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Nurse/Non Medical Prescribing in Cardiology: News and Updates

This important national conference provided essential updates for current and aspiring nurse/non medical prescribers in cardiology and cardiovascular care.

Through national updates and practical case studies delegates had the opportunity to hear from expert speakers on how to develop and maintain prescribing competence and how to develop effectiveness in post qualification practice.

The conference included extended sessions focusing on developing your skills in nurse/non medical prescribing practice as well as case study sessions from specialist speakers in the areas of nurse/non medical prescribing in the management of arrhythmias, nurse/non medical prescribing for heart failure, nurse/non medical prescribing within a rapid access chest pain clinic and nurse prescribing in a cardiac prevention and rehabilitation programme.

They day concluded with a session on medicines optimisation and medicines adherence within the healthcare pathway of patients with cardiovascular disease

Speakers and presentations

National developments in nurse prescribing: Including policy practice and evidence

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

  • Developing confidence and competence in your ability to prescribe and compliance with the NMC Code for re-validation

Andrew Rideout Presentation

In his presentation Andrew Rideout stated: 

"NMC consultation closed last week, 2 broad areas, Pre-registration education for nurses and access to Nurse Prescribing training & how it will work in the future"

"Royal Pharmaceutical Society 'A Competency Framework for all Prescribers' is a very useful tool not just for education but to help with our practice. NMC suggesting this will replace current outdated guidance"

Andrew spoke about the significant change in the way you feel about your decision making from advising the Dr what to prescribe to signing your 1st prescription 

Andrew shared developments in Scotland such as Realistic Medicine and NAVVY

Andrew also suggested taking some time to Google 'Real Medicine' and decide are you able to do its 6 elements in your practice 

"Do we have the systems in place to support prescribers and stress related experiences, think we need to look at this"

Andrew raised in Q&A the point that Nurse training has been 3 years forever but we are now trying to cram more and more in, should we be looking at this?

Andrew Rideout Abstract:

This session will cover national developments in non-medical prescribing, developing confidence and competence in your ability to prescribe, and compliance with the NMC Code for re-validation.

National developments in non-medical prescribing

The NMC consultation on educational provision for non-medical prescribing closed on 14th September.  The NMC were consulting due to perceived changes in the needs of the population, and the way that care will be delivered in the future, and asked for responses on the following points:

  • Using the Royal Pharmaceutical Society’s Single Competency Framework (https://tinyurl.com/ycaa93el) as the basis for nurse and midwife prescribing proficiencies.
  • Replacing the designated medical practitioner role with a prescribing practice supervisor and assessor role.
  • Allowing completion of V150 qualification immediately after initial training.
  • Allowing completion of V300 qualification after one year post-qualification.
  • Removal of the Standards for Medicines Management.

Some of these suggestions will be discussed within the session.

There will also be a mention of current changes to prescribing status of various Allied Health Professions, and legislation surrounding the prescribing of controlled drugs.

Realistic Medicine (https://tinyurl.com/y76vul88) and Values BAsed Reflective Practice (https://tinyurl.com/ydduvmx2) are two approaches to healthcare that are changing the way all care, including prescribing, is being delivered, and these will be introduced.

Developing confidence in prescribing practice

There will then be feedback from a research study examining non-medical prescribing practice.  Non-medical prescribing has developed as a new nursing role over the last ten years. The numbers of non-medical prescribers, the breadth of their practice, and their contribution to overall prescribing activity continues to grow each year.  Prescribing is a complex task, and poor prescribing decisions pose a risk to both public and individual health. However, there is little evidence about the influences on non-medical prescribing decision making.

Therefore the study sought to answer the research question “What are the influences on non-medical prescribing decision making in acute care?” using Q-methodology.

Nineteen non-medical prescribers working in acute care settings in one Scottish NHS Board were involved in the study. They considered their prescribing decisions under three Conditions of Sort: general prescribing, prescribing antibiotics, and prescribing drugs that may cause dependence.

The study demonstrated that there are two categories of prescribers – ‘confident prescribers’ and ‘cautious prescribers’, and the two groups had different influences on their prescribing decision making. Confident prescribers based their prescribing on formal guidelines, but were sensitive to individual patient factors and needs, and could adapt their prescribing accordingly. Cautious prescribers were more likely to base their decisions on the advice of senior doctors, and were more likely to prescribe in a way that did not correspond to guidelines. In contrast to other areas of practice, intuition played a very small part in decision making for both groups. The teams within which prescribers worked were a significant influence on prescribing confidence and behaviour.

Compliance with the NMC Code

Finally there will be a discussion of governance around non-medical prescribing practice, and one approach to ensuring governance that can support evidencing compliance with the NMC Code, and contribute to revalidation.  The model of governance discussed has elements of competence, education, and supervision.  The prescribing traffic lights will be introduced, and the implications for practice and revalidation.

Andrew Rideout Biography:

Andrew Rideout works in Public Health, and as an Advanced Nurse Practitioner in Out of Hours/Unscheduled Care in Dumfries & Galloway – a remote and rural Health Board in south west Scotland.  Previously he worked as an ANP within the Emergency Department.  He is also co-chair of the Scottish Non-medical Prescribing Leads’ Group, and also a committee member for the Association for Prescribers.

His academic interests include aspects of prescribing including decision making and human factors in anti-microbial resistance, using both qualitative and quantitative methodologies, and reviews regularly for journals, and NIHR grant proposals.

EXTENDED SESSION: Nurse prescribing in Cardiology

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

  • Nurse/non medical prescribing for cardiology: where are we now?
  • what are nurse/non medical prescribers prescribing in cardiology?
  • the range of cardiology drugs prescribed and new products on the horizon
  • improving outcomes
  • issues and challenges around prescribing in cardiology

Jan Keenan Presentation

In her presentation Jan spoke of a colleague who said 'I don't prescribe much'. Even though not many new prescriptions you can be making numerous complex prescribing decisions. 

Jan also spoke of the adverse press about Statins is written about Statins in primary prevention. People do not understand difference to secondary prevention. 

Jan also spoke of spending increasing amounts of time in the chest pain clinic as it is becoming more and more complex. 

"As Nurse Prescribers we do not publish what we are doing, need to publish it"

"Lack of funding could limit growth in NMP"

"We can demonstrate that NMP is becoming a well-integrated and established means of managing conditions and improving access to medicines"

"Target achievement and secondary prevention with prescribing is very much on the ESC agenda at the moment"

Jan Keenan Biography:

Jan Keenan has extensive background in cardiac nursing, and for the last 27 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 she 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 has encounter 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 Jan feels it is an absolute privilege to meet nurses and allied health professionals with an interest in prescribing as part of advanced practice and take 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:

Nurse/Non Medical Prescribing for Pain
Friday 29 September 2017 
De Vere W1 Conference Centre, London

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

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

Nurse Prescribing Summit 2018
Monday 19 February 2018
De Vere West One Conference Centre, London


18 September 2017

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