PILOT STUDY OF NURSE PRESCRIBING PROJECT Neonatal Unit, Rotunda Hospital, 20042005'

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PILOT STUDY OF NURSE PRESCRIBING PROJECT
Neonatal Unit, Rotunda Hospital, 2004-2005.
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Two senior neonatal nursing staff were
authorised to prescribe ten specific
medications, following successful completion of
the formal training course provided by the Royal
College of Surgeons in Ireland,Ms. Christine
McDermott, Candidate Advanced Neonatal Nurse
Practitioner. Ms. Edna Woolhead, Candidate
Advanced Neonatal Nurse Practitioner. Draft
protocols written by the Nurse Prescribers and
approved by each of the members of the
authorisation group.
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PROTOCOL AUTHORISATION

• Medical Directors
• Professor Tom Clarke
• Professor Tom Mattthews
• Dr. David Corcoran
• Nursing Director
• Ms. Pauline Treanor
• Chief Pharmacist
• Ms. Anne Frankish

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ROTUNDA HOSPITALINDEX OF PROTOCOLS

• Caffeine
• Dextrose 10
• Dextrose 10 bolus
• Dopamine
• Frusemide
• Gentamicin Paediatric
• Heparin
• NaCl
• Penicillin
• Surfactant - curosurf

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Nurse/Midwife Clinical Decision-Making Audit Tool

• The medications were prescribed according to the
  agreed protocol
• 21 item Audit Form
• Audit sheet completed by mentors, two consultant
  neonatologists, and feedback provided to the
  prescribing nurse.

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DEFINITION OF ANP/AMP

• Advancecd nursing practice is carried out by
  autonomous, experienced practitioners who are
  highly competent, accountable and responsible for
  their own practice.
• They are highly experienced in clinical practice
  and are educated to masters degree level or
  higher.
• .
• ANPs/AMPs must have a vision of areas of
  nursing/midwifery practice that can be devloped
  beyond the current scope of nursing/midwifery
  practice and a commitment to the development of
  these areas.

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Being a consultant involves continuing
responsibilty for investigation and for treatment
of patients without supervision in professional
matters by any other personThe consultant may
discharge this responsibility directly , in the
exercise of his/her clinical judgement, he/she
may delegate aspects of the patients care to
other appropriate staff.Nothwithstanding this,
the unique position of the consultant in the
hospital requires that he/she carries continuing
responsibility for his/her patient so long as
they remain in his/her care. (Consultants
Common Contract)
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Feasibility of autonomous practice (in Ireland
elsewhere) may vary in different clinical
settings.Nurse Consultants in NHS (Tony Blair
1999) Expert practice Professional leadership
consultancy Education, training
development Practice Service
development (application of the role can vary
within the different contexts within which the
role is set)
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National Council Website

• ANP/AMP Clinically accountable to Senior
  Nurse/Midwufe Manager or another named
  professional member of the healthcare in the
  hospital setting
• Suggest consdieration should be given to adding,
  usually in the hospital setting this will be the
  responsible hospital consultant.

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Clinical Mentor Post Implementation Questionnaire
(12 questions)

• Potentially, more timely treatment ot patients
• Nurses professional skills more fully utilised
  with this model of prescribing
• Nursing, medical, pharmacy and microbiology staff
  collaborated readily there was no conflict !
• (The nurses in Rotunda had both qualified in 2001
  as Advanced Neonatal Nurse Practitioners, Course
  (A19) (English National Board for
  Nursing, Midwifery Health Visiting )
• Enables better use of experience and knowledge of
  the senior neonatal nursing staff involved.

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Increased turnover NCHDs recent years with more
structured training. ANNPs other senior nursing
staff maintain organisational knowledge.
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