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This chapter describes the development of non-medical prescribing across the different healthcare professional groups. Prescribing by community nurses is described and its expansion to include independent prescribing by other first-level registered nurses and later pharmacists and allied health professionals. Supplementary prescribing and how it is used is also outlined along with the educational preparation for the independent/supplementary prescribing role.
In the UK, the education and training landscape for healthcare students has changed considerably in the last few years. This is largely because of key governmental policies introduced in response to the wider workforce issue in the UK National Health Service. In this chapter, we discuss recent UK policies and standards relevant to non-medical prescribing and reflect on the potential implications they may have on the provision of future education and training for undergraduate and prescribing course providers and students. We also highlight opportunities for providers that will help future-proof programmes
Written by a group of multi-professional authors, this fully updated third edition builds on the success of this classic text. The book explores a number of key areas for prescribers, including prescribing within a multidisciplinary team context, consultation skills, ethical and legal issues surrounding prescribing, the psychology and sociology of prescribing, and applied pharmacology. Among the other topics featured are monitoring skills, medicines concordance, evidence based prescribing, prescribing within a public health perspective, calculation skills, prescribing in dermatology, and minimizing the risk of prescribing errors. Each chapter has been revised and additional chapters on antimicrobial prescribing, education and training to become a prescriber, and a new section on renal impairment have been added. This book is an essential resource for both new and experienced prescribers and anyone undertaking the non-medical prescribing (NMP) programme including nurses, pharmacists, allied health professionals and optometrists.
The introduction of non-medical prescribing has meant that nurses, pharmacists, allied health professionals and optometrists have had to expand their practice and so acquire new knowledge and skills in a number of fields. This new knowledge has had to be applied to the many issues surrounding prescribing in the practice setting. There are currently few books available that provide these prescribers with information to help them in this role. As the number of non-medical prescribers grows and as other healthcare professionals take on this role, the need for such information will increase. This book is aimed at those non-medical professions involved in prescribing medicines.
Chapter 1 provides a general overview of non-medical prescribing and describes the current education and training available for extended independent and supplementary prescribers. Chapters 2 to 5 examine non-medical prescribing within a multiprofessional team context, the different models of consultation that might be used by prescribers and the legal and ethical aspects surrounding prescribing. The psychology and sociology of prescribing, applied pharmacology and monitoring skills are explored in chapters 6 to 8. Chapters 9 to 12 deal with promoting concordance, evidence-based prescribing, prescribing within a public health context and the calculation skills required by prescribers. Chapter 13 describes how prescribing can be implemented for practitioners working in the area of dermatology. It is hoped that insights gained from this chapter can be applied to other practice settings.
The second edition of Independent and Supplementary Prescribing builds on the success of this classic text by providing a unique resource for prescribing and medicines management for both new and experienced prescribers. This is an essential resource for anyone undertaking the non-medical prescribing programme. The book explores a number of key areas for prescribers, including the ethical and legal issues surrounding prescribing, prescribing within a public health context, evidence-based prescribing, basic pharmacology, medication safety, monitoring skills and drug calculations. Each chapter has been updated for the second edition and an additional chapter 'Minimising the risk of prescribing error' has been added. Written by a group of multi-professional authors working at all stages of the medication management process, this book will be essential reading for all nurses, midwives, pharmacists and allied health professionals qualified to prescribe as independent and/or supplementary prescribers.
In 1986, recommendations were made for nurses to take on the role of prescribing. The Cumberlege report, Neighbourhood nursing: a focus for care (Department of Health and Social Security (DHSS) 1986), examined the care given to clients in their homes by district nurses (DNs) and health visitors (HVs). It was identified that some very complicated procedures had arisen around prescribing in the community and that nurses were wasting their time requesting prescriptions from the general practitioner (GP) for such items as wound dressings and ointments. The report suggested that patient care could be improved and resources used more effectively if community nurses were able to prescribe as part of their everyday nursing practice, from a limited list of items and simple agents agreed by the DHSS.
Following the publication of this report, the recommendations for prescribing and its implications were examined. An advisory group was set up by the Department of Health (DoH) to examine nurse prescribing (DoH 1989). Dr June Crown was the Chair of this group.
The following is taken from the Crown report:
Nurses in the community take a central role in caring for patients in their homes. Nurses are not, however, able to write prescriptions for the products that are needed for patient care, even when the nurse is effectively taking professional responsibility for some aspects of the management of the patient. However experienced or highly skilled in their own areas of practice, nurses must ask a doctor to write a prescription. It is well known that in practice a doctor often rubber stamps a prescribing decision taken by a nurse. […]
A medication safety incident is defined by the National Patient Safety Agency (NPSA) as:
‘any unintended or unexpected incident which could have or did lead to harm for one or more patients’ (NPSA, 2007:9).
These incidents can occur at each stage of the process involved in the delivery of medicines to patients, i.e. prescribing (including transcribing or physician ordering), dispensing, preparation, administering and monitoring (NPSA, 2007). Medication incidents have been reported as accounting for 10%–20% of all Adverse Events (AE) (Department of Health (DoH), 2004), i.e. an event that causes an unintended injury to a patient that either prolongs hospitalization or produces disability (Karson & Bates, 1999).
The impact of medication safety incidents on patient outcomes includes increased length of stay, disability and mortality (Vincent et al., 2001). Across the UK, about two and a half million medicines are prescribed across hospitals and the community every day (DoH, 2004) and an indicator of quality, adopted to demonstrate medication safety, is the incidence of medication errors (DoH, 2004). The Government has committed to reducing the incidents of medication errors in prescribed drugs by 40% (DoH, 2004).
Between January 2005 and June 2006, 60 000 medication incidents were reported to the NPSA via the National Reporting and Learning System (NRLS) (NPSA, 2007). Although most medicine-related activity is carried out in the community, over 80% of the incidents reported to the NPSA were from the hospital setting. The majority of these incidents (over 80%) did not result in harm.
The supply and administration of medicines is an area of practice in which a number of healthcare professionals (e.g. nurses, pharmacists and allied health professionals) are involved. Prescribing is a relatively new role which many of these healthcare professionals have adopted. Medication Safety focuses on promoting safety in the delivery of medicines. Chapters explore the various stages in the medication process including safety in prescribing, dispensing and administering drugs. Adverse reactions, parenteral administration, dosage calculations, safety with controlled drugs, and reporting errors and near misses are all addressed in evidence-based contributions from a highly experienced team of contributors. This text is essential reading for all healthcare professionals involved in the delivery of medicines to patients.