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Extended and Supplementary Prescribing
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Extended and Supplementary Prescribing. Supports modernisation in the NHS Vision for Pharmacy More staff, working differently NICE/CHAI Improving working.

Mar 27, 2015

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Page 1: Extended and Supplementary Prescribing. Supports modernisation in the NHS Vision for Pharmacy More staff, working differently NICE/CHAI Improving working.

Extended and Supplementary Prescribing

Page 2: Extended and Supplementary Prescribing. Supports modernisation in the NHS Vision for Pharmacy More staff, working differently NICE/CHAI Improving working.

Supports modernisation in the

NHS “Vision for Pharmacy” “More staff, working differently” NICE/CHAI Improving working lives Junior Hospital Doctors hours Working Time Directive Skill-mix

Page 3: Extended and Supplementary Prescribing. Supports modernisation in the NHS Vision for Pharmacy More staff, working differently NICE/CHAI Improving working.

Benefits of Supplementary Prescribing

Improved access Improved patient choice Greater flexibility for management of

patients Re-distribution of prescribing workload Improved job satisfaction for

supplementary prescriber Formalises some vicarious prescribing

that currently goes on

Page 4: Extended and Supplementary Prescribing. Supports modernisation in the NHS Vision for Pharmacy More staff, working differently NICE/CHAI Improving working.

Latest DoH position "We need to fundamentally transform the NHS by giving and

extending choice. Nursing and midwifery has a central part to play in this transformation because you are close to people - you listen to them and they listen to you. Patients must play a bigger role in their health care and your help is vital in helping them to learn how to manage their condition."

Mr Reid also announced that independent nurse prescribing would be expanded with the addition of a further 10 new medical conditions and more than 30 additional medicines to the list, which Extended Formulary nurse prescribers can prescribe. These conditions include acute attacks of asthma and animal and human bites. He also made clear that nurse prescribing would be further extended next year to include emergency care.

John Reid CNOs Conference 14/11/03

Page 5: Extended and Supplementary Prescribing. Supports modernisation in the NHS Vision for Pharmacy More staff, working differently NICE/CHAI Improving working.

Role of Extended and Supplementary

Prescribing Mode 1 and 2 prescribing

– Original legislation to allow health visitors and district nurses to prescribe from limited list

Extended prescribing for nurses– Allows independent prescribing from wider range

of products, but still doesn’t include all products Supplementary prescribing

– Very few limits to drugs that can be prescribed, but must be done in conjunction with independent prescriber and clinical management plan

Page 6: Extended and Supplementary Prescribing. Supports modernisation in the NHS Vision for Pharmacy More staff, working differently NICE/CHAI Improving working.

What is Supplementary

prescribing? “A voluntary prescribing partnership

between the independent prescriber and a supplementary prescriber, to implement an agreed patient-specific Clinical Management Plan with the patient’s agreement”.

The Supplementary Prescriber must be a Registered Nurse, Registered Midwife or Registered Pharmacist.

Coming soon – optometrists, physiotherapists, other AHPs

Page 7: Extended and Supplementary Prescribing. Supports modernisation in the NHS Vision for Pharmacy More staff, working differently NICE/CHAI Improving working.

Supplementary Prescribing

is not restricted SRx to specific clinical conditions

decision to introduce SRx arrangements for a specific patient will depend on agreement between the independent and the supplementary prescriber, and the patient

Page 8: Extended and Supplementary Prescribing. Supports modernisation in the NHS Vision for Pharmacy More staff, working differently NICE/CHAI Improving working.

Prescribing Partnerships

Voluntary Share responsibility Professionally accountable for own

decisions If responsibility moves from one

medical practitioner to another, the supplementary needs to forge new partnership

Page 9: Extended and Supplementary Prescribing. Supports modernisation in the NHS Vision for Pharmacy More staff, working differently NICE/CHAI Improving working.

Independent prescriber responsible for:

the initial clinical assessment of the patient and the formulation of a diagnosis,

the development of a written clinical management plan, in conjunction with the supplementary prescriber, following diagnosis

ensuring the clinical management plan is kept up-to-date

informing the supplementary prescriber of the limits of responsibility delegated to that supplementary prescriber

providing access to the patient’s record for the supplementary prescriber.

Page 10: Extended and Supplementary Prescribing. Supports modernisation in the NHS Vision for Pharmacy More staff, working differently NICE/CHAI Improving working.

Independent prescriber responsible for:

providing advice and support to the supplementary prescriber as required

carrying out a review of patient’s progress at appropriate intervals, depending on the nature and stability of a patient’s condition, or at the request of the supplementary prescriber, and normally not longer than 1 year from the initial assessment

resuming full responsibility for the patient’s care at the request of the supplementary prescriber

Page 11: Extended and Supplementary Prescribing. Supports modernisation in the NHS Vision for Pharmacy More staff, working differently NICE/CHAI Improving working.

Supplementary prescriber responsible for:

monitoring and assessing the patient’s progress as set out in the clinical management plan, and as appropriate to the medicines prescribed, including the reporting of any adverse reactions

contributing to the clinical management plan prescribing for the patient in accordance with

the agreed clinical management plan changing the medicine prescribed, within the

limits set out in the clinical management plan, if monitoring of the patient’s progress indicates that this is clinically appropriate

Page 12: Extended and Supplementary Prescribing. Supports modernisation in the NHS Vision for Pharmacy More staff, working differently NICE/CHAI Improving working.

Supplementary prescriber responsible for:

accepting clinical responsibility and professional accountability for their prescribing decisions and practice

working at all times within their clinical competence and their professional Code of Conduct, consulting the independent prescriber as necessary and particularly if a matter falls outside their own clinical competence.

Page 13: Extended and Supplementary Prescribing. Supports modernisation in the NHS Vision for Pharmacy More staff, working differently NICE/CHAI Improving working.

Supplementary prescriberresponsible for:

as soon as possible, and preferably contemporaneously, recording clinically relevant facts, including prescribing and monitoring activity, in the patient’s medical records.

referring prescribing responsibility back to the independent prescriber if the agreed clinical reviews are not carried out within the intervals specified in the clinical management plan or if monitoring of the patient’s progress indicates that this is appropriate

Page 14: Extended and Supplementary Prescribing. Supports modernisation in the NHS Vision for Pharmacy More staff, working differently NICE/CHAI Improving working.

Principles of SRx

there should be benefit to patients and the NHS

supplementary prescribing should support but not replace multi-disciplinary care

patient safety should be paramount prescribing and dispensing responsibilities

should, where possible, be separate in keeping with the principles of patient safety and governance.

Page 15: Extended and Supplementary Prescribing. Supports modernisation in the NHS Vision for Pharmacy More staff, working differently NICE/CHAI Improving working.

How can SRx be used in Practice?

Ongoing management of long-term conditions– Asthma, diabetes , hypertension, mental

health– Heart Failure, COPD

Management of out-patients– HRT clinic, renal patients, HIV/AIDs, anti-coag.

In-patient settings with predictable pathways– Nausea in oncology, post-operative pain

Page 16: Extended and Supplementary Prescribing. Supports modernisation in the NHS Vision for Pharmacy More staff, working differently NICE/CHAI Improving working.

The clinical management plan MUST

– specify the range of medicines that may be prescribed

– specify the range and circumstances within which the supplementary prescriber can vary the dosage, frequency and formulation of the specified range of medicines as appropriate.

– when to refer back to the independent prescriber– contain relevant warnings about any known

sensitivities of the patient to particular medicines – Include arrangements for the notification of any

adverse drug reactions.– Start date and review date (max 12 months)

Page 17: Extended and Supplementary Prescribing. Supports modernisation in the NHS Vision for Pharmacy More staff, working differently NICE/CHAI Improving working.

Before starting

The nurse or pharmacist must– successfully complete the specified training

and preparation for SRx – record their SRx competency on the relevant

professional register– agree with their employer that SRx should be

included in their job description.– make arrangements for Rx pads, prescribing

budget or other arrangements (e.g. patients’ prescription charts in hospitals)

Page 18: Extended and Supplementary Prescribing. Supports modernisation in the NHS Vision for Pharmacy More staff, working differently NICE/CHAI Improving working.

Training and preparation - nurses

consultation, decision-making, therapy and referral

influences on and psychology of prescribing

prescribing in a team context clinical pharmacology including the

effects of co-morbidity and recognition of potential adverse drug reactions

Page 19: Extended and Supplementary Prescribing. Supports modernisation in the NHS Vision for Pharmacy More staff, working differently NICE/CHAI Improving working.

Training and preparation - nurses

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.

Page 20: Extended and Supplementary Prescribing. Supports modernisation in the NHS Vision for Pharmacy More staff, working differently NICE/CHAI Improving working.

Managed Entry System

Single system for SW WDCs for application for training

All applications go to one place Ensures appropriate practitioners

are applying and training will be used in suitable situation

Can help to form networks of supplementary prescribers

Page 21: Extended and Supplementary Prescribing. Supports modernisation in the NHS Vision for Pharmacy More staff, working differently NICE/CHAI Improving working.

Process for ApplicationDecision that supplementary prescribing is necessary and appropriate

Fill in Application form and send to Project Team

Project Team consider applications and approve / advise where necessary

Approved applicants apply to university

Applicant undertakes supplementary prescribing training

Supplementary prescriber uses training. Project team provide support and links to prescriber networks

Page 22: Extended and Supplementary Prescribing. Supports modernisation in the NHS Vision for Pharmacy More staff, working differently NICE/CHAI Improving working.

www.prescribing.swest.nhs.uk

Page 23: Extended and Supplementary Prescribing. Supports modernisation in the NHS Vision for Pharmacy More staff, working differently NICE/CHAI Improving working.

Points to Consider

Availability of mentors Backfill Candidate ability to undertake

distance learning study Whether qualification will be used

after training Whether there are other ways to

fulfil the role e.g. PGDs

Page 24: Extended and Supplementary Prescribing. Supports modernisation in the NHS Vision for Pharmacy More staff, working differently NICE/CHAI Improving working.

Course providersCourse providers

PharmacistsPharmacists– BathBath

NursesNurses– GloucestershireGloucestershire– BournemouthBournemouth– PlymouthPlymouth– Oxford BrookesOxford Brookes– PlymouthPlymouth

Page 25: Extended and Supplementary Prescribing. Supports modernisation in the NHS Vision for Pharmacy More staff, working differently NICE/CHAI Improving working.

Further Information

All information can be found on the website

» www.prescribing.swest.nhs.uk» National information at

www.doh.gov.uk/supplementaryprescribing

Contacts– Kim Hogan – Avon, Gloucestershire, Wiltshire

» [email protected]

– Alaster Rutherford – Devon and Cornwall» [email protected]

– Danielle Gorman – Dorset and Somerset» [email protected]