MM05 Procedure for Non-Medical Prescribers

Transcription

1 Plicy Number MM05 This dcument has been reviewed in line with the Plicy Alignment Prcess fr Liverpl Cmmunity Health NHS Trust Services. It is a valid Mersey Care dcument, hwever due t rganisatinal change this FRONT COVER has been added s the reader is aware f any changes t their rle r t terminlgy which has nw been superseded. When reading this dcument please take accunt f the changes highlighted in Part B and C f this frm. Part A Infrmatin abut this Dcument Plicy Name MM05 Prcedure fr Nn-Medical Prescribers Plicy Type Bard Apprved (Trust-wide) Trust-wide Divisinal / Team / Lcality Actin N Change Minr Change Majr Change New Plicy N Lnger Needed Apprval As Mersey Care s Executive Directr / Lead fr this dcument, I cnfirm that this dcument: a) cmplies with the latest statutry / regulatry requirements, b) cmplies with the latest natinal guidance, c) has been updated t reflect the requirements f clinicians and fficers, and d) has been updated t reflect any lcal cntractual requirements Signature: Date: Part B Changes in Terminlgy (used with Minr Change, Majr Changes & New Plicy nly) Terminlgy used in this Dcument New terminlgy when reading this Dcument Include reference t Liverpl Cmmunity Services Part C Additinal Infrmatin Added (t be used with Majr Changes nly) Sectin / Paragraph N Outline f the infrmatin that has been added t this dcument especially where it may change what staff need t d Part D Ratinale (t be used with New Plicy & Plicy N Lnger Required nly) Please explain why this new dcument needs t be adpted r why this dcument is n lnger required Part E Oversight Arrangements (t be used with New Plicy nly) Accuntable Directr Recmmending Cmmittee Apprving Cmmittee Next Review Date

2 Plicy Number MM05 LCH Plicy Alignment Prcess Frm 1

3 Plicy Number MM05 SUPPORTING STATEMENTS This dcument shuld be read in cnjunctin with the fllwing statements: SAFEGUARDING IS EVERYBODY S BUSINESS All Mersey Care NHS Fundatin Trust emplyees have a statutry duty t safeguard and prmte the welfare f children and adults, including: being alert t the pssibility f child / adult abuse and neglect thrugh their bservatin f abuse, r by prfessinal judgement made as a result f infrmatin gathered abut the child / adult; knwing hw t deal with a disclsure r allegatin f child / adult abuse; undertaking training as apprpriate fr their rle and keeping themselves updated; being aware f and fllwing the lcal plicies and prcedures they need t fllw if they have a child / adult cncern; ensuring apprpriate advice and supprt is accessed either frm managers, Safeguarding Ambassadrs r the trust s safeguarding team; participating in multi-agency wrking t safeguard the child r adult (if apprpriate t yur rle); ensuring cntempraneus recrds are kept at all times and recrd keeping is in strict adherence t Mersey Care NHS Fundatin Trust plicy and prcedures and prfessinal guidelines. Rles, respnsibilities and accuntabilities, will differ depending n the pst yu hld within the rganisatin; ensuring that all staff and their managers discuss and recrd any safeguarding issues that arise at each supervisin sessin EQUALITY AND HUMAN RIGHTS Mersey Care NHS Fundatin Trust recgnises that sme sectins f sciety experience prejudice and discriminatin. The Equality Act 2010 specifically recgnises the prtected characteristics f age, disability, gender, race, religin r belief, sexual rientatin and transgender. The Equality Act als requires regard t sci-ecnmic factrs including pregnancy /maternity and marriage/civil partnership. The trust is cmmitted t equality f pprtunity and anti-discriminatry practice bth in the prvisin f services and in ur rle as a majr emplyer. The trust believes that all peple have the right t be treated with dignity and respect and is cmmitted t the eliminatin f unfair and unlawful discriminatry practices. Mersey Care NHS Fundatin Trust als is aware f its legal duties under the Human Rights Act Sectin 6 f the Human Rights Act requires all public authrities t uphld and prmte Human Rights in everything they d. It is unlawful fr a public authrity t perfrm any act which cntravenes the Human Rights Act. Mersey Care NHS Fundatin Trust is cmmitted t carrying ut its functins and service delivery in line the with a Human Rights based apprach and the FREDA principles f Fairness, Respect, Equality Dignity, and Autnmy

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5 Plicy Number MM05 Plicy Name Plicy Type Accuntable Directr Authr Recmmending Cmmittee Apprving Cmmittee Date Originally Apprved Nn Medical Prescribing Guidelines Trust Wide fr Lcal, Secure and Specialist LD Divisin ONLY Executive Directr f Nursing Senir Nurse Drugs and Therapeutics Cmmittee Executive Cmmittee May 2015 Next Review Date May 2018 This dcument is a valid dcument, hwever due t rganisatin change sme references t rganisatins, rganisatinal structures and rles have nw been superseded. FOR OFFICE USE ONLY (Wrk Stream submissin check) This dcument is cmpliant with current best practice guidance This dcument is cmpliant with legislatin required in relatin t its cntent What change has this dcument undergne in the plicy alignment prcess relating t the Suth Seftn Transactin? Nne X Minr Majr This is a new dcument This dcument has been reviewed and is n lnger required This is a Trust wide Plicy fr LOCAL, SECURE and SPECIALIST LD DIVISION ONLY. A Suth Seftn Cmmunity Divisin specific plicy has been recmmended fr adptin. Des this dcument impact n any ther plicy dcuments? Yes, if yes, which plicies are effected? Click here t enter text. N Signed: Date: MM05 Nn Medical Prescribing Guidelines 1

6 TRUST-WIDE CLINICAL GUIDELINES DOCUMENT Nn Medical Prescribing Guidelines Plicy Number: Scpe f this Dcument: Recmmending Cmmittee: Apprving Cmmittee: MM05 All Staff Drugs and Therapeutics Cmmittee Executive Cmmittee Date Ratified: May 2015 Next Review Date (by): May 2018 Versin Number: Versin 1 Lead Executive Directr: Lead Authr(s): Executive Directr f Nursing Senir Nurse TRUST-WIDE CLINICAL GUIDELINES DOCUMENT 2015 Versin 1 Quality, recvery and wellbeing at the heart f everything we d MM05 Nn Medical Prescribing Guidelines 2

7 TRUST-WIDE CLINICAL GUIDELINES DOCUMENT Nn Medical Prescribing Guidelines Further infrmatin abut this dcument: Dcument name Dcument summary Authr(s) Cntact(s) fr further infrmatin abut this dcument Published by Cpies f this dcument are available frm the Authr(s) and via the trust s website T be read in cnjunctin with Nn Medical Prescribing Guidelines The aim f these guidelines is t prvide a framewrk fr the implementatin f nn-medical prescribing within Mersey Care NHS Fundatin Trust. This prvides guidance fr supervisin f independent & supplementary prescribers, and ensures a service need has been clearly identified and that apprpriate practitiners are given access t training t becme registered nn-medical prescribers. Jayne Bridge Senir Nurse Telephne: Jayne.Bridge@merseycare.nhs.uk Mersey Care NHS FundatinTrust V7 Buildings Kings Business Park Presct Merseyside L34 1PJ Yur Space Extranet: Trust s Website All Mersey Care NHS FundatinTrust Medicine management plicies All Mersey Care NHS Fundatin Trust Mental Health act plicies Mersey Care NHS Fundatin Trust Cnsent t treatment plicy Mersey Care NHS Fundatin Trust handling f medicines This dcument can be made available in a range f alternative frmats including varius languages, large print and braille etc Cpyright Mersey Care NHS Fundatin Trust, All Rights Reserved Versin Cntrl: Versin Histry: Versin 1 Apprved March 2015 MM05 Nn Medical Prescribing Guidelines 3

8 SUPPORTING STATEMENTS this dcument shuld be read in cnjunctin with the fllwing statements: SAFEGUARDING IS EVERYBODY S BUSINESS All Mersey Care NHS Fundatin Trust emplyees have a statutry duty t safeguard and prmte the welfare f children and vulnerable adults, including: being alert t the pssibility f child/vulnerable adult abuse and neglect thrugh their bservatin f abuse, r by prfessinal judgement made as a result f infrmatin gathered abut the child/vulnerable adult; knwing hw t deal with a disclsure r allegatin f child/adult abuse; undertaking training as apprpriate fr their rle and keeping themselves updated; being aware f and fllwing the lcal plicies and prcedures they need t fllw if they have a child/vulnerable adult cncern; ensuring apprpriate advice and supprt is accessed either frm managers, Safeguarding Ambassadrs r the trust s safeguarding team; participating in multi-agency wrking t safeguard the child r vulnerable adult (if apprpriate t yur rle); ensuring cntempraneus recrds are kept at all times and recrd keeping is in strict adherence t Mersey Care NHS Fundatin Trust plicy and prcedures and prfessinal guidelines. Rles, respnsibilities and accuntabilities, will differ depending n the pst yu hld within the rganisatin; ensuring that all staff and their managers discuss and recrd any safeguarding issues that arise at each supervisin sessin EQUALITY AND HUMAN RIGHTS Mersey Care NHS Fundatin Trust recgnises that sme sectins f sciety experience prejudice and discriminatin. The Equality Act 2010 specifically recgnises the prtected characteristics f age, disability, gender, race, religin r belief, sexual rientatin and transgender. The Equality Act als requires regard t sci-ecnmic factrs including pregnancy /maternity and marriage/civil partnership. The trust is cmmitted t equality f pprtunity and anti-discriminatry practice bth in the prvisin f services and in ur rle as a majr emplyer. The trust believes that all peple have the right t be treated with dignity and respect and is cmmitted t the eliminatin f unfair and unlawful discriminatry practices. Mersey Care NHS Fundatin Trust als is aware f its legal duties under the Human Rights Act Sectin 6 f the Human Rights Act requires all public authrities t uphld and prmte Human Rights in everything they d. It is unlawful fr a public authrity t perfrm any act which cntravenes the Human Rights Act. Mersey Care NHS Fundatin Trust is cmmitted t carrying ut its functins and service delivery in line the with a Human Rights based apprach and the FREDA principles f Fairness, Respect, Equality Dignity, and Autnmy MM05 Nn Medical Prescribing Guidelines 4

9 CONTENTS 1 Purpse and Ratinale 5 2 Scpe 5 3 Definitins 5 4 Duties 7 5 Prcess/Prcedure 10 6 Cnsultatin 20 7 Resurce/Implementatin Issues 20 8 Mnitring 20 9 Supprting Dcuments 21 APPENDICES Page A Flwchart f applicatin prcess 23 B Nn-medical prescribing prpsal frm 24 C Nn-medical apprval t practice frm 31 D Declaratin f cmpetency 33 E Jb descriptin including prescribing rle 36 F Equality and Human Rights Analysis 37 MM05 Nn Medical Prescribing Guidelines 5

10 1 PURPOSE AND RATIONALE 1.1 The aim f these guidelines is t prvide a framewrk fr the implementatin f nn-medical prescribing within Mersey Care NHS Fundatin Trust. This prvides guidance fr supervisin f independent & supplementary prescribers, and ensures a service need has been clearly identified and that apprpriate practitiners are given access t training t becme registered nn-medical prescribers. This is t ensure that: The changes benefit service users and imprve access t medicines The prescribing practice is cmpatible with the service develpment plans f Mersey Care NHS Fundatin Trust and is an apprpriate extensin f a practitiner s rle All nn-medical prescribers are apprpriately qualified fr their rle and wrk within the agreed natinal and lcal plicies and within their scpe f practice. All nn-medical prescribers in training will receive regular supervisin frm a prescribing supervisr relevant t their field f practice (during training this must be a Dedicated Medical Practitiner. All nn-medical prescribers are supprted in their rle and have access t cntinuing prfessinal develpment. 1.2 Fllwing parliamentary apprval changes t enable nurse and pharmacist independent prescribing fr all licensed medicines except mst Cntrlled Drugs within their cmpetence came int effect n the 1 May This was amended t include unlicensed drugs and mst cntrlled drugs in These guidelines shuld be read in cnjunctin with the Trust's Medicine management plicies and it is essential that all staff that are currently practising, supervising r undertaking nn-medical prescribing training are cnversant with these guidelines. 2 SCOPE 2.1 These guidelines apply t all clinical staff. 3 DEFINITIONS 3.1 Table 1 n the fllwing page utlines the terms utilised thrughut this plicy and the definitin f these terms. MM05 Nn Medical Prescribing Guidelines 6

11 3.2 Table 1: Definitins Term Nn Medical Prescribing Independent Prescribing Definitin Nn-medical prescribing (NMP) relates t prescribing by prfessinal grups ther than dctrs r dentists wh have been granted prescribing rights fllwing the cmpletin f an NMP qualificatin. Nurse independent prescribers and pharmacist independent prescribers are registered nurses and pharmacists wh have successfully cmpleted the specific prgramme f preparatin laid dwn by the Nursing and Midwifery Cuncil (NMC) and the General Pharmaceutical Cuncil (GPhC). This nw als cvers Pdiatrist and Physitherapist independent prescribers (HCPC). They are able t prescribe any licensed and unlicensed medicines within their cmpetency frm the entire British Natinal Frmulary (BNF) with the exceptin f sme cntrlled drugs. An independent prescriber (IP) is a practitiner (dctr, nurse r pharmacist) respnsible and accuntable fr the assessment f service users with undiagnsed r diagnsed cnditins and fr decisins abut the clinical management required, including prescribing. Within medicines legislatin the term used is apprpriate practitiner (DOH 2006). Independent prescribing is ne element f the clinical management f a service user. It requires an initial assessment, interpretatin f that assessment, a decisin n safe and apprpriate therapy, and a prcess fr n-ging mnitring. The verall aim f this new way f wrking is t enhance service user s care by prviding a quicker and mre flexible access t healthcare by extending the rle and skill base f nurses and pharmacists. MM05 Nn Medical Prescribing Guidelines 7

12 Supplementary Prescribing Designated Medical Practitiner (DMP) Supplementary prescribing is a vluntary partnership between the designated medical practitiner (DMP) and a supplementary prescriber (SP) t implement an agreed service user specific clinical management plan (CMP) with the service users agreement. Practitiners wh are eligible t act as supplementary prescribers within Mersey Care NHS Fundatin Trust include nurses, pharmacists r apprved allied health prfessinals (AHP) wh have successfully cmpleted an apprpriate validated prescribing training prgramme that is registered with their prfessinal bdy. They are able t prescribe all medicines including cntrlled drugs, brderline substances and unlicensed medicines as lng as it is within their CMP and scpe f cmpetency. They may prescribe fr the full range f medical cnditins prvided that they d s under the terms f a service user specific CMP. In practice this will fllw a sequence invlving: the diagnsis by a dctr; agreement by the service user t be managed by a prescribing partnership; preparatin f a clinical management plan; and the management by the supplementary prescriber within the terms f the CMP. A designated medical practitiner is a dctr wh agrees t supervise NMPs thrughut their perid f learning and practice. 4 DUTIES 4.1 Bard / Lead Cmmittee Mersey Care NHS Fundatin Trust Drugs and Therapeutics Cmmittee will be respnsible fr the develpment, review, cnsultatin, implementatin, mnitring and apprval f the NMP guidelines. MM05 Nn Medical Prescribing Guidelines 8

13 4.2 Chief Executive The chief executive has delegated the clinical respnsibility fr the implementatin f nn-medical prescribing t the Executive Directr f Nursing. 4.3 Chief Pharmacist The Chief Pharmacist has crprate respnsibility fr all aspects f medicines management. The Chief Pharmacist is respnsible fr ensuring that NMP pharmacists act in accrdance with this plicy, and fr agreeing and authrising all NMP pharmacists persnal prescribing frmularies n the apprpriate frms. 4.4 Deputy Directr f Nursing The Deputy Directr f Nursing is respnsible fr ensuring that NMP Nurses act in accrdance with this plicy, and fr agreeing and authrising all persnal prescribing frmularies fr NMP Nurses n the apprpriate frms. 4.5 Divisinal Medicine Management Grups Divisinal Medicines Management Grup will identify the ptential fr nn-medical prescribing and will receive and apprve the NMP training apprval applicatin frm and be respnsible fr frwarding that t Mersey Care NHS Fundatin Trust NMP lead. They are als respnsible fr mnitring the practice f NMP s within their respective Divisins. 4.6 NMP CPD Frum This grup will meet quarterly and is respnsible fr prviding: CPD (cntinuing prfessinal develpment) sessins; pprtunities t raise any prfessinal prescribing practice issues; any internal and external updates fr NMP s. The grup is chaired and facilitated by the Deputy Directr f Nursing. 4.7 Trust Lead fr Medicine Management and NMP The Trust NMP lead is respnsible fr: Ensuring that all relevant infrmatin abut prescribing is cascaded t all NMPs within the rganisatin Maintaining an up t date database and register f all practising NMP s and their persnal frmularies Cllatin f BNF rders and distributin t all practising NMPs Ensuring that apprpriate healthcare prfessinals wh meet the criteria can access the curse Maintaining links with apprpriate statutry external rganisatins Chairing the NMP CPD grup Ensuring that CPD pprtunities are available fr all NMP`s within the rganisatin MM05 Nn Medical Prescribing Guidelines 9

14 Ensuring that all NMP applicatins and persnal frmularies are presented thrugh the Nn-medical prescribing apprval and mnitring panel C-rdinatin f an audit t meet internal and external bdies requirements. Prviding supprt t services when develping new prescribing rles 4.8 Divisinal Lead fr Nursing and Quality Respnsible fr identifying: Develpment f NMP within the Divisin 4.9 Managers Hw the implementatin f nn-medical prescribing can facilitate multi prfessinal service re-design, service develpment r refining service prvisin t meet service user need. Any pprtunities fr nn-medical prescribing when reviewing service develpments and where apprpriate integrate them int wrkfrce planning Managers are respnsible fr the mnitring f the daily prescribing activities f NMPs in relatin t their jb descriptin. They are als respnsible fr ensuring that systems are in place t facilitate prescribing practice including: 4.10 NMP s Ensuring the duties f the NMP are included in jb descriptins Facilitating access t a prescribing budget Prviding a lcked facility fr prescriptins Ensuring that NMPs are given the pprtunity t attend CPD fr maintaining their cmpetencies in line with their jb descriptin. Ensuring apprpriate clinical supervisin is in place fr NMP s Infrming the Trust NMP lead if an NMP leaves the Trust r there is cncern abut the prescribing practice f the NMP. Ensuring NMPs are cmpliant with any audit requirements. Ensuring that NMPs have an identified DMP during training and prescribing supervisr pst training NMPs are individually respnsible and accuntable fr their prescribing practice and must adhere t the medicines management plicies f Mersey Care NHS Fundatin Trust at all times. They are als respnsible fr: Nn-Medical Prescribing Plicy Ensuring that they prvide apprpriate, evidence based, safe, and cst effective prescribing t service users f Mersey Care NHS Fundatin Trust. MM05 Nn Medical Prescribing Guidelines 10

15 Adhere t their prfessinal cdes f cnduct such as the NMC Cde f Cnduct (2015) and nly practice within their wn level f cmpetence and apprved persnal frmulary. Ensuring that service users are made aware f their scpe f prescribing practice and their right t refuse treatment/prescribing by an NMP. Cmpleting an apprval t practice frm prir t prescribing medicatin within Mersey Care NHS Fundatin Trust. They are respnsible fr ensuring that this is agreed and signed ff by their line manager and prescribing supervisr, and then submitted t the NMP lead fr apprval at the NMP panel. Cmpletin f an annual declaratin f cntinued cmpetence t prescribe as part f the annual PDR prcess. Participating in annual audit f prescribing practice (appendix 6). 5 PROCESS / PROCEDURE 5.1 T be eligible t prescribe within Mersey Care NHS Fundatin Trust the NMP will be a first level registered nurse r a registered pharmacist wh has: Successfully cmpleted a validated prescribing training prgramme Their name recrded n the apprpriate prfessinal register A jb descriptin that includes the prescribing rle (appendix 5) Their name recrded n Mersey Care NHS Fundatin Trust s NMP register Access t apprpriate clinical and prescribing supervisin 5.2 Eligibility fr Nn-Medical Prescribing Training T be accepted fr entry nt the nn-medical prescribing prgramme the NMP applicant must have agreement f the service manager r line manager and be able t demnstrate that their pst is ne in which they will have the need and pprtunity t act as either an independent r supplementary prescriber. They must have cmpleted a NMP training apprval applicatin frm (appendix 3) and cmplete annual declaratin f cmpetency (appendix 4). 5.3 Nurses These are first level nurses registered with the Nursing & Midwifery Cuncil (NMC) wrking in a rle where there is a need t prescribe regularly as an independent prescriber frm an identified frmulary r as a supplementary prescriber in a pst where they will have the pprtunity t wrk in partnership with an independent medical practitiner using a CMP. MM05 Nn Medical Prescribing Guidelines 11

16 5.3.2 Nurses must have: 5.4 Pharmacists At least 3 years pst registratin clinical experience r part time equivalent, f which at least ne year immediately preceding their applicatin t the training prgramme shuld be in the clinical area in which they intend t prescribe. Be band 6 r abve t prescribe. An identified medical practitiner wh is willing t cntribute t and supervise 12 days f learning practice. Supprt frm their manager fr CPD as described in the plicy Prir cmpetencies in the therapeutic area/areas in which they will prescribe Pharmacists registered t practice with the General Pharmaceutical Cuncil (GPhC) in a pst where they will have the pprtunity t prescribe regularly as an independent prescriber frm an identified frmulary, r as a supplementary prescriber in a pst where they will have the pprtunity t wrk in partnership with a DMP using a CMP Pharmacists wrking as Independent Prescribers will practice in accrdance with this plicy when undertaking their prescribing rle. It shuld be recgnised hwever that as pharmacists, their scpe f practice will be extended in accrdance with the Rle f the Pharmacist as utlined in the Trust Medicine Management Plicy Pharmacists must have: 3 r mre years pst registratin experience 2 years pst registratin experience r part time equivalent in the field they are ging t prescribe in. A pst graduate qualificatin in mental health r equivalent experience in mental health An identified medical practitiner t cntribute t and supervise 12 days f learning practice Supprt frm their manager fr CPD Prir cmpetencies in the therapeutic area/areas in which they will be expected t prescribe. 5.5 Preparatin fr Independent/supplementary Prescribing fr Pharmacists/nurses A ttal f 26 days at a HEI ( higher educatin Institutin), this can be either face t MM05 Nn Medical Prescribing Guidelines 12

17 face r by pen learning, plus 12 supervised days in practice with a DMP is the requirement fr training. Successful cmpletin f the curse will lead t independent/supplementary prescriber anntatin t the register f the GPhC r NMC register. 5.6 Designated Medical Practitiners (DMP) All NMP students require the supprt f a DMP. The DMP shuld be identified and agreed prir t an applicatin being submitted t the NMP Lead. They must be a registered medical practitiner wh has had at least 3 years recent clinical experience and has the supprt f the emplying rganisatin. They must have sme experience f training in teaching and/r supervisin in practice and wuld nrmally wrk alngside the NMP student in everyday clinical practice. They must prvide dedicated time and pprtunities fr the student NMP t: Observe prescribing in actin Have in depth discussin and analysis f clinical management using real cases frm practice t enable prescribing behavir t be fully examined Learn by encuraging critical thinking and reflectin with the use f the student`s prfessinal prtfli r learning lg Carry ut cnsultatins and suggest clinical management plans and prescribing ptins which can then be discussed and agreed with the DMP Learn and practice in relatin t the medical cnditins and clinical speciality in which the NMP student is wrking Dctrs wh are t act as medical supervisrs can seek guidance n the expectatins required when perfrming this rle frm the Trust NMP lead, and prir t cmmencing the rle f DMP will receive details f the prgramme and learning utcmes. A DMP is nly required thrughut the duratin f training but all NMP s must have a suitably qualified prescribing supervisr identified pst training. 5.7 Applicatin prcess (appendix 1) The Trust will use 3 key principles t priritise ptential applicants fr NMP: Service user safety Maximum benefit t service users in terms f quicker and mre efficient access t medicines Use f prfessinal skills The service manager and the nminee fr the NMP curse will develp the case fr NMP within their service. NMP prpsal frm (Appendix 2) must be cmpleted by the service manager, DMP and NMP nminee and frwarded t the NMP lead fr the Trust wh will take the prpsal and cnsider if it can be supprted in practice Fllwing cnfirmatin f selectin fr the NMP curse by the NMP lead, the ptential NMP nminee will then cmplete and pass the nline numeracy assessment. Access t the nline numeracy assessment is via the NMP lead. Access t the applicatin packs t apply t the higher educatin institutes (HEI) shuld als be accessed frm the NMP lead. Cmpleted applicatin frms shuld MM05 Nn Medical Prescribing Guidelines 13

18 be returned t the NMP lead fr final apprval and signature. The NMP lead will then frward the applicatin frm t the chsen HEI and infrm the Trust Learning and Develpment Department An applicatin fr funding if applicable shuld be made thrugh the nline CPD apply system accessed thrugh the fllwing website: Nn Medical Prescribing Practice in Mersey Care NHS Fundatin Trust Once a nurse r pharmacist has successfully cmpleted the NMP curse, the HEI will infrm the relevant prfessinal bdy and the newly qualified NMP must supply a cpy f their qualificatin t their line manager and NMP lead. It is the respnsibility f the newly qualified NMP t register their qualificatin with their wn prfessinal bdy. The jb descriptin f a newly qualified NMP shuld be reviewed t reflect his r her prescribing respnsibilities in the scpe f practice. This is the respnsibility f the NMP and their line manager (appendix 3). NMP`s shuld nt cmmence prescribing until cntact is made with the NMP lead and an apprval t practice as an NMP frm is cmpleted (see appendix 4). The Chief Pharmacist will sign and apprve the frm fr pharmacists and the Deputy Directr f Nursing fr nurses; a cpy will be held by the NMP lead. Cpies will be circulated t the NMP, pharmacy department, Prescribing supervisr, and line manager. Fllwing qualificatin there will be a perid f preceptrship. The length f time f the preceptrship will be agreed with the line manager, the independent prescriber and the NMP. 5.9 Supplementary Prescribing There are n legal restrictins n the clinical cnditins that may be treated r medicines that may be prescribed by supplementary prescribing, prviding they are within the persnal cmpetency f the supplementary prescriber. Supplementary prescribers must als cmplete the apprval t practice frm and will wrk clsely with an independent medical prescriber. The CMP is the framewrk f this prescribing partnership Wherever it is prpsed t manage a service user s cnditin thrugh the use f supplementary prescribing, the cncept f the prescribing partnership must be explained in advance t the service user by the independent medical prescriber/ supplementary prescriber. Cnsent shuld be btained frm the service user r their advcate befre supplementary prescribing takes place The Clinical Management Plan (CMP) Befre supplementary prescribing can take place it is bligatry fr a CMP t be agreed relating t a named service user and their specific cnditin t be managed by the supplementary prescriber. This shuld be included in the service user recrd as it is a legal requirement and supplementary prescribing cannt take place withut ne. The CMP must identify any circumstances where the supplementary MM05 Nn Medical Prescribing Guidelines 14

19 prescriber shuld refer the service user back t the independent prescriber and must be reviewed n an annual basis. Fllwing qualificatin there will be a perid f preceptrship. The length f the preceptrship will be agreed with the Line Manager, the Independent Prescriber and the Nn-Medical Prescriber Regulatins specify that the CMP must include certain infrmatin: The name f the service user t whm the CMP relates. The illness r cnditins which may be treated by the supplementary prescriber Be agreed by bth the medical and supplementary prescriber befre supplementary prescribing begins and signed by bth f them. The date n which the CMP has t take effect and when it is t be reviewed by the independent medical prescriber wh is party t the CMP (review date n lnger than 1 year) Reference t the class r descriptin f medicines r types f appliances which may be prescribed r administered under the CMP Any restrictins r limitatins as t the frmulatin r dse f any medicine which may be prescribed r administered under the CMP and any perid f administratin r use f any medicine r appliance which may be administered under the CMP Specify the range and circumstances within which the supplementary prescriber can vary the dsage, frequency r frmulatin f the medicines identified (medicines must be listed individually by generic name, strength, rute f administratin, dsage and frequency) The CMP may include a reference t published natinal r lcal guidelines hwever, the CMP must clearly identify the range f relevant medicinal prducts t be used in the treatment f the service user and the CMP shuld draw attentin t the relevant part f the guidelines. Relevant warnings arund knwn sensitivities f the service user and/r knwn difficulties f the service user with particular medicines r appliances. The arrangements fr ntificatin f suspected r knwn reactins t any medicine which may be prescribed r administered under the plan and suspected r knwn adverse reactins t any ther medicine taken at the same time as any medicine prescribed r administered under the plan. The circumstances in which the supplementary prescriber shuld refer t r seek the advice f the independent medical prescriber wh is party t the plan. Fllwing diagnsis by a medical prescriber the medical and supplementary prescriber will discuss the CMP befre the dcument itself is prepared The independent medical prescriber r supplementary prescriber may draft MM05 Nn Medical Prescribing Guidelines 15

20 the CMP, hwever, bth must frmally agree t the CMP and receive service user cnsent befre supplementary prescribing can begin The CMP cmes t an end: At any time at the discretin f the medical prescriber, supplementary prescriber r the service user At the time specified fr the review f the service user (unless it is renewed by bth prescribers at that time) If the medical prescriber leaves their pst. In these circumstances the CMP must be renewed by the successr 5.11 Independent Nurse and Pharmacy Prescribing within Mersey Care NHS FundatinTrust Independent NMPs are limited by their cdes f prfessinal practice t prescribe within their area f cmpetence. Independent NMPs shuld nly prescribe fr service users fllwing an apprpriate clinical assessment as utlined in their respective prfessinal bdies guidance and natinal prescribing guidance. The grup f service users t be prescribed fr and medicines t be prescribed independently must be agreed with the NMP, the NMP service manager and the medical practitiner wh wrks clsely with the NMP. Once agreed this shuld frm the basis f an apprval t practice frm which must be cmpleted prir t any prescribing practice Fllwing this agreement NMPs will develp a persnal frmulary fr the drugs they will be prescribing independently. Persnal frmulary must be discussed with the service manager and the medical practitiner wh wrks in the service area where the NMP will be prescribing. Once this is agreed a cpy shuld be frwarded t the Trust NMP lead wh will submit this t the NMP apprval panel fr ratificatin Nrmally prescribing will be carried ut in the cntext f practice within a multidisciplinary healthcare team either in a hspital r in a cmmunity setting and within a single electrnic patient recrd NMPs cannt write prescriptins unless they are cmpetent t prescribe the medicatin, have full understanding f the pharmaclgy invlved, have the medicatin within their authrised scpe f practice and have cmpleted an apprpriate clinical assessment prir t issuing a prescriptin All registered NMP s must have an apprpriate prescribing supervisr that has knwledge and expertise in the NMP s clinical area f prescribing practice; this can either be a dctr r an experienced NMP. It is suggested that the NMP and clinical supervisr meet frmally nce a mnth t discuss prescribing practice, hwever an agreement shuld be reached with the nn-medical prescriber s line manager and cnsultant lead fr the services fr the NMP will prescribe t what will be apprpriate clinical supervisin. Clinical supervisin will highlight any further training requirements Any nurse r pharmacist wishing t extend their persnal frmulary must re submit the apprval t practice frm t the NMP apprval and mnitring panel. All NMP s and supplementary prescribers must resubmit their apprval t practice frm n an Nn-Medical Prescribing Plicy annual basis t the NMP lead fr re apprval at the NMP apprval an mnitring panel t ensure cmpetency has been maintained. MM05 Nn Medical Prescribing Guidelines 16

21 5.12 Independent Prescribing f Cntrlled Drugs In April 2012 amendments t the Misuse f Drugs Regulatins permitted the independent prescribing f schedules 2-5 cntrlled drugs by registered nurse and pharmacist NMPs fr any medical cnditin (but nt t prescribe ccaine, diamrphine and dipipanne fr the treatment f addictin). In additin t this nurse independent prescribers wh wrk in substance misuse services can nw supply articles fr administering r preparing cntrlled drugs Mersey Care NHS Fundatin Trust is in full supprt f nurses and pharmacist prescribers extending their prescribing scpe t include cntrlled drugs hwever it is stressed that this must nly ccur within the practitiner s individual clinical cmpetence Prescribing fr Children and yung peple Only nurses and pharmacists with the relevant knwledge, cmpetence, skills and experience in caring fr children shuld prescribe fr children. Anyne prescribing fr a child must be able t demnstrate cmpetence t prescribe fr children and refer t anther prescriber when wrking utside their level f expertise In all cases reference shuld be made t the BNF fr Children when prescribing medicines fr pediatrics Prescribing f unlicensed medicatins by nurses wh are independent prescribers During December 2009 legislatin was amended t allw nurse and midwife independent prescribers t prescribe unlicensed medicines. The NMC published a circular in March 2010 indicating that nurse independent prescribers may prescribe an unlicensed medicatin. Prescribers shuld refer t the Trust unlicensed medicatin plicy fr guidance Mental Health Act, Mental Capacity Act and Cnsent t Treatment NMP s shuld ensure that they are fully cnversant and wrk within the requirements f the Mental Health Act 1983; the Mental Capacity Act 2005; DH guidelines fr cnsent t treatment; and the assciated Mersey Care plicies in relatin t these in their prescribing practice Patients Detained under the Mental Health Act Fr a patient subject t Part 4 r Part 4A f the Mental Health Act 1983, an NMP may prescribe medicatin fr treatment f that patient s mental disrder, r any assciated physical symptms that are a manifestatin f it, prvided that the NMP: (a) (b) (c) is the apprved clinician in charge f treatment r is prescribing the medicatin under the directin f the apprved clinician in charge f the treatment; and is cmpliant with all registratin and training requirements; and is nly acting within their area f cmpetence; and MM05 Nn Medical Prescribing Guidelines 17

22 (d) is cmpliant with the prvisins f Part 4 f the Mental Health Act 1983, where applicable (any medicatin prescribed must be authrised under Sectin 63, Sectin 62, Sectin 58(1)(a) (ie n T2 r T3) r Sectin 58A); and (e) is cmpliant with the prvisins f Part 4A, where applicable (any medicatin prescribed must be authrised under Part 4A and in accrdance with CTO11 r CTO12 where relevant) The apprved clinician must be registered and prfessinally qualified as set ut in the Mental Health Act 1983 Apprved Clinician (General) Directins This may include thse persns registered with the relevant bdy as a nurse, scial wrker, psychlgist, r ccupatinal therapist (althugh nly nurses are currently authrised under this plicy) Fr thse patients requiring physical treatment, which is nt a manifestatin f their mental disrder, r fr treatment f mental disrder fr thse patients nt subject t Part 4 r Part 4A f the Mental Health Act 1983, any NMP may prescribe treatment prvided that persn is: (a) (b) cmpliant with all registratin and training requirements; and nly acts within their area f cmpetence and in accrdance with this plicy Recrd Keeping NMP s are required t: Cmplete accurate and detailed recrds f all prescribing decisins. Recrd prescriptins in service user s clinical recrds in a timely manner. Infrm GPs, where apprpriate, f any changes in medicatin Adverse Drug Reactins If a service user reprts a severe r unexpected reactin t a prescribed medicine it shuld be reprted immediately t the service user s GP and/r respnsible medical fficer. The NMP must dcument any adverse reactins and the actin taken in the service user`s clinical recrds. Prescribers wh are suspicius that an adverse reactin has taken place must reprt this via the yellw card scheme (see BNF) and cmplete a trust incident frm. NMP s shuld adhere t the Trust`s Medicines Management plicy in relatin t this Legal and Clinical Liability Where a nurse r pharmacist is apprpriately trained and qualified and prescribes as part f their prfessinal duties with the cnsent f their emplyer then the emplyer is held vicariusly respnsible fr their actins. Nnetheless each NMP is prfessinally accuntable fr their prescribing decisins, including actins and missins, and cannt delegate this accuntability t any ther persn. Each NMP is expected at all times t wrk within the standards and cde f prfessinal cnduct as set ut by their wn regulatry bdies, as well as plicies and prcedures ratified by their rganisatin. All prescribers shuld ensure that they have adequate prfessinal indemnity insurance. MM05 Nn Medical Prescribing Guidelines 18

23 It is the respnsibility f the NMP`s line manager in cnjunctin with the NMP lead t agree the areas in which they are able t prescribe as part f their prfessinal duties. In the case f supplementary prescribing the therapeutic area in which prescribing will take place must be agreed. Shuld the independent/supplementary prescriber wish t expand n these areas, the line manager shuld explre any further clinical training r experience which may be required and this must be prvided befre this new area can be included in their prfessinal duties. A revised apprval t practice frm shuld be cmpleted and returned t the Trust NMP lead Medicatin Errrs T reduce the ptential fr errrs it is best practice fr the NMP t neither dispense nr administer medicatin they have prescribed NMPs are respnsible fr reprting any prescribing errrs as per Trust plicy, ensure their line manager and the medical team are infrmed, and take any necessary actin t maintain service user safety. Medicatin errrs will be mnitred by the NMP Apprval and Mnitring Panel Verificatin f Prescribing status It is the respnsibility f every emplyer (via the prfessinal head) t ensure that the prescriber is legally entitled t prescribe by means f anntatin t his r her prfessinal registratin. Fllwing successful cmpletin f the apprpriate prescribing training r when a prescriber is a new emplyee the emplyer will check with the prfessinal rganisatin. It is the respnsibility f the prescriber t ensure prfessinal registratin is maintained at all times Handling and security f prescriptin frm/pads There will be n restrictin n the type f prescriptin frm/chart fr use by the NMP in Mersey Care NHS Fundatin Trust Nrmal rutes f supply will be maintained via lcal prcedures in services. NMP`s in Mersey Care NHS Fundatin Trust may use Trust prescriptin cards and FP10 frms t cmplete prescriptins. Prescriptins are cntrlled statinery and must be stred securely in line with lcal prcedures FP10s - recrds f issue and destructin f prescriptins must be kept in line with lcal prcedures. This shuld include the serial numbers f prescriptins issued, date f issue as well as details f the nurse r pharmacist requesting the prescriptin. It is the respnsibility f the NMP t ensure the security f prescriptins at all times. When in use the prescriptins must remain in the pssessin f the NMP at all times. Individual stcks f prescriptin frms shuld be kept t a minimum by all NMPs. Blank prescriptins must nt be left n the desk but placed in a lckable drawer. Blank prescriptin frms must never be pre-signed. If travelling between service users the prescriptin pads shuld nt be visible and must be lcked in the bt f the car. Any prescriptins must be remved frm the car when the car is unattended In the event f lss r suspected theft f FP10 prescriptins the NMP must fllw their lcal prcedure and reprt this immediately t their line manager and NMP lead wh will infrm the lcal cunter fraud specialist and the apprpriate NMP peratinal leads (including pharmacy) giving details f: apprximate number f scripts stlen/lst MM05 Nn Medical Prescribing Guidelines 19

24 their identificatin (serial) numbers when and where the prescriptins were lst r stlen A DATIX incident frm must be cmpleted detailing all f the abve Lcal cmmunity pharmacists will be ntified via the apprpriate channels Fllwing the reprted lss f a prescriptin frm the trust will nrmally tell the prescriber t write and sign all prescriptins in a particular clur (usually red) fr a perid f tw mnths. The trust will infrm all pharmacies in their area and adjacent CCG s f the name and address f the prescriber cncerned. The apprximate number f prescriptin frms stlen and the perid within which the prescriber will write in a specific clur. This will nrmally be put in writing within 24 hurs with the exceptin f weekends Wrking with the Pharmaceutical Industry All NMPs shuld adhere t the Trust Medicines Management plicy n cnduct and liaisn with pharmaceutical cmpany emplyees Cntinuing Prfessinal Develpment (CPD) All healthcare prfessinals including NMPs have a statutry respnsibility t maintain their CPD. This is in line with the natinal prescribing centre cmpetencies framewrk (available t view at All NMPs shuld be able t demnstrate applicatin f the NPC cmpetency framewrk in their NMP rle. Nurse and pharmacist prescribers will be expected t keep up t date with the management f cnditins fr which they may prescribe and in the use f drugs, dressing and appliances. Nurses may use the learning frm this activity as part f their pst registered educatin and practice (PREP) Nn-medical prescribing shuld be discussed at individual perfrmance develpment reviews and any training needs identified thrugh cntinued prfessinal develpment (CPD). The NMP`s dedicated prescribing supervisr and manager will need t cnfirm the maintenance f the NMP`s clinical knwledge and skills T maintain high standards f prescribing practice a Trust frum will als be prvided n a quarterly basis t update all prescribers and share gd practice n the principles f prescribing If a NMP has nt prescribed fr ver ne year (this may be due t a changing rle r the need fr supprt) r failed t attend the prescribing frum (except in special circumstances) then they may need supprt r be asked t cmplete the cmpetency framewrk t enable them t cntinue prescribing safely. This shuld be a supprtive meeting between the NMP, line manager, prescribing supervisr, and NMP lead t determine what actin is required that meets service and individual need British Natinal Frmulary (BNF) and drug tariff These publicatins are essential t the prescriber. The trust will supply the latest BNF t the independent/supplementary prescribers every 6 mnths. The drug tariff is published every mnth and can als be accessed with a prescriptin pricing authrity website. MM05 Nn Medical Prescribing Guidelines 20

25 5.26 Maintaining the trust NMP Prescribing Register The NMP lead will maintain the trust`s NMP Prescribers Register. All changes f details are t be ntified t the NMP lead fr any amendments t the register. The NMP register must cntain: a) Name b) NMC pin r GPhC number. c) Qualificatin and speciality e.g. RMN, wrking as CPN d) Date f NMP qualificatin e) Base and cntact details f) Eligibility t prescribe i.e. independent, supplementary r bth The NMP must ntify the NMP lead f a change f details fr any f the fllwing: a) Change f name b) Change f base and cntact n. c) Change f NMC pin r GPhC n. 6 CONSULTATION 6.1 The fllwing staff / grups were cnsulted with in the develpment f this plicy dcument: a) Nn-medical Prescribers b) Lead fr Nn-medical Prescribers c) Drugs and Therapeutics Cmmittee 7 RESOURCE/IMPLEMENTATION ISSUES 7.1 All NMP s require a DMP thrughut the training prcess and a prescribing supervisr pst qualificatin. Services need t factr this int any business plans fr the develpment f NMP rles. 8 MONITORING 8.1 Analysis f medicines usage and expenditure will prvide useful management infrmatin. The rute fr accessing prescribing data fr NMP s will depend n the type f prescriptins being utilised and where the prescribing csts are allcated. The trust medicines management cmmittee will versee and direct any audit requirements relating t nn-medical prescribing as part f the trust clinical annual audit prgramme. NMP s will be required t participate in and prvide evidence fr any prgrammes as directed by the medicines management grup. 8.2 Mnitring t be in place t ensure that there is equity f access t all staff with particular reference t the prtected characteristics. Minimum requ Frequency Prcess fr mn Evidence Respnsible Indi Respnse Cm MM05 Nn Medical Prescribing Guidelines 21

26 Audit irem ent f NM P indi vidu al prac tice itri ng vidu als Annual Annual audit Audit reprt Trust NMP Lea d mitte e(s) Medicatin S 9. SUPPORTING DOCUMENTS 9.1 List f Supprting Dcuments (a) (b) (c) (d) (e) (f) (g) (h) (i) (j) (k) (l) The Nn-Medical Prescribing Prgramme - Department f Health are/medicinespharmacyandindustry/prescriptins/thenn- MedicalPrescribingPrgramme/DH_ Imprving Patients Access t Medicines: A Guide t Implementing Nurse and Pharmacist Independent Prescribing within the NHS in England GuideApril06.pdf Supplementary Prescribing by Nurses, Pharmacists, Chirpdists/Pdiatrists, Physitherapists and Radigraphers within the NHS in England: a guide fr implementatin - Department f Health are/medicinespharmacyandindustry/prescriptins/thennmedicalpres cribingprgramme/supplementaryprescribing/dh_ Medicines Matters: A Guide t current mechanisms fr prescribing, supply and administratin f medicines - Department f Health Nn-medical prescribing - Natinal Prescribing Centre - Cmpetency framewrks and ther publicatins Training nn-medical prescribers in practice - Natinal Prescribing Centre MM05 Nn Medical Prescribing Guidelines 22

27 actitiners_guide.pdf (m) (n) Standards f prficiency fr nurse and midwife prescribers cyfrnurseandmidwifeprescribe MM05 Nn Medical Prescribing Guidelines 23

28 Appendix A Flwchart f the Applicatin Prcess fr Nn- Medical Prescribing (NMP) The service Cmplete manager NMP and Prpsal nmine Frm fr NMP and have gain apprval read and at understand lcal medicines what NMP is. He/she can demnstrate management hw (Service it can be Manager, used in Nminee practice and NMP, hw DMP) it will frm part f their prfessinal respnsibilities prvide patients with quicker and easier access t medicines in rder t imprve the patient experience. If required the ptential NMP may wish t cntact the NMP lead in rder t get mre infrmatin Frward NMP Prpsal frm t NMP lead Once prpsal accepted and cnfirmed by NMP Lead cmplete n-line Numeracy Assessment (accessed thrugh lead) Fllwing successful cmpletin f Numeracy Assessment, cmplete applicatin university frm, access frm NMP lead. Return fully cmpleted applicatin frm t Nn-medical Prescribing lead Applicatin frm will be frwarded by Nn-Medical Prescribing Lead t the University f yur chice. Apply n line fr CPD funding MM05 Nn Medical Prescribing Guidelines 24