Enhancing Skills and Leadership in Non-Medical Prescribing

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Developing your skills and
leadership as a prescriber
 
Dr. Q. Wang
Nurse Consultant Geriatrics
Trust Lead for Non-Medical Prescribing
 
                                                       05.10.2022
 
Support Non-Medical Prescribers (NMP) need
Developing your skills as a NMP
Scope of Practice and safe prescribing
Prescribing leadership-prescribing is integrated into
service development
Difference you can make to the service as a NMP
Case study-older people’s care
Objectives
 
Competency guidance-National prescribing competency
framework (RCP, 2021).
Local guidelines
Individual organisation’s NMP governance
Clinical support from multi-professionals
CPD support
 
The drive for developing NMP is to provide high quality,
patient-centred care where and when is needed within
constricted financial recourses (NHS England, 2014)
Support needed as NMPs
 
Trust Governance:
a)
Aims to ensure all NMPs are prescribing within the law,
with Trust approval, compatible with service
development, and provide benefits for patient care.
b)
Roles and responsibilities of NMPs; Designated
Prescribing Practitioners (DPPs); Heads of
Nursing(HoN), Divisional directors (DDs), NMP
committee.
c)
Process for qualifying as a NMP
d)
Accountability and professional Indemnity of NMPs
e)
Safe prescribing monitoring(audit)
Support needed as NMPs
 
NMP competency/confidence
Clinical supervision
Organisational factors
Developing skills as a NMP
 
Competency and confidence as a NMP
 
Qualifying ≠ Competence
Competence ≠ Confidence
Confidence ≠ Competence
Developing skills as a NMP
 
Self-awareness: strength/limitations ( within scope of
practice)
Team work: inter-professional and multi-professional
Updated Knowledge and skills
Shared learning
Accountability
Prioritise patient-centred care
Scope of Practice and safe
prescribing
 
Systemic support to integrate NMP into service
development
Appropriate NMP governance
Quality and safety of prescribing
Support for NMPs’ education and CPD
Robust clinical training for trainee NMPs
Responsibility as DPP/supervisor/assessor
Leadership to inspire and influence
Prescribing Leadership
 
The ability to prescribe enhances the roles of non-
medical workforce
Improve patient care through facilitating patients’
safety and treatment
Make a quicker and easier access for patients to get
the medicines they need, improve clinical output
Make difference through prescribing
 
87 Yrs, George
 
BG: A/w delirium, right sided abd pain radiates to his back; fast AF; AKI on
CKD; USS: cholecystitis.
 
PMH: Smoker 40/day for over 50 yrs
               CABG
               Gall stones
               CKD stage 3
               PAF
               TIA
               HTN
               AAA repair
Case study
 
SH: lives with wife, normally independent, mobile with a stick, still
drives.
 
DH: Ciprofloxacin/Metronidazole
            Clopidogrel
            Bisoprolol
            Simvastatin
            Morphine
            Heparin injection
            Omeprazole
            Ramipril
Case study
 
Surgical Plan: IVI 6 hourly; IV Abx; Further radiology
              investigations, pain control, HR control
 
Referred To COTE 3 days later: (despite inflammatory markers normalising, more confused, unwell)
 
EWS: 5 BP: 110/50
                    P: 150
                    RR: 24; SPO2:96% on 3 L O2
                    T:37.8
OE: bi-basal crackles; BLL oedema; breathless; HR:120.
BNP: 1350.
CxR: Bil Pleural effusion, consolidation RLL, Cardiomegaly
Echo: LVEF: 45% ( over 50% a yr ago)
ECG: fast AF
 
Diagnosis: Acute HF
 
 
Case study
 
COTE Plan (medication review
):
 
Stop Morphine
CHA2DS2-VASc Score (AF stroke risk): 5, needs coagulation
treatment (warfarin commenced)
Stop IVI, Fluid restriction 1.5L/day for 3 days
Furosemide 40 IV stat, followed by 40mg Po daily
Daily UEs, repeat Echo in 3months, COTE O.P follow up in 3
months.
 
 
Case study
 
Prescribing is a process
:
Sound knowledge & skills within specialty
Know the patient’s Hx, presentation, PE, interpretation of
laboratory tests/radiological examination results
Clear diagnosis
Management (phraseological/non-pharmacological)
Close monitor and organising follow up
 
Use prescribing framework as guideline
Work with the team
Patient-centred care
Conclusion
 
NHS England (2014). Five year forward review.
Accessed online at: 
www.england.nhs.uk
.
A competency framework for all prescribers (RPS,
2021). Online access (20.09.22):
https://www.rpharms.com/resources/frameworks/pre
scribing-competency-framework/competency-
framework
 
References
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Support and guidance for Non-Medical Prescribers (NMPs) in developing skills, leadership, and competence. Emphasis on scope of practice, safe prescribing, governance, and the impact on service development. Importance of clinical supervision, organizational factors, and prescribing leadership for high-quality, patient-centered care.


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  1. Developing your skills and leadership as a prescriber Dr. Q. Wang Nurse Consultant Geriatrics Trust Lead for Non-Medical Prescribing 05.10.2022

  2. Objectives Support Non-Medical Prescribers (NMP) need Developing your skills as a NMP Scope of Practice and safe prescribing Prescribing leadership-prescribing is integrated into service development Difference you can make to the service as a NMP Case study-older people s care

  3. Support needed as NMPs Competency guidance-National prescribing competency framework (RCP, 2021). Local guidelines Individual organisation s NMP governance Clinical support from multi-professionals CPD support The drive for developing NMP is to provide high quality, patient-centred care where and when is needed within constricted financial recourses (NHS England, 2014)

  4. Support needed as NMPs Trust Governance: a) Aims to ensure all NMPs are prescribing within the law, with Trust approval, compatible with service development, and provide benefits for patient care. b) Roles and responsibilities of NMPs; Designated Prescribing Practitioners (DPPs); Heads of Nursing(HoN), Divisional directors (DDs), NMP committee. c) Process for qualifying as a NMP d) Accountability and professional Indemnity of NMPs e) Safe prescribing monitoring(audit)

  5. Developing skills as a NMP NMP competency/confidence Clinical supervision Organisational factors

  6. Developing skills as a NMP Competency and confidence as a NMP Qualifying Competence Competence Confidence Confidence Competence

  7. Scope of Practice and safe prescribing Self-awareness: strength/limitations ( within scope of practice) Team work: inter-professional and multi-professional Updated Knowledge and skills Shared learning Accountability Prioritise patient-centred care

  8. Prescribing Leadership Systemic support to integrate NMP into service development Appropriate NMP governance Quality and safety of prescribing Support for NMPs education and CPD Robust clinical training for trainee NMPs Responsibility as DPP/supervisor/assessor Leadership to inspire and influence

  9. Make difference through prescribing The ability to prescribe enhances the roles of non- medical workforce Improve patient care through facilitating patients safety and treatment Make a quicker and easier access for patients to get the medicines they need, improve clinical output

  10. Case study 87 Yrs, George BG: A/w delirium, right sided abd pain radiates to his back; fast AF; AKI on CKD; USS: cholecystitis. PMH: Smoker 40/day for over 50 yrs CABG Gall stones CKD stage 3 PAF TIA HTN AAA repair

  11. Case study SH: lives with wife, normally independent, mobile with a stick, still drives. DH: Ciprofloxacin/Metronidazole Clopidogrel Bisoprolol Simvastatin Morphine Heparin injection Omeprazole Ramipril

  12. Case study Surgical Plan: IVI 6 hourly; IV Abx; Further radiology investigations, pain control, HR control Referred To COTE 3 days later: (despite inflammatory markers normalising, more confused, unwell) EWS: 5 BP: 110/50 P: 150 RR: 24; SPO2:96% on 3 L O2 T:37.8 OE: bi-basal crackles; BLL oedema; breathless; HR:120. BNP: 1350. CxR: Bil Pleural effusion, consolidation RLL, Cardiomegaly Echo: LVEF: 45% ( over 50% a yr ago) ECG: fast AF Diagnosis: Acute HF

  13. Case study COTE Plan (medication review): Stop Morphine CHA2DS2-VASc Score (AF stroke risk): 5, needs coagulation treatment (warfarin commenced) Stop IVI, Fluid restriction 1.5L/day for 3 days Furosemide 40 IV stat, followed by 40mg Po daily Daily UEs, repeat Echo in 3months, COTE O.P follow up in 3 months.

  14. Conclusion Prescribing is a process: Sound knowledge & skills within specialty Know the patient s Hx, presentation, PE, interpretation of laboratory tests/radiological examination results Clear diagnosis Management (phraseological/non-pharmacological) Close monitor and organising follow up Use prescribing framework as guideline Work with the team Patient-centred care

  15. References NHS England (2014). Five year forward review. Accessed online at: www.england.nhs.uk. A competency framework for all prescribers (RPS, 2021). Online access (20.09.22): https://www.rpharms.com/resources/frameworks/pre scribing-competency-framework/competency- framework

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