Non-Medical Prescribing clinical competencies Name: Role: Band 6/7 Base: Date initial training completed: Competency Statement: The participant demonstrates clinical knowledge and skill in Non Medical Prescribing without assistance and/or direct supervision (level 3 - see level descriptors). Assessment in practice must be by a Registered Nurse who can demonstrate competence at level 4 or above. Performance Criteria Assessment Method Level achieved Date The Participant will be able to: 1. Demonstrate up-to-date clinical and pharmaceutical knowledge relevant own area of practice a) understands the medical condition being treated, their natural progress and how to assess the severity of disease b) Understands different non pharmacological and pharmacological approaches to modifying conditions and promoting health, desirable and undesirable outcomes and how to identify and assess them c) Understands the mode of action and pharmacokinetics of medicines and how these mechanisms may be altered ( by age, renal impairment etc) d) Understands the potential for unwanted effects, (e.g. adverse drug reactions [ADRs], drug interactions, allergy), and how to avoid/minimise and manage them e) Maintains an up-to-date knowledge of products contained in the NPF/BNF f) Understands how medicines are licensed, sourced, supplied and monitored (e.g. how ADRs are reported) g) Applies the principles of evidencebased medicine, and clinical and cost-effectiveness h) Understand the public health issues related to medicines use i) Appreciates the misuse potential of drugs
2. Make a diagnosis and generate treatment options for the patient. Always follow up treatment a) Takes a comprehensive medical history and undertake an appropriate physical examination b) Makes a working or final diagnosis by considering and systematically deciding between the various possibilities (differential diagnosis) c) Requests, and interprets, relevant investigations d) ) Views and assesses the patient s needs holistically (e.g. psychosocial, physical) e) Considers no treatment, non-drug and drug treatment options (including referral and preventive measures f) Assesses the effect of multiple pathologies, existing medication and contraindications on treatment options g) Assesses the risks and benefits to the patient of taking/not taking a medicine (or using/not using a treatment) h) Selects the most appropriate drug, dose and formulation for the individual patient i) Monitors effectiveness of treatment and potential unwanted effects j) Establishes and maintains a plan for reviewing the therapeutic objective, discharge or end point of treatment k) Manages repeat prescribing 3. Establish a relationship based on trust and mutual respect. Sees patients as partners in the consultation. Applies the principles of concordance a) Listens to and understands patients beliefs and expectations b) Understands the cultural and religious implications of the diagnosis / prescribing c) Deals sensitively with patients emotions and concerns
d) which does not Creates a relationship based on prior expectation of a prescription e) Helps the patient to make informed choices about their treatment f) Explains the nature of the patient s condition, the rationale behind and potential risks and benefits of management options g) Negotiates an outcome of the consultation that both patient and prescriber are satisfied with h) Encourages patients to take responsibility for their own health and self manage their conditions i) Adapts consultation style to meet the needs of different patients j) Gives clear instructions about the medication (e.g. what it is for, how to use it, where to get it from, possible unwanted effects k) Check the patients understanding of, and commitment to their treatment 4. Demonstrate awareness of own limitations. Does not compromise patient safety a) Know the limits of own knowledge and skill and work within them b) Knows when to refer to or seek guidance from other members of team or specialist c) Prescribes a medicine only with adequate knowledge of actions, indications, contraindications, cautions, dose and side effects d) Check does and calculations to ensure accuracy and safety e) Know common types of medication errors and how to prevent them f) Prescribes often enough to maintain confidence and competence g) Understands the need for and makes accurate, clear and timely records h) Writes legible, clear and complete prescriptions, which meet legal requirements 5. Work within professional and organisational standards. Take personal responsibility
for prescribing decisions a) Accept personal responsibility for own prescribing and understand implication for doing so b) Makes prescribing decisions, based on the needs of patients and not the personal considerations of the prescriber c) Understands how current legislation affects prescribing practice d) Prescribes within current professional and organisational codes of practice / standards e) Keeps up-to-date with advances in practice and emerging safety concerns related to prescribing f)keeps prescriptions safely and knows what to do if they are stolen/lost 6. Actively participate in the review and development of prescribing practice a) Reflect on own performance, learns and change practice b) Willing to share and debate own, and others prescribing practice c) Challenges inappropriate practice constructively d) Participates in clinical supervision and develops own support networks e) Understands and uses tools to improve practice (e.g. data, audit and feedback) f) Reviews and reports prescribing errors and near misses within a clinical governance context g) Establishes multi-professional links with practitioners working in the same specialist area 7. Know how to access relevant information. Critically appraise an apply information in practice
a) Understand advantages and limitations of information sources b) Uses relevant, up-to-date information both written, and verbal c) Critically appraises the validity of information sources (e.g. promotional literature, research) d) Applies information to the clinical context (linking theory to practice) e) Uses relevant patient record systems, prescribing and information systems, and decision-support tools 8. Understand and work with local and national policies and services that impact on prescribing practice a) Work within local frameworks for medicines use as appropriate b) work within organisational codes of conduct when dealing with pharmaceutical industry c) Understands budgetary constraints at local and national levels d) Understand national frameworks for medicines use ( e.g. NICE, NSF s) 9. Work in partnership with colleagues for the benefit of patients. Is self aware and confident in own ability as a prescriber a) Work with colleagues to ensure that continuity of care is not compromised b) Uses the multidisciplinary team to its full extent c) Establishes relationships with colleagues based on understanding, trust and respect for each others roles d) Recognises and deals with pressures that might result in inappropriate prescribing e) Is proactive, adaptable, flexible and responsive to change
f) Negotiates the appropriate level of support for role as a prescriber g) Provides support and advice to other prescribes where appropriate Source National Prescribing Centre: Maintaining competency in prescribing 2001 Date all elements of Competency Tool completed to level 3 Name Signature Status Date I confirm that I have the above named individual and can verify that he/she demonstrates competency in non medical prescribing Assessor Signature Status Date Review Competent Registered Verifier signature Comments Dates: Yes / No Nurse Signature