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Nurse/Non Medical Prescribing for Pain

This important national conference provided essential updates for current and aspiring nurse/non medical prescribers on prescribing for pain.

Through national updates and extended interactive practical case studies delegates heard how to develop and maintain prescribing competence, and how to develop effectiveness in post qualification practice. Extended sessions included developing prescribing competence and confidence, medication management, managing medication safety and preventing medication errors and overcoming the barriers to effective pain management.

Speaker news and presentations

Nurse/Non Medical Prescribing: National Update

Marion Russell, Medicines Management Advisor, Member, Association for Prescribers

  • national developments in nurse/non medical prescribing
  • developing confidence and competence in your ability to prescribe
  • demonstrating compliance with the NMC Code for revalidation
  • the benefits of nurse/non medical prescribing for pain

Marion Russell Presentation

Marion gave a brief update on national developments, she mentioned that we are all waiting for see what will happen from the NMC and other organisations. In her presentation Marion stated:  

“We have all experienced pain in some way or another including mental pain, and its an area that I think is not always address”

“Therapeutic Radiographers now have full prescribing rights, but diagnostic radiographers remain as supplementary prescribers. Paramedics there has been no change in there ability to prescribe. Dietitians are now supplementary prescribers.”

“NICE Guidelines Managing medicines in care homes (2014) – is key. More and more people are getting care at home”

“The RPS launched the A Competency Framework for all Prescribers in June 2016. This is an important document, it is only a competency framework, but it is looks like it will be adopted across all organisations”

“The professional Standards for Pharmacy Services consultation ended 11 September 2017”

“RPS - Consultation whether experienced non-medical prescribers could be the students NMP's assessor. You need to think about this. Is this something you would want to do. If we go down this route then statues would have to change”

“The NMC are now beginning to make changes there are 3 consultation pages out and they end on the 30 September 2017. These are for:

  • Consultation on standards of proficiency for registered nurses. 
  • Consultation on education framework: standards for education and training.
  • Consultation on prescribing and standards for medicines management.”

Marion Discussed in-depth  what the NMC is proposing in the consultation on prescribing and standards for medicines management:

  • nurses and midwives will be able to prescribe much earlier in their careers
  • nurses and midwives will be ‘prescribing ready’ when they register
  • nurses who prescribe will do so in line with the RPS Competency Framework
  • withdrawing current standards for medicines management

Marion broke this down for delegates:

  • The NMC are proposing to include a V100 type of programme into the pre-registration programme.
  • Changing the DMP from a doctor to a suitably qualified health care professional.
  • Reducing the length of experience required before undertaking the V300 from 3 years to 1 year.
  • Lowering the pass mark for the numeracy from 100% to 80% or lower. 
  • The standards for medicines management will be withdrawn completely and each organisation will set their own standards

Marion then went back to the Competency frame work and stated “The measurement of competence is variable and subjective.”

“Non-Medical Prescribers need to be COMPETENT and to have COMPETENCE”

Competence depends on many things from personal influences and  the assessor.

Marion Cautioned delegates “Competency Documents are NOT assessments. Filling in a form does not make for competence in practice.” And asked delegates to remember “I can be measured as competent and safe today but tomorrow I need not be!”

Marion then discussed what you should do to keep competent:

  • Ensure history taking, clinical assessment, diagnostic skills and knowledge are up-to-date.
  • Practice and use your skills.
  • Meet with colleagues and other prescribers to share experiences.
  • Start or join an NMP Forum.
  • Attend as many conferences on NMP/ Pharmacology/specialist groups as possible.
  • Join the Association for Prescribing.

Marion Russell 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 Russell Biography:

Since her retirement from the NHS in November 2013 Marion Russell has been working as an independent medicines management advisor. This includes running training days on medicines management for nurses, midwives and allied health care professionals as well as writing and reviewing medicines management related documents.

She was employed from 2003 -2013 at Guys and St Thomas NHS Foundation Trust as the Clinical Development Nurse: Medicines Management and was the Non Medical Prescribing Lead for the Trust. In this role she developed learning programmes for nurse/midwives and allied health professionals relating to medicines management, as well as  writing and monitoring the development of patient group directions and supporting nurses in non medical prescribing.

Her career in nursing spans over 40 years. She has worked in both the secondary and independent sector and held senior positions in the adult setting.

In 1980 she moved into mainstream education and qualified as a teacher. After this she worked in further education with students following social care courses.

In 1984 she entered Nurse Education and remained in this field until 2003 progressing from nurse tutor to managing education.

She was a member of the steering group working with the NMC on the development of the Standards for Medicines Management which was launched in February 2008.

She was the initiator and founder member of the Nurses Working In Pharmacy Network Group set up to support nurses who work in pharmacy.

She is a committee member of the Association for Prescribing.

Nurse/Non Medical prescribing for in-patient pain

Inge Bateman, Lead Clinical Nurse Specialist In-patient Pain Service, Western Sussex Hospitals NHS Foundation Trust & External Reference Group Member, The National Prescribing Competency Framework

  • nurse/non medical prescribing for in-patient pain: the practicalities
  • governance of nurse/non medical prescribing
  • my experience as a pain nurse/non medical prescriber
  • interactive discussion

Inge Bateman Presentation

In her presentation Inge discussed how her trust develops, demonstrates and maintains continued competence in nurse prescribing for pain.

Inge stated that “there is a huge benefit to non medical prescribing in in-patient management”

Benefits include:

  • Early access to treatment 
  • Improved patient care:                
    • Safe & appropriate prescribing
    • Cost-effectiveness         
    • Concordance
  • More flexible use of workforce skills

Inge stated when she “prescribers she thinks about a number of things, you have to make all the little issues fit in to what you are prescribing”.

“It is really important to have an idea of what they are taking, why they are taking it and reviewing”

Inge Bateman 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 know 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. 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. Being a non-medical prescriber fits in well with this and I will share some of my experiences to show how this in practices benefits patients.

Inge Bateman Biography:

Inge qualified as a registered general nurse in Denmark and a few years later followed this up with a degree in anaesthesiology and a two year training programme to become a nurse anaesthetist. Since then she has worked in different countries mainly in the speciality of anaesthesia and acute pain as well as a lecturer at Greenwich University. Inge is currently a Lead Clinical Nurse Specialist In-patient Pain Service and for the last 15 years has been part of the inpatient pain service at Western Sussex Hospitals NHS Foundation Trust, which achieved the CQC rating of outstanding in 2016 with the In-patient Pain Service being quoted as working in a proactive manner.

Despite the fact that Western Sussex Hospitals NHS Foundation Trust is classed as a district general hospital the inpatient pain service has been able to develop innovative approaches in pain management and won the regional Acute Care Award for Enhanced Recovery 2010. She has been using her prescribing qualification for 13 years and was the Trust Non-medical Prescribing Lead for several years. Inge has been teaching on the Non-medical Prescribing course at Brighton University and was part of the subject lead group as a Trust Non-medical Prescribing Lead representative. She was also part of the Safe Prescribing Programme Board Health Education Kent, Surrey and Sussex and an External Reference Group Member The National Prescribing Competency Framework.

She has been an active member of the South Thames Acute Pain Conference Group committee since 2003 and became the chair in 2011.

Inge has had the opportunity to speak a National as well as local conferences both on the subjects related to pain management and Non-medical Prescribing.

Future events of interest:

Effective Nurse/Non Medical  Prescribing in End of Life Care
Friday 6 October 2017 
De Vere West One Conference Centre, London

Nurse Clinics 2017
Monday 20 November 2017 
De Vere West One Conference Centre, London

Demonstrating & Improving Prescribing Competence & Practice: Implementing the National competency framework for all prescribers
Friday 1 December 2017
De Vere West one Conference Centre, London

Controlled Drugs Summit: Safe Use, Prescribing and Management
Monday 4 December 2017
De Vere West One Conference Centre, London

Nurse/Non Medical Prescribing in Cancer Care
Friday 15 December 2017 
De Vere West One Conference Centre, London

Electronic Prescribing In Hospitals: Moving Forward
Monday 15 January  2018
De Vere West One Conference Centre, London

Effective Nurse Prescribing in End of Life Care
Monday 26 February 2018 
De Vere West One Conference Centre, London

29 September 2017


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