THE EVOLUTION OF NONMEDICAL PRESCRIBING IN THE UNITED KINGDOM AND ITS POTENTIAL IMPACT ON HAEMOPHILI

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THE EVOLUTION OF NON-MEDICAL PRESCRIBING IN THE
UNITED KINGDOM AND ITS POTENTIAL IMPACT ON
HAEMOPHILIA SERVICE PROVISION.

• Angela Westoby
• St James University Hospital, Leeds. UK

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EARLY PRESCRIBING
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THE HISTORY

• 1986

• Recommendation for nurses to take on prescribing
  role

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THE HISTORY

• 1998

• DOH introduced the Nurse Prescribers formulary
  for District Nurses and Health Visitors in
  England.

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THE HISTORY

• 1999
• Crown Report recognized potential for extending
  nurse prescribing

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THE HISTORY

• 2002
• Nurse Prescribers Extended Formulary
• (extended again in 2003 and 2004)

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THE HISTORY

• Meanwhile back in 1999

• Suggestion of dependent
• or
• supplementary prescribing

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SUPPLEMENTARY PRESCRIBING

• A voluntary partnership between an independent
  prescriber (doctor/dentist) and a supplementary
  prescriber to implement an agreed patient
  specific Clinical Management Plan, with the
  patients agreement
• Very few restrictions about what can be
  prescribed within the CMP

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THE HISTORY

• 2003

• Supplementary prescribing training for nurses and
  pharmacists began

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THE HISTORY

• 1st May 2006
• PRESCRIBING POWERS EXTENDED
• ANY LICENCED MEDICINE FOR ANY MEDICAL CONDITION
• with the exception of some controlled drugs

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Standards of proficiency for nurse and midwife
prescribers

• Nursing and Midwifery Council UK regulatory
  body
• Standards and proficiencies for programmes of
  preparation
• Standard of conduct
• Within own level of competency

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THE TRAINING

• Within Approved Educational Institutions
• Minimum first degree level
• Students must undertake independent and
  supplementary elements of programme
• 26 days face to face contact time
• 12 days clinical practice time
• Additional self directed learning
• Completed within 1 academic year
• Distance learning min 8 days face to face

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ASSESSMENT

• Reflective portfolio demonstrating application of
  theory to practice
• OSCE
• Satisfactory completion of the period of practice
  
• 20 question short answer and multiple choice
  paper (pass mark 80)
• Numeracy test (pass mark 100)

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COURSE CONTENT

• Consultation, decision making and therapy
  including referral
• Influences on and psychology of prescribing
• Prescribing in a team context
• Clinical pharmacology including the effects of
  co-morbidity
• Evidence based practice and clinical governance
  in relation to nurse prescribing
• Legal, policy and ethical aspects
• Professional accountability and responsibility
• Prescribing in the public health context

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WHY US? WHY NOW?

• About time and why not?
• Nurses and allied health professionals

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THE GOVERNMENT VIEW

• Patricia Hewitt (Health Secretary in 2005/6) said
• Extending prescribing responsibilities is an
  important part of our commitment to modernise the
  NHS. By expanding traditional prescribing roles,
  patients can more easily access the medicines
  they need from an increased number of highly
  trained health professionals
• This is another step towards a truly patient led
  NHS, giving the patients power to choose where
  and by whom they are treated.

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BENEFITS FOR PATIENTS

• Timely access to treatment
• Speedier and more accessible service
• Sometimes easier to consult a nurse than a
  doctor-
• - Availability
• - Time to talk
• - Approachability

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BENEFITS FOR NURSES 1

• Provides New Opportunities
• To use and develop our skills
• To improve practice and knowledge base
• To manage whole episode of care and provide
  continuity
• To save time

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BENEFITS FOR NURSES 2

• Provides scope for-
• Professional and clinical advancement
• More nurse led services
• Greater job satisfaction

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EXAMPLE OF HAEMOPHILIA NURSE FORMULARY

• FACTOR CONCENTRATES
• DDAVP
• TRANEXAMIC ACID
• ANALGESIA
• VACCINES
• HEPATITIS C TREATMENTS
• ANTI RETROVIRALS
• SUPPORTIVE THERAPY
• e.g. ANTI-EMETICS, ANTI-HISTAMINES

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CAUTIONARY POINTS

• Change in team dynamics

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POINTS TO CONSIDER

• Expectations or pressure from others
• Awareness of own level of competence
• Accountability
• Development of nurse prescribing policies within
  organisations
• Clarification of insurance
• Review of job descriptions
• Continuing Professional Development

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WINDOW OF OPPORTUNITY
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THE FUTURE

• The future is bright the future is nurse
  prescribing!