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Nurse/Non Medical Prescribing in Cardiology: News and Updates

This important national conference provides an essential update for current and aspiring nurse/ non medical prescribers in cardiology and cardiovascular care.

Through national updates and practical case studies delegates will hear how to develop and maintain prescribing competence, and how to develop effectiveness in post qualification practice. The conference will include extended sessions focusing on developing your skills in nurse prescribing practice. The afternoon sessions will include case study presentations on nurse/non medical prescribing in rapid access chest pain clinics, heart failure, a nurse/non medical-led follow-up service for patients who have undergone percutaneous coronary intervention, pre admission clinics for elective cardiology patients, nurse/non medical prescribing in the management of arrhythmias, prescribing medications in acute coronary syndromes and nurse prescribing in a cardiac prevention & rehabilitation programme. The conference will conclude with a session on pharmacist prescribing for medicines optimisation and medicines adherence within the healthcare pathway of patients with cardiovascular disease.

The conference will update delegates on their responsibilities with regard to maintaining prescribing competence for revalidation and the NMC Code which includes specific requirements for prescribing and medicines management as well as leadership.

Speaker updates and presentations:

Nurse/Non Medical Prescribing: National Update

Andrew Rideout Nurse Practitioner, Emergency & Unscheduled Care The Association for Prescribers

  • national developments in nurse/non medical prescribing - including ‘Realistic Medicine’ and ‘Values Based Refective Practice’
  • decision making and prescribing confidence - results from a research study
  • reflections from the above on improving patient outcomes, developing practice, and demonstrating compliance with the NMC Code for revalidation

Andrew Rideout Full Presentation Click Here

In his presentation Andrew Rideout Stated: 

Allied Health professions – new professions have come into prescribing role – physio, podiatry, therapeutic radiographers, optometrists; dietetics, diagnostic radiographers; orthoptists, paramedics (different parameters for each group in terms of what they are able to prescribe in what situations).  Difficult for paramedics to be exempt from legal parameters.  

Designated medical practitioners/mentors – general pharmaceutical council consultation wants to move away from designated medical practitioner towards mentor; requirements for DMP/Mentor (what are they?) Currently only that they are a doctor, is this the best suited person, should we be looking at broader skills, working in a similar clinical area, will we lose out if we don’t have close link with medics?  Some use critical friends – trainers who can support in clinical environment, understand roles, work with and mentor more effectively.

Pre-registration prescribing – NMC consultation on this started in January, has gone out to a small group of people around the country, likely to lead to a full consultation in June, encourage you to take part of this, will need nurses who can prescribe so its very much needed.  How will this be supported?  Safety is key.  How will this be supported – nurses supporting students learning to prescribe?  How to catch up – e.g. nurse working for 10 or 20 years not qualified as a newly qualified student nurse.

Capacity and succession planning – What capacity exists currently – availability of higher educational institutions, DMP’s and practitioners – body of professionals coming through is not sufficient currently, need to think about how to encourage colleagues into prescribing roles.  Need to think ahead and plan for succession.

Single competency framework – Royal Pharma Soc, published July 2016.  Lists components important to be a prescriber.

Realistic Medicine (website looking at how we practice our care, now includes prescribing) – Encourages to think more widely about what we do.  What matters to you, what is needed to deliver these outcomes, how ready is nursing to take this on?

Values Based Reflective Practice – NAVVY (whose needs are being met, what does this say aobut abilities, whose voice is heard, do they feel valued, you are important)

Summary – how do we demonstrate competency for revalidation – competency framework, reflective discussions

How do we ensure that we are improving patient outcomes and developing practice?  What additional skills do we need, what extra resources can we utilize? 

Andrew Rideout Presentation Abstract:

This presentation discussed national changes within non-medical prescribing and NHS culture including the development of Allied Health Profession prescribing, changes to NMC position of pre- and post-registration prescribing, ‘Realistic Medicine’ and ‘Values Based Reflective Practice’, considering how these may impact on individual practice.

The results from a recent research study examining factors that influence prescribing decision making, and the implications for patients and service delivery were briefly discussed.

These areas were then tied together briefly, with the opportunity to discuss the challenges to developing, maintaining, and demonstrating practice.

Andrew Rideout Biography:

Andrew Rideout is chair of the NHS Scotland Non-medical Prescribing Leads’ Group, and member of the committee of the Association for Prescribers.  He has been an active prescriber in acute and unscheduled care settings for the last ten years, and his current roles are within Public Health (with an interest in Health Service Public Health – the delivery of safe and effective health interventions to populations) and as an Advanced Nurse Practitioner within the Out of Hours service in NHS Dumfries & Galloway.  Dumfries and Galloway is a Remote and Rural Health Board in south west Scotland with a population of 150,000 over an area of 2,500 square miles.

Jan Keenan Nurse Consultant in Cardiology & Trust Lead for Non Medical Prescribing Oxford University Hospitals NHS Foundation Trust & Past President British Association for Nursing in Cardiovascular Care

Jan Keenan Full Presentation Click Here

In her presentation Jan Keenan stated: 

Pulse which has had an impact on perceptions about prescribing, giving misleading impression.  We’ve made huge improvements but some doctors still believe that nurses shouldn’t prescribe.  

Coronary heart disease was added very late to list of conditions that could be treated – but even then very very restricted in what could be prescribed

Qualifications issued to nurse prescribers was 58497 but 5k of these seem to have dropped off somewhere, registered with NMC 53582 – difficult to establish how many actually working in cardiology

Cardiology Outreach – Early access to treatment, get info needed to make early diagnosis, liaison between A&E/outpatient and Cardiology, advise management, early access to diagnostics, right treatment, right patient, right time.

RACPC – Preventing admission, preventing MI, improving access to treatment.

Heart Failure – Make patients better, expedite SAFE discharge, likely prevented readmission.  Principles of patient involvement, patient priority, and safeguarding.  Patient centred care.  Specialist advice, long term management.

Arrhythmias and devices – supporting patients, advising colleagues, point of contact; preventing admission, expediting front door assessment, patient centred care.

Communication and Advice – talk to colleagues, ask for advice and give advice.  Talk to the patient as well.  Nurse prescribers are a brilliant source of advice to colleagues.

Range of drugs/new products – see slide in handouts

Improving outcomes – nurse prescribers have had a huge impact on prescribing (see case studies above)!  Unfortunately this is not always reflected by the media, which likes to criticize.  Evidence base – NMP is safe and clinically appropriate, delivers similar level of care as GP’s and generates higher satisfaction rating among patients, patient acceptability of NMP is high.

Challenges – lack of hard data, literature scarce and unreliable, need to demonstrate economic impact

What next – consultation skills, content analysis of consultation (comparative), adherence measures, target achievement (secondary prevention)

Jan Keenan Biography:

Jan Keenan has an extensive background in cardiac nursing, and for the last 25 years has been working at the Oxford Heart Centre. Jan has an educational, clinical and academic background but her true passion lies in clinical practice, and in particular the development and evolution of services that place our patients at the centre of care and expertise, delivered by nurses alongside all our inter-related professional groups.

Jan takes a clinical lead in service provision and development of nurse led services, in particular in relation to people with coronary heart disease, but also in relation to a growing number of sub-specialities in Cardiology. As a nurse prescriber Jan was one of the first nurses in acute care to take on a prescribing role, and thereafter rapidly became a champion of non-medical prescribing. In addition as Non-Medical Prescribing lead for the Oxford University Hospitals NHS Foundation Trust Jan encounters nurses and AHPs working in primary secondary and tertiary care who are developing innovative approaches to care. Jan publishes independently and collegiately in the fields of cardiac nursing, advanced practice and nurse prescribing and has an unashamed reputation for championing the value of nurse led services.

As NMP lead it is Jan’s absolute privilege to meet nurses and allied health professionals with an interest in prescribing as part of advanced practice and Jan takes a great interest in supporting the development of services around the patient, that offer improved access to treatment by those who truly are the experts in their field.

Future events of interest:

Controlled Drugs: Safe Use, Prescribing and Management: Monitoring Adherence to the 2016 NICE Guidance
Thursday 11 May 2017
The Studio Conference Centre, Birmingham

Demonstrating & Improving Prescribing Competence & Practice: Implementing the New National competency framework for all prescribers
Friday 19 May 2017
De Vere W1 Conference Centre, London

Nurse/Non Medical Prescribing in Cancer Care
Monday 5 June 2017
De Vere West One Conference Centre, London

Electronic Prescribing In Hospitals: Moving Forward
Thursday 13 July 2017
Manchester Conference Centre, Manchester

Non Medical Prescribing on the Wards
Thursday 13 July 2017
Manchester Conference Centre, Manchester

31 March 2017


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