Past, Present and Future An Exploration of Prescribing and Medication Management

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Past, Present and FutureAn Exploration of
Prescribing and Medication Management
2001-2006

• An Bord Altranais National Council for the
  Professional Development of Nursing and
  Midwifery
• Project Team Kathleen Walsh Denise Carroll

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Where have we been ...where are we going

• 4 year project examining
• Medication management, the prescribing process
• International prescribing practices of nurses
  midwives (Sweden, Australia, NZ, UK, US Canada)
  
• Research studies on nurse prescribing

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Project Activities
Guidance to Nurses Midwives on Medication
Management
Medication Management Seminars
Query Database for Medication Management
Needs Assessment Survey
Exploration of Need Survey
Pilot Sites for Collaborative Prescribing
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From the Project findings to...

• October 2005 - National Conference with Launch of
  the Report
• 5 Recommendations of the Reviewsupported by the
  Minister for Health and Children
• This move is in the interest of patients and I
  want to ensure that this happens in a way that
  makes the best use of the professionals working
  in the system. I support prescriptive authority
  for nurses in situations where it would mean
  greater accessibility and convenience for
  patients, where it would help community services
  and acute services and where it is safe.
• (DOHC Press release October 17 2005)

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Recommendation 1 Continuation of the Use of
Medication Protocols
Recommendation 2 Expansion of the Use of
Medication Protocols
Recommendation 3 Supply Administration of
Over-the- Counter Medications
Recommendation 4 Prescriptive Authority
Recommendation 5 Implementation of the
Recommendations Actions
Actions outline the requirements for legislation,
professional guidance and regulation and health
service responsibilities
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Project Implementation Phase 2005-2008

• An Bord Altranais National Council with 3 year
  project plan
• 5 key areas of development

Professional regulation
Education
Legislation
Professional development communication
Collaboration
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Legislation

• Irish Medicines Board
• (Miscellaneous Provisions) Act 2006

• Secondary Legislation to be drafted

DOHC Consultation on the Extension of
Prescriptive Authority to Nurses Midwives isto
inform the necessary regulations Other Acts and
Statutes may need to be amended (e.g Medicinal
Products (Prescription and Control of Supply)
Misuse of Drugs etc)
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Professional Regulation by An Bord Altranais
Rx

• Establishment of criteria for prescriptive
  authority regulations for professional practice
  continued competency
• What type of authority/model of practice will be
  legislated for?
• Consideration of individuals scope of practice
  and other variables

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Education for Prescribing
Rx

• An Bord Altranais is responsible for defining and
  
• maintaining the Requirements and Standards for
  Education
• Learning outcomes, competencies,
  syllabus/indicative content
• Awareness of international preparation and
  standards
• Typically at masters level
• UK has stand alone module
• Consideration of Irish needs and system e.g.
  nursing midwifery career pathways, health
  service reforms, structural supports needing to
  be developed w/i HSE, HEIs...

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Medication Protocol Use Supply Administration

• Clear legislative framework needed
• Structural framework clinical governance at
  national and local level
• Implementation plan
• Professional guidance by An Bord Altranais

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Collaboration

• DOHC- e.g. Nursing Policy Division, Medicines
  Division
• HSE Nursing Services Director, NMPDUs, CNEs,
  National Office of Quality Risk
• Other health care regulatory bodies Medical
  Council, Pharmaceutical Society of Ireland
• Higher education institutions
• Professional organisations and patient groups
• International nursing boards

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An Bord Altranais Guidance

• Revision of guidance document early 2007
• New additions for medication protocol use,
  OTCs, adverse events...

• Quarterly newsletter Scope of practice section
• Education Department ask a staff member
• Future learning/guidance tools for continued
  competency in development

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Professional Involvement and Communication

• Awareness Governmental and Professional
• Progression of legislation and government policy
  and national standards www.oireachtas.ie,
  www.dohc.ie, www.hse.ie
• Updates in ABA and NCNM newsletters websites
• Discussion and Collaboration with other members
  of health care team - medical practitioner/consult
  ant and pharmacist
• Educating patients clients of the expanded role
  of nurses in medication management

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Professional Development for Medication
Management

• Define what is needed for your scope of practice
  to meet patient need
• Prescribing, protocol use, organisational
  policies
• Examine evidence base practice
• National/international guidelines and clinical
  practice
• NICE National Institute of Clinical Excellence
  (UK)
• NZGG New Zealand Guidelines Group
• National Guideline Clearinghouse/Agency for
  Healthcare Research and Quality (US)
• National Health and Medical Research Council
  (AUS)
• Resources www.ismp.org, www.imb.ie,
  www.medicines.ie,
• www.npc.org.uk, WHO guide to good
  prescribing

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Thank you
Contact details for the Project Team Kathleen
Walsh kwalsh_at_nursingboard.ie 016398502 Denise
Carroll dcarroll_at_nursingboard.ie 01 6398557