Non- medical Prescribing Policy

Transcription

1 Non- medical Prescribing Policy February 2010

2 Policy Title: Non-medical Prescribing Policy Policy Reference Number: Acute10/005 Implementation Date: February 2010 Review Date: February 2012 Responsible Officer: Anne Friel, Head of Pharmacy and Medicines Management 2

3 Contents Introduction Policy Objectives Policy Scope Independent versus Supplementary Prescribing Definition of Independent Prescribing Definition of Supplementary Prescribing Categories of individuals who may prescribe Application Process Trust Approval Admission criteria to prescribing programmes Designated Medical Practitioner Registration Process Trust register of non-medical prescribers Vicarious Liability Legal liability Guidance on Aspects of Prescribing Prescribing for Inpatients Community care setting Obtaining Prescriptions and Prescription Security Patient assessment and information Record keeping Separation of prescribing, administering, dispensing process Prescribing for self, family and friends Review of prescribing Guidance on prescribing unlicensed medicines Guidance on prescribing medicines ( off-label ) Guidance on prescribing Controlled Drugs (CDs) Transcription of medicines kardex Discontinuing medication Adverse drug reactions Incident reporting Pharmaceutical Industry Verification of prescribing status Governance Arrangements and Continuing Professional Development Governance arrangements for NMP Continuing Professional Development Buddying /mentor post qualification Audit Page

4 Contents continued Page Appendices 1. Admission to the nurse independent supplementary prescribing programme 2. Admission to the pharmacist independent prescribing programme 3. Application form to enrol on a non-medical prescribing course 4. Application for inclusion on the Western Health and Social Care Trust Register of non-medical prescribers 5. Obtaining prescription pads process for registration of non-medical prescribers with Business Services Organisation (BSO) 6. Notification of nurse prescriber: Community practitioner nurse prescriber 7. Notification of nurse prescriber: Independent / supplementary nurse prescriber. 8. Controlled Drugs which nurse Independent prescribers are authorised to prescribe under The Misuse of Drugs Regulations (Northern Ireland) Useful reference sources for non-medical prescribers 10. Clinical management plan template

5 Introduction It is Department of Health, Social Services and Public Safety (DHSSPS) policy to extend prescribing responsibilities to non-medical prescribers (NMPs). This policy initiative is designed to: Improve patient care without compromising patient safety Make it easier for patients to get the medicines they need Increase patient choice in accessing medicines Make better use of the skills of health professionals Contribute to the introduction of more flexible team working across Health and Social Care Services. Policy Objectives. This policy sets out a framework for the development and implementation of non-medical prescribing (NMP) within the Western Health and Social Care Trust (WHSCT). It provides guidance on prescribing standards and continuing professional development for practitioners as well as describing trust governance arrangements to oversee this process. The policy has been produced to: Advise potential applicants on their eligibility to undertake an approved prescribing programme of training. Identify professional and statutory obligations which must be met. Provide robust standards for non-medical prescribing within the Trust. Clarify accountability and responsibility. Outline how the trust will monitor the standard of NMP. Outline how non medical prescribers can maintain their competency. Where the term nurse is used throughout the remainder of this document it includes midwives and specialist community public health nurses. Policy Scope. This policy refers specifically to how NMP will be managed within the WHSCT. Present legislation allows only the following groups of healthcare professionals to act as independent or supplementary prescribers following successful completion of an approved prescribing programme. Registered nurses (first level) Registered specialist community public health nurses/specialist Registered midwives Registered pharmacists Registered optometrists 5

6 In addition the following group of professionals may act as supplementary prescribers providing they have successfully completed an approved prescribing programme: Physiotherapists Radiographers Podiatrists/chiropodists This policy therefore applies only to the above professional groups but will be updated in line with legislation as other professional groups gain NMP status. 6

7 Independent versus Supplementary prescribing As outlined above non-medical prescribers may practise as a supplementary or independent prescriber or in some cases both. Definition of Independent prescribing The working definition of independent prescribing is prescribing by a practitioner (e.g. doctor, dentist, nurse, pharmacist and optometrist) responsible and accountable for the assessment of patients with undiagnosed or diagnosed conditions and for decisions about the clinical management required, included prescribing. Within medicines legislation the term used is appropriate prescriber Definition of Supplementary prescribing Supplementary prescribing is a voluntary prescribing partnership between an independent prescriber (doctor or dentist) and a supplementary prescriber, to implement an agreed patient specific clinical management plan (CMP) with the patient s agreement. A CMP template is enclosed in the appendices of this document. Categories of individuals who can prescribe Nursing Nurse Independent Supplementary Prescribers (NISPs) (formerly extended independent and supplementary nurse prescribers) these are nurses who are able to prescribe any licensed medicine for any medical condition including some controlled drugs. More detailed information is provided in the British National Formulary (BNF). Community Practitioner Nurse Prescribers (CPNPs) (formerly District nurse/ Health Visitor prescribers). These are nurses who can prescribe from the Nurse Prescribers Formulary for Community Practitioners. Community Practitioner Nurse Prescribers must only prescribe items listed within the Nurse Prescribers Formulary for Community Practitioners as outlined in the Northern Ireland Drug Tariff Pharmacists Pharmacist Independent Prescribers can prescribe similarly to Nurse Independent Prescribers, but currently cannot prescribe any Controlled Drug (CD) independently. Pharmacist supplementary prescribers can prescribe any medicine under a CMP in partnership with an independent prescriber (doctor or dentist). Allied Health Professionals (AHPs) AHP supplementary prescribers will be able to prescribe all medicines with the exception of Controlled Drugs under a CMP. 7

8 Application Process All entrants to NMP training courses funded by DHPSS must fulfill both trust and academic institution entry criteria before successfully enrolling on a prescribing programme. Trust Approval It is essential the applicant has the support of the trust to enroll on a prescribing programme. This will help to ensure that: There is a locally agreed need for them to prescribe Once qualified they can commence their prescribing role immediately They will have access to continuing professional development (CPD) They will work within a robust clinical governance framework They will receive support during their training The trust application form to enroll on a NMP course is detailed in the appendices of this document. Admission criteria to the Nurse Independent Supplementary Prescribing Programme. The admission criteria checklist is outlined in the appendices of this document. Further information can be found at the following links; (follow link for schools, Nursing and midwifery, postgraduate courses) (follow link for faculty, Life and Health Science, Nursing/Midwifery, course) Admission criteria to the Community Practitioner Nurse Prescribing Programme. At present the nurse prescribing programme is integrated (three-day course) into the BSc (Hons) / PG Diploma Community and Public Health Nursing. Admission criteria to the Pharmacist Independent Prescribing Course. The admission criteria checklist is outlined in the appendices of this document. Further information can be found at the following link 8

9 Admission criteria to optometrist supplementary/independent prescribing programme. Courses are available for optometrists to train as supplementary and independent prescribers. For more information go to the General Optical Council website It will be necessary to confirm that the relevant legislation which has been passed in England has also been enacted in Northern Ireland before optometrists undertake prescribing programmes. Admission criteria for AHP supplementary prescribing programme. The University of Ulster has developed a Supplementary prescribing Programme for AHPs and subject to accreditation will commence delivery in Semester One Admission criteria will be available once the course particulars will be released. Work is ongoing to verify that the associated legislation has been enacted in Northern Ireland before AHPs begin to prescribe. Designated medical practitioner (DMP) All applicants wishing to undertake an independent/supplementary prescribing programme must have a named designated medical practitioner who will oversee practical aspects of training. The DMP must be a registered medical practitioner who: Has normally had at least three years recent clinical experience Is a specialist registrar, clinical assistant or consultant Has the support of the trust to act as a DMP Has experience or training in teaching and/or supervising in practise. DMPs have a critical and highly responsible role in educating and assessing the NMP and assuring competence in prescribing. This involves: Establishing a learning contract with the trainee Contribute to planning a learning programme which will allow the trainee opportunities to develop competency in prescribing Encouraging critical thinking and reflection Provide dedicated time and opportunities for the trainee to observe how the DMP conducts consultations Allowing opportunities for the trainee to carry out consultations and suggest clinical management and prescribing options, which are then discussed with the DMP Helping to ensure the trainee integrates theory with practice Taking opportunities to discuss clinical management using a random case analysis approach, when patient care and prescribing behaviour can be examined further Assessing and verifying that, by the end of the programme, the trainee is competent to assume the prescribing role. Further guidance entitled Training non-medical prescribers in practice- A guide to help doctors prepare for and carry out the role of designated medical practitioner is available via the following link: 9

10 Registration Process Trust register of non-medical prescribers Following successful completion of an approved prescribing programme a practitioner must register their prescribing status both with the respective professional body and the WHSCT before he or she begins prescribing. This enables the trust to keep a register of non medical prescribers which is an essential part of good governance arrangements. This register will be held by the Head of Pharmacy and Medicines Management. The process for registration is outlined below: On successful completion of the appropriate prescribing course the NMP must have their prescribing status recorded on the appropriate professional register. Acknowledgement of this will be required before registration as a NMP with the Trust. The non-medical prescriber must complete the application form for inclusion on the WHSCT register of non-medical prescribers and forward to the Head of Pharmacy and Medicines Management (appendix 4) Having received the appropriate documentation the Head of Pharmacy and Medicines management will arrange for the practitioners name to be entered on the trust register and issue a letter to the individual to authorise that he/she can prescribe as part of their role. The Head of Pharmacy and Medicines Management will assess the need for registration with BSO for purposes of obtaining a prescription pad. These individuals will prescribe from the identified non-medical prescribing budget and the Non- Medical Prescribing Co-ordinator will facilitate this process. 10

11 Vicarious Liability Where a non-medical prescriber is appropriately trained and qualified and prescribes as part of their professional duties within the parameters agreed and their name is included on the Trust register, the Trust is held vicariously liable for their actions. Legal liability NMPs are individually accountable to their professional body for this aspect of their practice, as for any other, and must act at all times in accordance with same. NMPs are advised to ensure that they have sufficient professional indemnity as recommended by their respective professional organisations or trade unions. In all settings job descriptions must state if prescribing is to be included in the prescriber s role. 11

12 Guidance on Aspects of Prescribing Prescribing for Inpatients. Within the hospital setting non-medical prescribers will prescribe on the relevant prescription form. In the majority of cases this will be the patients Medicine Prescription and Administration Record (medicine kardex). Community and Primary care Settings In community and primary care settings nurse prescribers will use the prescription form HS21(N). Nurses working in family planning clinics may prescribe using the same system as doctors in the clinic. Obtaining prescription pads Community practitioner nurse prescribers (district nurses and health visitors) will need to be registered with Business Services Organisation (BSO) to obtain a prescription pad. For other NMPs the Head of Pharmacy and Medicines Management will assess the need for the individual to have access to the non-medical prescribing budget depending on their individual role. The process for registration with BSO is outlined in the appendices of this document. Prescription Security For NMPs employed in community and primary care settings the security of prescription forms is the responsibility of both the prescriber and their employing organisation. Prescribers must ensure absolute compliance with the HSCB guidance on prescription pad security. Patient assessment and prescribing Non-medical prescribers can only prescribe for patients who they have assessed for care. Before writing a prescription the NMP should have assessed the patient and have knowledge of: Patient s full medication (this should include all prescribed and non-prescribed medication including over the counter and alternative remedies). Past medical history Allergy status Patient s current health status A thorough knowledge of the item to be prescribed, i.e. dosage, therapeutic action, side effects, and interactions, frequency of use. The current British National Formulary (BNF) or Nurse Prescribers Formulary (NPF) for reference The NMP should refer to the BNF / NPF or the first page of the WHSCT medicines kardex for guidance on prescription writing standards. 12

13 Patient Information The non-medical prescriber will explain to the patient: The dosage, frequency and method of administration. The common side effects. Any precautions they should take. What to do if they have any concerns or adverse reactions. How to store medicines safely. What to do with any left over medicines at the end of treatment. Record keeping In-Patient Setting The non-medical prescriber will record details of the prescribing and relevant consultation details into the patients medical notes at the time of prescribing. Community and Primary Care Setting In primary/community care the non-medical prescriber should agree the process for accessing medical records and recording prescriptions with the GP. If the non-medical prescriber is using computerised records he/she must ensure that they receive adequate and relevant training. Prescribers wishing to produce computer generated scripts should contact the Non-medical Prescribing Co-ordinator in the first instance. Where there is no direct access to the GP records, the prescriber will ensure: Written documentation of prescription is sent to the practice manager or an agreed designated member of staff at the GP practice at time of writing (in exceptional circumstances this may be extended to 48 hours). The duplicate copy pad may be used to facilitate this process. These are available from the Non-medical Prescribing Co-ordinator. This designated member of staff at the GP practice will be responsible for ensuring details of the prescription are entered on the prescribing section of the patient s electronic record. The record must clearly indicate: Date of prescription Name of Patient Name of prescriber and the category of prescriber Name of item prescribed, quantity, dose, frequency, and treatment duration. 13

14 Separation of prescribing, administering, dispensing process. Non-medical Prescribers must ensure separation of prescribing dispensing and administering activities whenever possible. In circumstances where the prescriber is involved in both prescribing and dispensing a patient/client s medication, a second suitably competent person must be involved in checking the accuracy of the medication provided. Prescribing for self, family and friends Non-medical prescribers must not prescribe any medicine for themselves. Neither should they prescribe a medicine for anyone with whom they have a close personal or emotional relationship, other than in exceptional circumstances. Review of prescribing Each prescription is regularly reviewed and is only re-issued to meet clinical need. Suitable provision for monitoring each patient/client s condition is in place for ensuring that patient/client s who need a further examination or assessment do not receive further prescriptions without being seen by an appropriate prescriber. Guidance on prescribing unlicensed medicines Unlicensed medicines are those medicines without a current marketing authorisation. Independent non-medical prescribers at present are not legally permitted to prescribe unlicensed medicines. They may however prescribe an unlicensed medicine as a supplementary prescriber as part of a CMP providing: The doctor or dentist and the supplementary prescriber, have agreed the plan with the patient in a voluntary relationship; The supplementary prescriber is satisfied an alternative licensed medicine would not meet the patient s needs; The supplementary prescriber is satisfied there is sufficient evidence base and/or experience to demonstrate the medicine s safety and efficacy for that particular patient; The doctor/dentist and the supplementary prescriber are prepared to take the responsibility for prescribing an unlicensed medicine and have agreed the patient s CMP to that effect; The patient agrees to a prescription in the knowledge that the medicine is unlicensed and understands the implications of this; The medicine chosen and the reason for choosing it, is documented in the CMP/clinical records. 14

15 Guidance on prescribing medicines for use outside the terms of their licence ( off-label ) Off-label prescribing describes the process were by a licensed medicine is prescribed outside the terms of its product licence. It is possible, under current legislation, for both independent and supplementary prescribers to prescribe off-label. However, in order to do so the practitioner should ensure that the following conditions are met: The practitioner is satisfied that there is sufficient evidence base and/or experience of using the medicine to demonstrate its safety and efficacy in these circumstances. Where the manufacturer s information is of limited help, the necessary information should be sought from another source; The practitioner has explained to the patient or carer in broad terms, the reasons why medicines are not licensed for their proposed use; The practitioner makes a clear, accurate and legible record of all medicines prescribed for the patient and the reasons for prescribing a medicine off-label ; The prescribing of unlicensed and off-label medicines must be agreed as part of the parameters of prescribing section during the trust registration process (Appendix 4). Guidance on prescribing Controlled Drugs (CDs) Guidance on prescribing CDs is profession specific as well as the type of prescribing undertaken i.e. independent versus supplementary. Nursing: Nurse Independent Prescribers are authorised to prescribe some specific Controlled Drugs but these can only be prescribed for the medical conditions indicated in the Regulations. A list of these together with the relevant indication is provided in the appendices of this document. Nurse Supplementary prescribers acting under and in accordance with the terms of a CMP may be able, under that plan, to prescribe other CDs. In addition nurse prescribers who wish to prescribe CDs: Must have completed recognised Controlled Drug training, either through tutorial or online. Online training (which issues certificates) can be accessed at Must indicate to the trust that they will be prescribing CDs as part of their parameters of prescribing. This needs to be agreed by the line manager and Trust. 15

16 It is important to note that nurse independent prescribers may only prescribe as detailed above. There are a significant number of commonly used medicines which fall into schedules 3-5 of the Misuse of Drugs Regulations (Northern Ireland) 2002 and hence may not be independently prescribed. Some common examples include clobazam, clonazepam, nitrazepam, zolpidem and pholcodine. A comprehensive list of Controlled Drugs in Schedules 1-5 of the Misuse of Drugs regulations is available on the Home Office website Pharmacists: An independent pharmacist prescriber cannot prescribe any CD from any schedule of the Misuse of Drugs Regulations (northern lreland) A Supplementary Pharmacist Prescriber may prescribe a CD as part of a CMP. In addition Pharmacist Supplementary Prescribers who wish to prescribe CDs: Must have completed recognised Controlled Drug training, either through tutorial or online. Online training (which issues certificates) can be accessed at Must indicate to the trust that they will be prescribing CDs as part of their parameters of prescribing. This needs to be agreed by the line manager and trust as part of the Trust registration process. (Appendix 4) Allied Health Professionals Currently AHPs are not permitted to prescribe any Controlled Drugs as part of supplementary prescribing arrangements. Transcription of Medicines Kardex Transcription of a medicines kardex should only be carried out in line with recommendations from relevant professional practise standards. Discontinuing Medication Non-medical prescribers may discontinue medication if they have assessed a patient and in their clinical judgement think this is the best course of action for the patient. Non-medical Prescribers should always consider themselves part of the team and not undertake actions without considering the prescribing actions of others. Details of any discontinued medications should be recorded in the patients medical and or nursing records stating 16

17 Name and dose of medication discontinued Why the medication was discontinued Adverse drug reactions Adverse drug reactions are reported to the Medicines and Healthcare products Regulatory Authority (MHRA) via the Yellow Card Scheme. The electronic Yellow Card, together with instructions on how to use it, is available at alternatively non-medical prescribers can use hard copy Yellow Cards which can be found at the back of the BNF. Incident reporting Non-medical prescribers must act in accordance with the Trust s adverse incident / untoward incident policy. Pharmaceutical industry Non-medical prescribers need to be familiar with, and comply with Trust guidelines and professional standards relating to working relations with the pharmaceutical industry. Verification of Prescribing Status Both pharmacists who dispense and nurses who administer medicines under the direction of a non-medical prescriber must satisfy themselves that the prescriber is qualified. A central register including specimen signatures will be held by the Head of Pharmacy and Medicines Management for the trust. This register will be available to view online if there is any doubt as to the prescribing status of the practitioner. It is essential for the practitioner to introduce themselves to relevant senior staff if they find themselves working in a new environment. This will allow the practitioner to clarify their position and allow senior staff to communicate this appropriately within the environment. 17

18 Governance arrangements and Continuing Professional Development (CPD) Governance arrangements for NMP. The trust has set up a non-medical prescribing working group to manage and monitor the implementation of non-medical prescribing within the WHSCT. It will feed into the Drug and Therapeutic sub-group and provide assurance that appropriate governance arrangements are in place in line with legislation and DHSSPSNI guidelines. The key areas of focus for the group are: 1. Production of a Trust Non-Medical Prescribing Policy which will: List criteria for the selection of practitioners to become NMPs Outline training requirements Outline audit and governance requirements 2. Supporting Directorates in the development of a strategic plan for the use of non-medical prescribing within the Trust, to include independent prescribing by nurses, pharmacists and other healthcare professionals. 3. Setting up and managing a Trust register of non-medical prescribers which will include guidance on commencement of non-medical prescribing 4. Providing audit criteria to support the audit of non-medical prescribing practice within the Trust, including access to clinical supervision and continuing professional development 5. Providing regular information to the Trust s Drug and Therapeutics Sub-group including new applications to the Trust NMP register, and scope of practice Continuing Professional Development Non-medical prescribers will be expected to ensure continuous professional development and to keep up to date with evidence and best practice in the management of the conditions for which they prescribe, and in the use of relevant medicines. Non-medical prescribers must be provided with the opportunity to access continuing professional development on completion of the relevant programme. The non-medical prescriber must discuss learning needs and provide evidence of learning and development as a prescriber, as part of the appraisal process. The National Prescribing Centre (NPC) ( has produced the following documents which may be used as a tool to reflect on practice and identify CPD needs. 1. Maintaining Competency in Prescribing: an outline framework to help nurse prescribers 18

19 2. Maintaining Competency in Prescribing: an outline framework to help pharmacist prescribers The DHSSPSNI has made strong recommendations that healthcare professionals need to develop their competencies in the areas of management of Controlled drugs and medication related patient safety. The Department in collaboration with the Northern Ireland Centre for Pharmacy Learning and Development (NICPLD) have produced comprehensive guidance on these subjects which can be studied in both e-learning and hard copy format. The e-learning site can be found at and is free to access. As already described it is a prerequisite for practitioners wishing to prescribe controlled drugs that they undertake the Controlled drugs in clinical practice module. The non-medical prescribing working group will organise events for non-medical prescribers which will help further develop competency and share experiences with peers. 3. A list of useful documents and websites which will enhance CPD can be found in the appendices of this document. Buddying /mentor post qualification Support from other professional colleagues is invaluable to non-medical prescribers, especially to those who are newly qualified. The non-medical prescribing group will work towards developing a buddying/mentoring by an expert in field network within the Trust. In addition to this the Trust will work toward developing profession specific clinical supervisors for nonmedical prescribers who are themselves experts in their respective fields. Audit Review of non-medical prescribing is part of the overall prescribing monitoring arrangements. In primary and community care BSO prescribing information is available. The non-medical prescribing working group will establish audit criteria to inform the Trust on uptake and the range of non-medical prescribing. As for any professional it is essential that non-medical prescribers audit their own work as a means of improving the quality of care they provide to patients 19

20 Appendix 1 Admission to the Nurse Independent Supplementary Prescribing Programme (criteria checklist) Admission criteria checklist ref NMC standards Registered first level nurse, midwife and/or specialist community public health nurse At least three years experience. The year immediately preceding application must have been in the clinical field in which the applicant intends to prescribe The nurse has been identified through Individual Performance Review/ Appraisal, the suitability to prescribe before they apply for a training place. The applicant is in a role that enables them to prescribe Criteria met Y/N The prospective candidate must either be deemed competent in Health Assessment by his/her professional lead and has successfully undertaken a relevant module in Health Assessment.* Demonstrated ability to study at degree level through: 1. Undergraduate level (60 credits) Successful completion of three modules (60 credits) of study at level 2 with a mark of at least 50%. This will include evidence of the skills necessary for the implementation of evidence based practice Or 2. Postgraduate level Pre-registration degree in Nursing or Midwifery Post-registration degree in Nursing, Midwifery or Health Studies/ Sciences Degree in any other relevant subject area. In addition written confirmation will be required from The employer of their support for the nurse to undertake the preparation programme A designated medical practitioner who meets eligibility criteria for medical supervision of nurse prescribers, and who has agreed to provide the required term of supervised practice. 20

21 * The Health Assessment module for prescribing will be offered concurrently with the NISP programme for approximately the first two years of the new programme (commencing autumn 2007). After that students will be expected to have evidence of successful completion of the relevant Health Assessment module in advance of the programme. Appendix 2 Admission to the Pharmacist Independent Prescribing Programme (criteria checklist) Admission criteria checklist Registered pharmacist Criteria met Y/N At least two years experience practicising as a pharmacist in a clinical environment in a hospital setting, following their preregistration year after their graduation. The pharmacist has been identified through Individual Performance Review/ Appraisal, the suitability to prescribe before they apply for a training place. The applicant is in a role that enables them to prescribe Demonstrated ability to study at degree level In addition written confirmation will be required from The employer of their support for the pharmacist to undertake the programme A designated medical practitioner who meets eligibility criteria for medical supervision of pharmacist prescribers, and who has agreed to provide the required term of supervised practice. 21

22 Appendix 3 Application form to enrol on a non-medical prescribing course First Name Surname Job Title Year of Registration Current role and current clinical area Please state relevant work experience. Registration Number (Essential criteria: Minimum of 3 years clinical experience with at least one of these within the area in which you intend to prescribe) Please state proposed prescribing role and patient group/s Indicate any specialist qualifications you may hold with respect to proposed clinical role. Name of Designated medical practitioner. Signature of Applicant:. Date. Signature of Designated medical practitioner Date. Signature of Line Manager Date. Signature of Clinical Lead.Date.. Managers should send the completed application form to: 22

23 Nursing: Professional Lead Nurse for relevant Directorate Pharmacy: Head of Pharmacy and Medicines Management, Allied Health professionals: Manager of AHP services Appendix 4 Application for inclusion on the Western Health and Social Care Trust Register of non-medical prescribers Initials Hospital / Base REGISTRATION DETAILS NMC Pin No. / Pharm Soc Reg No/ Current NMC expiry date. Date of registration as a prescriber... (please include copy of verification from professional body that applicant is registered as a prescriber) Type of prescriber: Community Practitioner Nurse prescriber V100 Nurse Independent /supplementary V300 Pharmacist independent prescriber Pharmacist supplementary prescriber Other: Surname Job Title FOR OFFICE USE ONLY Verification of prescribing status 1. Copy of NMC Statement of Entry attached 2. Copy of certificate of completion of pharmacist independent prescribing course attached Signature Date PARAMETERS OF PRESCRIBING (ONLY TO BE COMPLETED BY INDEPENDENT / SUPPLEMENTARY PRESCRIBERS) Therapeutic area Groups of drugs to be prescribed (alternatively list exceptions) Nature of prescribing (independent / supplementary prescribing) Evidence based prescribing state local / national guidelines Experience / training to enable delivery of service 23

24 Will prescribing include prescribing of medicines outside the terms of their product licence (offlabel) or prescribing of un-licensed medicines Yes / No If Yes, please specify: LOCATION (please delete as appropriate) Hospital in-patients Yes / No Primary Care / community Yes / No Hospital out-patients /interface Yes / No * * If Yes please provide more details PRESCRIPTION PAD Only non-medical prescribers prescribing in the community will be able to prescribe from the non-medical prescribing budget and therefore require a prescription pad from BSO Prescription pad required Yes / No If Yes please refer to the section on obtaining prescription pads - process for registration of Nurse Prescribers with Business Services Organisation (BSO) NOTIFICATION OF CHANGES Prescriber employment ends DATE 24

25 Prescriber details change (e.g. NAME as per professional registration Prescribing suspended by professional body Please sign appropriately Prescriber Name Block Capitals Date: Signature Professional Name Block Capitals Date: Lead / Manager Signature Clinical Lead for Name Block Capitals Date: service Signature Original to be kept by Professional Lead. Completed copy to be sent to Head of Pharmacy and Medicines Management for inclusion on the Trust s Prescribing Register. 25

26 Appendix 5 Obtaining prescription pads - process for registration of Non-medical Prescribers with Business Services Organisation (BSO) Nurse prescribers working in primary and community care need to be registered with BSO and the attached forms have been developed to enable this process and subsequently for prescription pads to be issued. Prior to the introduction of the non-medical prescribing budget nurse prescribers were registered via the registration database or via the paper registration forms. A new web-based system for registration is currently in development and in the interim the attached forms should be used for all registrations. Electronic registrations or Annex 4 forms can no longer be accepted by BSO. Notes for completion of the forms are outlined below and a summary of the entire process is provided overleaf. NOTES FOR COMPLETION Nurse Details The name provided here will be printed on the prescription form. The forename can be no more than 15 characters in length, the surname no more than 19 characters. Action Required These forms can be used to add or delete nurse prescribers from the BSO s register of nurse prescribers. The only change that can be made to the nurse s details using this form is change to the nurse s name. Authorisation of registration Please provide details in this section of the person s authorising registration. It is this person s responsibility to verify that the form is completely in full and the NMC status of the nurse prescriber has been confirmed. Registration and Delivery ID numbers should be entered from the list included in Appendix 1: Non Medical Prescribers Prescription Pad Delivery Details. Confirmation of completion of the registration process will be made by BSO via to the address provided in this section. Completed forms should be sent to Mark Nelson, Business Services Organisation, 2 Franklin Street, Belfast, BT2 8DQ 26

27 Summary of registration process Notification of Nurse Prescriber form completed (Community Practitioner Nurse Prescriber or Independent / Supplementary prescriber as appropriate) Form authorised by line manager Completed form sent to BSO (Mark Nelson, Business Services Organisation, 2 Franklin Street, Belfast BT2 8DQ) Confirmation of registration sent via to the address provided in Authorisation of Registration section of notification form This will provide details of nurse prescriber s prescription order number Prescription pad ordered from De La Rue Smurfit in writing or by fax. Prescription pad is delivered to Delivery address entered on the notification form. A signature to confirm receipt of the prescription pad will be required by the courier. The prescription pad should be handled in accordance with the Board s prescription security policy. Prescription pads should not be forwarded via the internal mail system. Prescription security proforma completed Prescription pad issued to the nurse prescriber 27

28 Appendix 6 NOTIFICATION OF NURSE PRESCRIBER: COMMUNITY PRACTITIONER NURSE PRESCRIBER Health and Social Care Trust Details Belfast Northern Southern South-Eastern Western Nurse Details (please complete in block capitals) Title Mr / Mrs / Miss / Ms (Please delete as appropriate) Forename _ Surname (max 15 characters) (max 19 characters) DOB / / NMC Pin Number NMC status Registration current Yes / No Nurse prescribing qualification V100 Yes / No Nurse type District Nurse Health visitor Action required Add name to registration database Delete name from registration database Amend nurse details currently on database The only change permitted is a change to the nurse s name other changes require the current registration to be deleted and the nurse to be re-registered - please specify details of change below, including cypher number if known Authorisation of registration Name Designation Nurse prescribing co-ordinator Line manager Registration ID number (see Appendix 1) Delivery ID number (see Appendix 1) I verify that the above information is correct and NMC status has been verified Name (please print ) Signature address Tel no For BSO use only Actioned by Date: Cypher number (for new registrations) 28

29 Appendix 7 NOTIFICATION OF NURSE PRESCRIBER: INDEPENDENT / SUPPLEMENTARY NURSE PRESCRIBER Health and Social Care Trust Details Belfast Northern Southern South-Eastern Western Nurse Details (please complete in block capitals) Title Mr / Mrs / Miss / Ms (Please delete as appropriate) Forename _ Surname (max 15 characters) (max 19 characters) DOB / / NMC Pin Number NMC status Registration current Yes / No Nurse prescribing qualification V300 Yes / No Nurse type (please enter one number only from the list below) 1 Community learning disability 10 Diabetes Nurse Specialist 2 Community mental health 11 Palliative care Nurse 3 District nurse 12 Cancer care nurse 4 Other 13 Continence nurse 5 Occupational health nurse 14 Stoma care Nurse 6 School nurse 15 Cardiac rehabilitation nurse 7 Community children s nurse 16 Asthma nurse 8 Midwives 17 Practice nurse 9 Health Visitor 18 Nurse Practitioner Action required Add name to registration database Delete name from registration database Amend nurse details currently on database The only change permitted is a change to the nurse s name other changes require the current registration to be deleted and the nurse to be re-registered - please specify details of change below, including cypher number if known Authorisation of registration Name Designation Nurse prescribing co-ordinator Line manager Registration ID number (see Appendix 1) Delivery ID number (see Appendix 1) I verify that the above information is correct and NMC status has been verified Name (please print ) Signature address Tel no For BSO use only Actioned by Date: Cypher number (for new registrations) 29

30 Appendix 8 Controlled Drugs which Nurse Independent Prescribers are authorised to prescribe under The Misuse of Drugs Regulations (Northern Ireland) 2002 Drug Buprenorphine Chlordiazepoxide Indication Transdermal use in palliative care. Treatment of initial or acute withdrawal symptoms caused by the withdrawal of alcohol from persons habituated to it. Codeine phosphate Co-phenotrope Diamorphine Diazepam Use in palliative care, pain relief in respect of suspected myocardial infarction or for relief of acute or severe pain after trauma, including in either case post-operative pain relief. Use in palliative care, treatment of initial or acute withdrawal symptoms caused by the withdrawal of alcohol from persons habituated to it, tonic-clonic seizures. Dihydrocodeine tartrate Fentanyl Lorazepam Midazolam Morphine Oxycodone Transdermal use in palliative care Use in palliative care, tonic-clonic seizures Use in palliative care, tonic-clonic seizures Use in palliative care, pain relief in respect of suspected myocardial infarction or for relief of acute or severe pain after trauma, including in either case post-operative pain relief. Use in palliative care 30

31 Appendix 9 USEFUL RESOURCES FOR NON-MEDICAL PRESCRIBERS The Department of Health Social Services and Public Services. The Department of Health The National Prescribing centre The Medicines and Healthcare products Regulatory Agency The National Patient safety Agency The Royal Pharmaceutical Society of Great Britain Northern Ireland Centre for Pharmacy Learning and Development Queens University Belfast University of Ulster Nursing and Midwifery Council National Electronic library for medicines 31

32 Appendix 10 CLINICAL MANAGEMENT PLAN Name of Patient: Number Patient medication sensitivities/allergies: Patient identification e.g. ID number, date of birth: Independent Prescriber(s): Supplementary prescriber(s): Condition(s) to be treated: Aim of treatment: Medicines that my be prescribed by SP: Preparation Indication Dose schedule Specific indications for referral back to the IP Guidelines or protocols supporting Clinical Management Plan: Frequency of review and monitoring by: Supplementary prescriber. Supplementary prescriber and independent prescriber. Process for reporting ADRs: Shared record to be used by IP and SP: Agreed by independent prescriber(s): Date Agreed by supplementary prescriber(s): Date Date agreed with patient/carer 32

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