Developing the Supporting Structures for the Expanded Practice of Medication Management

1
Developing the Supporting Structures for the
Expanded Practice of Medication Management

• Anne-Marie Ryan
• Chief Education Officer, An Bord Altranais

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Objective of the Paper

• To explore regulatory issues for nurses and
  midwives underpinning safe and effective
  medication management practices.

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Regulation

• All those legitimate and appropriate
  means---governmental, professional, private, and
  individualwhereby order, identity, consistency,
  and control are brought to the profession. The
  profession and its members are defined the scope
  of practice is determined standards of education
  and of ethical and competent practice are set
  and systems of accountability are established
  through these means.

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Purpose of Regulatory Systems

• To protect the public
• To ensure the quality of services
• To inform the public about services from which to
  choose
• To foster the development of the profession
• To confer accountability, identity, and status
  upon the nurse

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REGULATION OF NURSING

• Purpose of An Bord Altranais
• provide for the registration, control and
  education of nurses and to provide for other
  matters related to the practice of nursing and
  the persons engaged in such practice
• (Nurses Act 1985)
• Functions
• Maintenance of a Register of Nurses (Part 3)
• Regulation of education and training of nursing
  and midwifery students and courses for nurses and
  midwives (Part 4)
• Fitness to practise function (Part 5)
• Guidance function (Part 5)

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SCOPE OF PRACTICE

• The scope of nursing/midwifery practice is
  defined as the range of roles, functions,
  responsibilities and activities, which a
  registered nurse/midwife is educated, competent,
  and has authority to perform in the context of a
  definition of nursing/midwifery. (ABA 2000 p. 3
  )

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COMPETENCE

• a complex mutidimensional phenomenon
• The ability of the registered Nurse to practice
  safely and effectively, fulfilling his/her
  professional responsibility within his/her scope
  of practice
• (An Bord Altranais 2000 14)
• regulated health care practitioners demonstrate
  their competence in the knowledge, judgement,
  technical skills, and interpersonal skills
  relevant to their jobs throughout their careers.
• (Pew Commission Taskforce on Health Care
  Workforce Regulation)

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Expanded practice

• competence at registration will change over time
  as roles and functions develop in response to
  many drivers affecting the provision of health
  care. It is not the nature of professional work
  to define it by tasks and skills. (UKCC 1999
  44)
• The extension of prescribing is intended to
  provide patients with quicker more efficient
  access to medicines to make the best use of
  nursing skills whilst ensuring that patient
  safety is paramount (DH 2002)

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Competencies for Collaborative Prescribing

• Professional/Ethical Practice
• Holistic Approaches to Care and Integration of
  Knowledge
• Interpersonal Relationships
• Organisation and Management of Care

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Safe and Effective Practice

• Requires a sound underpinning of theoretical
  knowledge that informs practice and is in turn
  informed by that practice.

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Education in Nursing
More likely to perform well contribute to the
health gain of the nation
Better educated the professional
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First Steps for ABA

• Review of the Guidance to Nurses and Midwives on
  Medication Management
• Guidance on Protocols
• Guidance and discussion on over-the-counter
  medications with HSE
• Develop Requirements and Standards for an
  educational programme in line with the pilot
  study and international education and the NQAI
  framework for the integration of the programme in
  existing post-graduate programmes
• Education for existing nurses to ensure public
  safety of nurses in medication management

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Key Challenges for Implementation

• Legislation
• Professional regulation
• Collaboration
• Educational infrastructure

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Closing remarks
Joined up leadership
Participation and buy in Collaborative practice

• Public Safety

Evolution and change