Non-Medical Prescribing 2014/15 Re-audit (897)

Transcription

1 Non-Medical Prescribing 2014/15 Re-audit (897) Tejas Khatau, Lead Pharmacist for Families,Young People and Children's Service Lakhvir Hullait, Clinical Audit Assistant Janie Chan, Clinical Audit Officer Audit Period: January 2015 Febuary 2015 Report Date: April 2015

2 Executive Summary Why the audit was undertaken To ensure that NMP staff prescribe safely and are following the requirements of the NMP Policy. How the audit was carried out Structured questions sent to all NMPs via SurveyMonkey. Key findings Criteria % Compliance % Compliance Progress % 1.1 Staff role as a NMP is specifically written into their job description 1.2 Staff working as a NMP understand their responsibilities defined within LPT's NMP policy (Oct 2012) 1.3 Staff working as NMPs have completed Scope of Practice - Appendix 3 in the NMP policy with their line manager. 1.4 Staff working as NMPs keep a portfolio that demonstrates up-to-date Continuing Professional Development and ongoing needs through reflection. 1.5 Staff working as NMPs receive clinical supervision related to their prescribing role. 1.6 The latest clinical supervision was within the previous three months. 64% 77% 13% 97% 97% 0% 27% 51% 24% 72% 84% 12% 56% 62% 6% 27% 37% 10% Key actions 1. Ensure all NMP staff and their line managers are aware of the audit results; 2. Ensure all NMPs have their prescribing activity written into their job description; 3. Ensure all v300 NMPs have a completed Scope of Practice - Appendix 3 ; 4. Ensure all NMPs receive adequate clinical supervision related to their prescribing role Re-audit date January of 17 Executive Summary Non-Medical Prescribing 2014/15

3 Contents Executive Summary... 2 Why the audit was undertaken 2 How the audit was carried out 2 Key findings 2 Key actions 2 Re-audit date 2 Contents... 3 Abbreviations 3 Background... 4 Criteria & standards... 4 Method... 5 Sample & data source 5 Audit type 5 Service areas / teams included 5 Findings... 6 Responses received 6 Page Page Audit findings 6 Findings by prescriber type in comparison with a previous audit 7 Comments... 7 Areas of good practice 7 Areas for improvement 7 Lessons learnt 8 Ethical / professional issues 8 Where results to be presented or discussed 8 Recommendations... 8 References... 8 Appendix 1 Audit tool... 9 Appendix 2 Breakdown tables Appendix 3 Distribution list Appendix 4 Action plan Abbreviations LPT NMPs V100 Leicestershire Partnership NHS Trust Non-Medical Prescribers. Staff that have a prescribing qualification but are not doctors or dentists A type of prescribing qualification. This is also known as Community Practitioner Nurse Prescriber. Can prescribe any item in the Nurse Prescriber s Formulary Independent Prescriber A type pf prescribing qualification. This is also known as v300 qualification for nurses. This can include a range of professionals who are permitted to prescribe any item and manage any condition within their sphere of competence (there are some restrictions though such as diamorphine for treating addiction). They are responsible for assessing, diagnosing and care planning. Non-Medical Prescribing 2014/15 Contents 3 of 17

4 Background Non-Medical Prescribing (NMP) relates to prescribing by professional groups other than doctors or dentists, as defined by legislation, who have undertaken and successfully completed an accredited non-medical prescribing training programme and who are registered with their professional body. Leicestershire Partnership NHS Trust (LPT) must ensure that all staff with the authorisation to prescribe medicinal products do so safely and in accordance with Trust policy and national requirements. To this effect, the LPT Non-Medical Prescribing Policy (November 2014) describes a framework within which NMP is implemented within the Trust. It includes the legal, professional and organisational checks to ensure that NMP activity is safe. The objectives of this audit are to: To establish how many of the NMPs listed on the Trust NMP Register are actively prescribing. To establish compliance with the Trust NMP policy for prescribers a) having a reference to their prescribing role within their job description, b) having a completed Scope of Practice appendix 3 completed in the last 12 months and c) receiving regular clinical supervision in relation to their prescribing role. The information gained as part of this audit will inform the conduct of a subsequent audit (a proposal submitted in due course) to establish whether the prescribing practice of these NMPs is in line with guidance. Criteria & Standards Identical criteria and standards that were used in the baseline audit were utilised again. An arbitrary threshold of 100% was set as the standard with a lower threshold of 95% to distinguish cases that narrowly missed out on compliance from those that fell unacceptably below the standard. Table 1 - Criteria and standards Criteria 1) All NMPs should have a reference to their prescribing role in their job description. 2) Staff working as a NMP understand their responsibilities defined within the latest version of LPT's NMP policy 3) Staff working as NMPs (V300 qualified) have completed Scope of Practice Statement (Appendix 3 in the NMP policy) with their line manager. 4) Staff working as NMPs keep a portfolio that demonstrates up-to-date Continuing Professional Development and ongoing needs through reflection. 5) Staff working as NMPs receive clinical supervision related to their prescribing role. 6) Staff working as NMPs have received clinical supervision within the previous three months. 4 of 17 Background Non-Medical Prescribing 2014/15

5 Thresholds of compliance Key: Full compliance x = 100% Partial compliance 95% x <100% Minimal compliance x < 95% Method The audit criteria were developed into an on-line survey using the SurveyMonkey software. Two versions of the tool were created as there were subtle differences in the questions for v100 staff compared to the v300 staff. Based on lessons learnt from last year, the survey was amended to ask if the individual was actively prescribing early on. This allows the staff to terminate the survey if they select no. A list of staff with a current NMP qualification was obtained from the Workforce Information team. These staff were ed a link to an on-line survey which asks about their NMP status (see attached audit tool). Data collection was over one month from the end of January 2015 to end of February 2015; staff who had not responded were sent a reminder by about the survey and encouraged to participate. All staff details were treated confidentially; however the survey was NOT anonymous. Audit Leads may contact staff or their line managers if their responses indicate they would benefit from further advice or guidance. Details of staff responses were stored securely on a restricted part of the Lakeside House shared drive and disposed of in line with the Trust records management policy. Responses were collated automatically. The figures were analysed by exporting the data to Excel for breakdowns. Sample & data source We received a total of 114 responses from SurveyMonkey. Of these, 17 were subsequently excluded as they had not prescribed recently. Audit type This is the first re-audit on this topic using a self-response survey as the main data source. See Appendix 1 on p.9 for a copy of the audit tool. Service areas / teams included Trust wide audit. All Non-Medical Prescribers within the Trust. Unfortunately, pharmacists who are prescribers are not on the Workforce Information team database and so were not included. Pharmacist account for a very small proportion of the overall NMP workforce, therefore, their exclusion should not heavily influence the data. Non-Medical Prescribing 2014/15 Method 5 of 17

6 Findings Responses received Overall return rate Overall v100 v300 Number Distributed (count) Number Returned (count) % Return Rate 26% 19% 38% Overall applicable responses Overall V100 V300 Number Returned (count) Number excluded from analyse* (count) Total applicable response (count) *Respondents stated, I've not prescribed for over two years or I've not prescribed since registered as a Non-Medical Prescriber. Audit findings Criteria % Compliance % Compliance Progress % 1.1 Staff role as a NMP is specifically written into their job description 1.2 Staff working as a NMP understand their responsibilities defined within LPT's NMP policy (Oct 2012) 1.3 Staff working as NMPs have completed Scope of Practice - Appendix 3 in the NMP policy with their line manager. 1.4 Staff working as NMPs keep a portfolio that demonstrates up-to-date Continuing Professional Development and ongoing needs through reflection. 1.5 Staff working as NMPs receive clinical supervision related to their prescribing role. 1.6 The latest clinical supervision was within the previous three months. 64% 77% 13% 97% 97% 0% 27% 51% 24% 72% 84% 12% 56% 62% 6% 27% 37% 10% 6 of 17 Findings Non-Medical Prescribing 2014/15

7 Findings by prescriber type in comparison with a previous audit Progress % Criteria 1.1 Staff role as a NMP is specifically written into their job description 1.2 Staff working as a NMP understand their responsibilities defined within LPT's NMP policy (Oct 2012) 1.3 Staff working as NMPs have completed Scope of Practice - Appendix 3 in the NMP policy with their line manager. 1.4 Staff working as NMPs keep a portfolio that demonstrates up-to-date Continuing Professional Development and ongoing needs through reflection. 1.5 Staff working as NMPs receive clinical supervision related to their prescribing role. 1.6 The latest clinical supervision was within the previous three months. V100 % compliance 2013/14 V100 % compliance % 70% 96% 91% 72% 80% 33% 23% 11% 7% 8% 5% 8% 10% 4% V300 % Compliance 2013/14 V300 % Compliance % 79% 98% 98% 27% 51% 71% 81% 80% 91% 44% 58% Progress % 13% = 24% 10% 11% 14% How compliance was calculated Compliance number of YES 100 number of YES and NO Comments Areas of good practice There was an overall improvement in all the criteria compared to last year s audit. Criterion 1.3 ( Scope of Practice Statement Appendix 3 ) showed the most dramatic overall improvement. This is probably owing to the drive by Divisions requesting their v300 NMPs to complete Appendix 3. When comparing the staff groups, v300 staff demonstrated an improvement in all the criteria compared to v100 staff who demonstrated an improvement in only 2 criteria. Areas for improvement Significant improvements are still required in most areas. It is imperative that staff have a reference to their prescribing function in their job description so that they are covered for this activity. Access to clinical Non-Medical Prescribing 2014/15 Comments 7 of 17

8 supervision relating to their prescribing role appears to be poor for the v100 staff and this needs to be addressed locally. Lessons learnt Following last year s audit, we designed a poster to highlight the key results and what actions to take. According to the results from this audit, the poster had a variable impact and therefore we may to look at other/additional methods to get the key messages across. Ethical / professional issues This audit identified some staff who are qualified as prescribers but have not prescribed for over 2 years. Divisional NMPs will ascertain who they are and, if necessary, remove their functionality to prescribe. This is in accordance with the NMP Policy and is intended to ensure that staff who wish to return back to practice are safe to do so. Where results to be presented or discussed See Appendix 2 on p.12 for the distribution list. Recommendations See 0 on p.16 for the action plan. References LPT Non-Medical Prescribing Policy (November 2014) 8 of 17 Recommendations Non-Medical Prescribing 2014/15

9 Appendix 1 Audit tool 9 of 17 Non-Medical Prescribing 2014/15 Audit tool

10 10 of 17 References Non-Medical Prescribing 2014/15

11 Non-Medical Prescribing 2014/15 References 11 of 17

12 Appendix 2 Breakdown tables Divisional Level break down Community Health Services (CHS) Adult Mental Health Services (AMH) V100 Families, Young People and Children's Services (FYPC) Other (please specify) Community Health Services (CHS) V300 Adult Mental Health Services (AMH) Families, Young People and Children's Services (FYPC) Other (please specify) Number of applicable returns (count) Staff role as a NMP is specifically written into their job description 54% N/A 80% 0% 79% 67% 83% 100% 1.2 Staff working as a NMP understand their responsibilities defined within LPT's NMP 85% N/A 93% 100% 97% 100% 100% 100% policy (Oct 2012) 1.3 Staff working as NMPs have completed Scope of Practice - Appendix 3 in the NMP N/A N/A N/A N/A 51% 50% 33% 100% policy with their line manager. 1.4 Staff working as NMPs keep a portfolio that demonstrates up-to-date Continuing Professional Development and ongoing 85% N/A 77% 100% 85% 67% 83% 50% needs through reflection. 1.5 Staff working as NMPs receive clinical supervision related to their prescribing role. 31% N/A 20% 0% 90% 100% 83% 100% 1.6 The latest clinical supervision was within the previous three months. 0% N/A 10% 0% 59% 33% 83% 50% 12 of 17 Non-Medical Prescribing 2014/15 Breakdown tables

13 Breakdown by prescriber Independent Prescriber V100 Supplementary Prescriber Community Practitioner Nurse Prescriber Independent Prescriber V300 Supplement ary Prescriber Community Practitioner Nurse Prescriber Number of applicable returns (count) Staff role as a NMP is specifically written into their job description 1.2 Staff working as a NMP understand their responsibilities defined within LPT's NMP policy (Oct 2012) 1.3 Staff working as NMPs have completed Scope of Practice - Appendix 3 in the NMP policy with their line manager. 1.4 Staff working as NMPs keep a portfolio that demonstrates up-to-date Continuing Professional Development and ongoing needs through reflection. 1.5 Staff working as NMPs receive clinical supervision related to their prescribing role. 1.6 The latest clinical supervision was within the previous three months. Blank 72% 79% 50% *N/A Blank 93% 98% 100% *N/A Blank 0% 51% 17% *N/A Blank 81% 81% 67% *N/A Blank 23% 91% 100% *N/A Blank 7% 58% 50% *N/A *N/A because: The Community Practitioner Nurse has not prescribed for over two years and Prescribing is not part of their current role. Non-Medical Prescribing 2014/15 References 13 of 17

14 Breakdown by profession V100 Nurse Other (please specify) Nurse Podiatrist Other (please specify) Number of applicable returns (count) Staff role as a NMP is specifically written into their job description 1.2 Staff working as a NMP understand their responsibilities defined within LPT's NMP policy (Oct 2012) 1.3 Staff working as NMPs have completed Scope of Practice - Appendix 3 in the NMP policy with their line manager. 1.4 Staff working as NMPs keep a portfolio that demonstrates up-to-date Continuing Professional Development and ongoing needs through reflection. 1.5 Staff working as NMPs receive clinical supervision related to their prescribing role. 1.6 The latest clinical supervision was within the previous three months. *N/A as not prescribed since registered as a Non-Medical Prescriber V300 64% 79% 78% *N/A 100% 88% 95% 98% *N/A 100% N/A N/A 52% *N/A 33% 84% 74% 80% *N/A 100% 28% 16% 92% *N/A 67% 4% 11% 60% *N/A 33% 14 of 17 References Non-Medical Prescribing 2014/15

15 Appendix 3 Distribution list Target audience NMP Group MRRG AMH.LD CASE CHS CAEG FYPC CASER To (for action) Name, designation Lead Pharmacist/Head of Pharmacy for circulation among the NMP group Clinical Audit Officer for inclusion within the papers Clinical Audit Officer for inclusion within the CASE agenda items. Clinical Audit Officer for inclusion within the CAEG agenda items. Clinical Audit Officer for inclusion within the CASER agenda items. Non-Medical Prescribing 2014/15 References 15 of 17

16 Appendix 4 Action plan Objective Ensure all NMP staff and their line managers are aware of the audit results Ensure all NMPs have their prescribing activity written into their job description Ensure all v300 NMPs have a completed Scope of Practice - Appendix 3 Ensure all NMPs receive adequate clinical supervision related to their prescribing role Level of Risk L M H L M M M Agreed Action By Whom By When Resources Required Cascade via Divisional Governance and discuss in Divisional CASE. Discuss in local team meetings. Tejas Khatau (FYPC), Joanne Charles (CHS), Lynn Wroe (AMH.LD) Tejas Khatau (FYPC), Joanne Charles (CHS), Lynn Wroe (AMH.LD) December 2015 November 2015 Devise results poster and to all NMPs Ben Moss Audit Team October 2015 All NMPs and their managers to review job Tejas Khatau (FYPC), March 2015 description and include this activity (could be Joanne Charles (CHS), done at next PDR if this is imminent) Lynn Wroe (AMH.LD) Devise results poster and to all NMPs Ben Moss Audit Team October 2015 All NMPs and their managers to complete this yearly (could be done at PDR if this is imminent) Divisions to recall these as part of a rolling programme Tejas Khatau (FYPC), Joanne Charles (CHS), Lynn Wroe (AMH.LD) Tejas Khatau (FYPC), Joanne Charles (CHS), Lynn Wroe (AMH.LD) March 2016 On-going Nil and existing meetings Nil and existing meetings Nil distribution list already established Time could be done as part of PDP Nil distribution list already established Time could be done as part of PDP Nil communication To investigate whether Ulearn can potentially include this in peoples PDRs. Tejas Khatau March 2016 Nil communication Devise results poster and to all NMPs Ben Moss Audit Team October 2015 Nil distribution list already established All NMPs to incorporate this as part of their Tejas Khatau (FYPC), March 2016 Nil could be part of overall clinical supervision. Joanne Charles (CHS), existing arrangements. Lynn Wroe (AMH.LD) Consider forming specialist groups where cases can be discussed. Tejas Khatau (FYPC), Joanne Charles (CHS), Lynn Wroe (AMH.LD) March 2016 Time (few hours every quarter) 16 of 17 Non-Medical Prescribing 2014/15 Action plan

17 Objective Level of Risk L M H Agreed Action By Whom By When Resources Required Devise results poster and to all NMPs Ben Moss Audit Team October 2015 Nil distribution list already established Non-Medical Prescribing 2014/15 References 17 of 17