a collection of competencies thought to be central to effective performance, as a prescriber
  • You have to demonstrate a movement through competence, novice to expert.
  • Deborah highlighted the apprenticeship model ‘see one, do one, teach one’, passing on to a buddy
  • To maintain safety and improve care: This is especially important at the end of life
  • Deborah brought to the attention of the room the CPD evaluation form within the handbook, highlighting that this can be one of their self reflections
  • I may be a university lecturer but I am also a nurse and I still think the patient should be at the centre of everything
  • Are you questioning what you do?  That’s good, that’s prescribing governance, looking at your practice & trying to make it better
  • You shouldn’t prescribe unless you can diagnose

Full PowerPoint Presentation

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