` School of Health and Human Sciences Community Nurse Prescribing (V100) Portfolio of Evidence Start date: September 2016 Student Name: Student Number:. Practice Mentor:.. Personal Tutor:... Submission date: 5 th May 2017
Contents Aims of the Portfolio 3 The portfolio as an item of assessment 3 Applying numeracy skills in practice 5 Prescribing for children and young people 6 Guidance for prescription writing 7 Reflective Log 8 Competency Assessment 9 Competency sign-off 30 Please ensure you have included evidence of the following when you submit your portfolio of evidence on 5 th May 2017 Evidence of reflective practice Completed numeracy questions Answers and practice prescription in respect of prescribing for children and young people Competency assessment records all signed by your prescribing mentor / practice teacher Statement of Clinical signed by your prescribing mentor / practice teacher 2
Aim of the Portfolio of Evidence The aim of the portfolio of evidence is for you to demonstrate the achievement of your competence to prescribe in the context of practice. How the aim is achieved The aim is achieved in a number of ways which include; mapping your developing competencies to the standards outlined in the Non-Medical Prescribing Competency Assessment Document (Appendix One) evidencing reflective practice to demonstrate closure of the theory practice gap in respect of prescribing applying numeracy skills to prescribing practice demonstrating knowledge, skill and competence in respect of prescribing for children When the aim is achieved The aim is successfully achieved when; Your prescribing mentor / practice teacher signs your statement of clinical competence to undertake prescribing as a community nurse prescriber. Their decision in this respect will be based on the evidence you produce within this portfolio as well as their observations and assessments of you in practice. You must therefore meet all the required competencies at the final practice assessment. The module tutor experienced & competent in prescribing confirms your demonstration of knowledge, skill and competence in respect of prescribing (for HV this must be relative to prescribing for children). The portfolio as an item of assessment Formative assessment: You will have an initial and mid-point formative assessment of your competencies conducted by your prescribing mentor or practice teacher. Your prescribing mentor or practice teacher will also give you on-going formative feedback regarding the development of your portfolio as well as the progress you are making in practice. Your portfolio will be also be reviewed by your personal tutor during a visit to the practice placement and will be submitted once to the University for formative assessment. It is very important that you respond to any formative feedback given prior to submitting your portfolio for summative assessment (Please see the note below*) Summative Assessment: You will have a summative assessment of your competencies conducted by your prescribing mentor or practice teacher. You will then submit your portfolio to the university where the module tutor experienced & competent in prescribing (for children for Health Visiting) will assess the evidence of your knowledge, skill and competence in respect of prescribing. Successful completion of the portfolio of 3
evidence is worth 20% of the overall mark for the Community Nurse Prescribing (V100) module. *Please note: The NMC stipulate that if you fail to correctly answer any question that may result in direct harm to a patient / client, you must be referred. This includes failure to ask about medication history, allergies, any over the counter medication, or incorrect dosage / prescribing of an unlicensed product. Engaging in reflective practice The importance of reflection as a tool for closing the theory / practice gap, improving your knowledge, skills and performance and consequently patient / client care will have been re-iterated to you before you undertake your practice placement. You will also have been re-orientated to a number of reflective theories and models widely used in practice. It is important to acknowledge that there are a number of contexts in which you may usefully engage in reflective practice. Consequently, there are also a number of ways that you may evidence reflective practice. These include; Keeping and submitting a reflective log relating to prescribing experiences. You will find a template for a reflective log in appendix one, feel free to adapt this or to develop your own. Use this as a basis to evidence and reflect upon your learning. This reflective evidence will help to; identify your achievement of the learning outcomes in University and in practice, direct your subsequent learning (for example, through the use of learning contracts or independent study), assist you in evaluating your progress, and inform your Mentor s final verification of competence to prescribe within your area of practice. These entries could also form the basis of reflective discussions with your prescribing mentor or practice teacher or be used as a basis for an in depth, written critical reflection using a reflective model. Reflecting on your exposure to prescribing through discussion with your prescribing mentor or practice teacher. Such reflection may take place informally or formally (during supervision for example). Keeping and submitting a record of reflective discussion either through your reflective log, supervision record or other means is recommended Reflecting on your prescribing experiences in discussion with student colleagues (during group supervision for example). Keeping and submitting a record of reflective discussion either through your reflective log, group supervision record or other means is recommended Completing and submitting a written, critical reflection using a reflective model. Whilst all the above are important, the latter is particularly valuable because critical reflection, that uses evidence and literature to underpin your reflection will help you achieve in depth learning and may help to close the theory / practice gap relatively quickly and effectively. Although the reflective essay required for this module is submitted and assessed separately to the portfolio, consider including a copy within the portfolio as evidence of critical reflection. It is impossible to be prescriptive regarding the type and number of reflections to include in your portfolio. However, there must be sufficient evidence to satisfy your prescribing mentor or practice teacher that you have used reflective practice as a 4
tool for helping you to meet your prescribing competencies. Reflective practice should chart your journey through the module. So, the nature and amount of evidence of reflection is a matter for on-going discussion and agreement with your prescribing practice teacher or mentor as your development is assessed. Remember you must use pseudonyms for individuals, families and groups to maintain and protect confidentiality. Student handbook Applying numeracy skills in prescribing practice: As a condition for gaining a place on this programme you were required to undertake and successfully complete an online numeracy test. This demonstrates that you have useful numeracy skills which you now need to be able to apply to community nurse prescribing. There will be many opportunities for you to be exposed to the use of numeracy in prescribing and to apply and develop your numeracy skills. It may be useful to reflect upon these and to action plan any on-going numeracy needs. Numeracy activities are available on Moodle. The following questions have been formulated in conjunction with prescribing mentors and practice teachers. Please demonstrate your numeracy skills, evidencing how you have arrived at your answer. Remember, the NMC stipulate that if you fail to correctly answer any question that may result in direct harm to a patient / client, you must be referred. This includes incorrect dosage. Question 1 A patient is requires 300mg of drug A to be taken at breakfast and lunchtime and a dose of 450mg in the evening. How many grams per day does the patient take? Question 2 Drug B is prescribed as 2.5mls twice daily for 2 weeks. How many mls of the drug should be prescribed? Question 3 A patient requires a wound to be dressed on alternate days. The regime consists of dressing C ( 1.55) and dressing D ( 3.50). How many dressings need to be prescribed for eight dressing changes and how much is the total cost? Prescribing for children and young people: The NMC stipulate that all nurse / midwife independent / supplementary prescribing programmes incorporate an additional learning outcome to ensure that on successful completion of the programme you can take an appropriate history, undertake a clinical assessment and make an appropriate diagnosis having considered the legal, cognitive, emotional & physical differences between children and adults. In addition the NMC stipulate that the assessment must demonstrate your recognition of the unique implications and developmental context of the 5
anatomical and psychological differences between neonates, children and young people. As the NMC state that any assessment should take place in the work context, you are required to evidence this additional learning outcome within the portfolio of evidence. In support of your learning in respect of prescribing for children and young people: It is strongly recommended that you gain exposure to prescribing for children and young people in the context of your work setting. If this is difficult you may need to consider spending time with a nurse who regularly prescribes for children and young people in a community setting. Consider therefore discussing with your mentor / practice teacher the possibility of a spoke placement with a nurse prescriber who may be working as, a community based nurse practitioner, a paediatric community nurse, a practice nurse, a community staff nurse on a health visiting team with or a health visitor. When planning such a spoke placement it is important to clearly state what you are hoping to achieve, as some activities undertaken by community nurse prescribers are more likely to result in exposure to prescribing than others. In this section you must evidence learning outcome 10: In respect of children, take an appropriate history, undertake a clinical assessment and make an appropriate diagnosis having considered the legal, cognitive, emotional and physical differences between children and adults. Read the following scenario and answer the questions below. NB There is no specified word count You are undertaking a routine, two month development check for John. During the assessment, his mother (Jane) identifies that John has developed a dry, redden area in the crease of his neck. On examination you identify and diagnose infantile eczema and need to prescribe accordingly. Consider the following: Question 1: How would you adapt your consultation and communication style to take an appropriate history from John? Underpin the rationale for your approach with supporting literature. Question 2: What factors would you need to consider when undertaking a clinical assessment of John and why? It may help to consider the legal, policy and ethical aspects that underpin clinical assessment in respect of an infant. Question 3: Explain how you would be able to make a diagnosis of eczema. Underpin your explanation with reference to the evidence base Question 4: What treatment could you prescribe for John? Justify your choice with reference to the evidence base, consider cost and efficiency. 6
Question 5: How would you ensure that the product prescribed was effective and appropriate? Finally: Write a prescription for the product you are to prescribe using a sample FP10 Guidance for writing a prescription: Please note the additional guidance re prescription writing produced by the NMC in the Standards of proficiency for nurse and midwife prescribers (NMC, 2006 p 43) Prescriptions must be written legibly and in ink, they should be dated, state the full name and address of the patient / client and be signed in ink by the prescriber. It is a legal requirement to state the age of a child under 12 years for a prescription of a prescription only medicine (POM) The names of drugs and preparations must be written clearly using approved titles only and not abbreviations. For further guidance on writing a prescription, see prescription writing in the British National Formulary Computer-generated prescriptions may be used; however you must be competent to write a prescription by hand. Remember, the NMC stipulate that if you fail to correctly answer any question that may result in direct harm to a patient / client, you must be referred. This includes failure to ask about medication history, allergies, any over the counter medication, or incorrect dosage / prescribing of an unlicensed product. Furthermore in respect of prescribing for children and young people if there is any doubt about your ability to demonstrate knowledge skill and competence in any of the areas stipulated, further training in relevant aspects of the legal, cognitive, emotional and physical differences between children and adults and in taking an appropriate history, undertaking a clinical assessment and making an appropriate diagnosis for a child, will need to be undertaken prior to completing a prescribing course. 7
Reflective Log Use this as a basis to evidence and reflect upon your learning. This evidence will help to; identify your achievement of the learning outcomes in University and in practice, direct your subsequent learning (for example, through the use of learning contracts or independent study), assist you in evaluating your progress, and inform your Mentor s final verification of competence to prescribe within your area of practice. These entries could also form the basis of reflective discussions with your prescribing mentor or practice teacher or be used as a basis for an in depth, written critical reflection using a reflective model. Date Evidence / Activity (Brief description of prescribing situation encountered) Key Reflective points Feel free to type in the boxes Action needed to ensure further learning (may include increasing knowledge of specific medicines or products) 8
Non Medical Prescribing Competency Assessment Document & Statement of Competencies
Domain A: The consultation NPC competency 1: Knowledge The student has an up-to-date clinical, pharmacological and pharmaceutical knowledge relevant to own area of practice. 1. Understands the conditions being treated, their natural progress and how to assess their severity. 2. Understands different non-pharmacological and pharmacological approaches to modifying disease and promoting health, identifies and assesses the desirable outcomes of treatment. 3. Understands the mode of action and pharmacokinetics of medicines and how these mechanisms may be altered (e.g. by age, renal impairment), and how this affects treatment decisions. 4. Understands the potential for adverse effects and how to avoid/minimise, recognise and manage them. Achieved (PT/ mentor signature) 5. Uses up-to-date information about relevant products (e.g. formulations, pack sizes, storage conditions, costs). 6. Applies the principles of evidence-based practice, including clinical and cost-effectiveness. 7. Aware of how medicines are licensed, sourced and supplied, and the implications for own prescribing. 8. Knows how to detect and report suspected adverse drug reactions. 9. Understands the public health issues related to medicines and their use. 10. Appreciates the potential for misuse of medicines. 11. Understands antimicrobial resistance and the roles of infection prevention, control and antimicrobial stewardship measures 1
NPC competency 1 Assessment Initial Formative Assessment Date: Mid point Formative Assessment Date: Final Summative Assessment Date:
NPC competency 2: Options The student makes or reviews a diagnosis, generates management options for the patient and follows up management. Competency 1. Takes an appropriate medical history and medication history which includes both current and previously prescribed and non-prescribed medicines, supplements and complementary remedies, and allergies and intolerances. Achieved (PT/ mentor signature) 2. Undertakes an appropriate clinical assessment using relevant equipment and techniques. 3. Accesses and interprets relevant patient records to ensure knowledge of the patient's management. 4. Makes, or understands, the working or final diagnosis by considering and systematically deciding between the various possibilities (differential diagnosis). 5. Requests and interprets relevant investigations. 6. Considers all treatment options including no treatment, non-pharmacological interventions and medicines usage. 7. Assesses the effect of multiple pathologies, existing medication, allergies and contraindications on management options.
NPC competency 2: Options The student makes or reviews a diagnosis, generates management options for the patient and follows up management. 8. Assesses the risks and benefits to the patient of taking or, not taking a medicine or treatment. Achieved (PT/ mentor signature) 9. Where a medicine is appropriate, identifies the different options. 10. Establishes and maintains a plan for reviewing the therapeutic objective, discharge or end point of treatment. 11. Ensures that the effectiveness of treatment and potential unwanted effects are monitored. 12. Makes changes to the treatment plan in light of on-going monitoring and the patient's condition and preferences. 13. Communicates information about medicines and what they are being used for when sharing or transferring prescribing responsibilities/information.
NPC competency 2 Assessment Initial Formative Assessment Mid point Formative Assessment Final Summative Assessment Date: Date: Date:
NPC competency 3: Shared decision making (with parents, care-givers or advocates where appropriate) The student establishes a relationship based on trust and mutual respect. Recognises patients as partners in the consultation. 1. Identifies and respects the patient s values, beliefs and expectations about medicines. Achieved (PT/ mentor signature) 2. Takes into account the nature of peoples diversity when prescribing. 3. Undertakes the consultation in an appropriate setting taking account of confidentially, dignity and respect. 4. Adapts consultations to meet needs of different patients (e.g. for language, age, capacity, physical or sensory impairments). 5. Deals sensitively with patients' emotions and concerns about their medicines. 6. Creates a relationship which does not encourage the expectation that a prescription will be supplied. 7. Explains the rationale behind and the potential risks and benefits of management options.
NPC competency 3: Shared decision making (with parents, care-givers or advocates where appropriate) The student establishes a relationship based on trust and mutual respect. Recognises patients as partners in the consultation. 8. Works with patients to make informed choices about their management and respects their right to refuse or limit treatment. 9. Aims for an outcome of the consultation with which the patient and prescriber are satisfied. Achieved (PT/ mentor signature) 10. When possible, supports patients to take responsibility for their medicines and self-manage their conditions. 11. Gives the patient clear accessible information about their medicines (e.g. what it is for, how to use it, where to get it from, possible unwanted effects). 12. Checks patient s understanding of and commitment to their management, monitoring and follow-up. 13. Understands the different reasons for non-adherence to medicines (practical and behavioural) and how best to support patients. Routinely assesses adherence in a non-judgemental way.
NPC competency 3 Assessment Initial Formative Assessment Date: Mid point Formative Assessment Date: Final Summative Assessment PT/SPM Signature:... Student Signature:..... Date:.... Student comment: Student comment: Student comment:
Domain B: Prescribing Effectively NPC competency 4: Safe The student is aware of own limitations. Does not compromise patient safety. 1. Knows the limits of their own knowledge and skill, and works within them. Achieved (PT/ mentor signature) 2. Knows when to refer to or seek guidance from another member of the team or a specialist. 3. Only prescribes a medicine with adequate, up-to-date awareness of its actions, indications, dose, contraindications, interactions, cautions, and side effects (using, for example, the BNF/BNFC). 4. Accurately calculates doses and routinely checks calculations where relevant, for example for children. 5. Keeps up to date with advances in practice and emerging safety concerns related to prescribing. 6. Knows about common types of medication errors and how to prevent them. 7. Ensures confidence and competence to prescribe are maintained. 8. Makes accurate, legible and contemporaneous records and clinical notes of prescribing decisions. 9. Effectively uses the systems necessary to prescribe medicines (e.g. medicine charts, electronic prescribing, decision support).
NPC competency 4 Assessment Initial Formative Assessment Date: Mid point Formative Assessment Date:... Final Summative Assessment Date:... Student comment: Student comment: Student comment:
NPC competency 5: Professional The student ensures prescribing practice is consistent with scope of practice, organisational, professional and regulatory standards, guidance and codes of conduct. 1. Accepts personal responsibility for prescribing and understands the legal and ethical implications of doing so. 2. Makes prescribing decisions based on the needs of patients and not the prescriber s personal considerations. 3. Knows and applies legal and ethical frameworks affecting prescribing practice (e.g. misuse of drugs regulations, prescribing of unlicensed/off label medicines). 4. Takes responsibility for own learning and continuing professional development. 5. Maintains patient confidentiality in line with best practice and regulatory standards and contractual requirements. Achieved (PT/ mentor signature)
NPC competency 5 assessment Initial Formative Assessment Date: Mid point Formative Assessment Date:... Final Summative Assessment Date:...
NPC competency 6: Always improving The student actively participates in the review and development of prescribing practice to optimise patient outcomes. Achieved (PT/ mentor signature) 1. Learns and changes from reflecting on practice. 2. Shares and debates own and others prescribing practice, and acts upon feedback and discussion. 3. Acts upon colleagues inappropriate prescribing practice using appropriate mechanisms. 4. Understands and uses tools to improve prescribing (e.g. review of prescribing data, audit and feedback). 5. Reports prescribing errors and near misses, reviews practice to prevent recurrence. 6. Makes use of networks for support, reflection and learning.
NPC competency 6 assessment Initial Formative Assessment Date:... Mid point Formative Assessment Date: Final Summative Assessment Date:...
Domain C: Prescribing in context NPC competency 7: The health care system The student understands and works within local and national policies, processes and systems that impact on prescribing practice. The student recognises how own prescribing impacts on the wider healthcare community. 1. Understands and works within local frameworks for medicines use as appropriate (e.g. local formularies, care pathways, protocols and guidelines). 2. Understands the need to work with, or develop, safe systems and processes locally to support prescribing, for example, repeat prescribing, transfer of information about medicines. 3. Works within the NHS/organisational or other ethical code of conduct when dealing with the pharmaceutical industry. 4. Understands budgetary constraints and prioritisation processes at local and national level (health-care resources are finite). 5. Understands the national frameworks for medicines use (e.g. NICE, SMC, AWMSG and medicines management/optimisation). 6. Prescribes generically where appropriate, practical and safe for the patient. Achieved (PT/ mentor signature)
NPC competency 7 assessment Initial Formative Assessment Date: Mid point Formative Assessment Date:... Final Summative Assessment Date:...
NPC competency 8: Information The student knows how to access relevant information can use and apply information in practice. 1. Understands the advantages and limitations of different information sources available to prescribers. Achieved (PT/ mentor signature) 2. Accesses relevant, up-to-date information using trusted evidence-based resources 3. Regularly reviews the evidence base behind therapeutic strategies
NPC competency 8 assessment Initial Formative Assessment Date:... Mid point Formative Assessment Date:... Final Summative Assessment Student Signature:..... Date:...
NPC competency 9: Self and others The student works in partnership with colleagues for the benefit of patients. Is self-aware and confident in own ability as a prescriber. 1. Thinks and acts as part of a multidisciplinary team to ensure that continuity of care is developed and not compromised. Achieved (PT/ mentor signature) 2. Establishes relationships with other professionals based on understanding, trust and respect for each other's roles in relation to prescribing. 3. Recognises and deals with pressures that might result in inappropriate prescribing (for example, pharmaceutical industry, media, patient, colleagues). 4. Negotiates the appropriate level of support and supervision for role as a prescriber. 5. Provides support and advice to other prescribers where appropriate.
NPC competency 9 Self and others Initial Formative Assessment Date: Mid point Formative Assessment Date:... Final Summative Assessment Date:...
Statement of Clinical to undertake prescribing as a Community Nurse Prescriber (V100) Student Prescriber s Name:. Practice Mentor:. I have assessed the above in practice as meeting all of the programme competencies, and to be a safe Nurse prescriber from the Nurse Prescribers Formulary for Community Nurses (NPFCP) in their current area of professional practice. Mentor signature:.. Qualifications: NMC PIN Number:.. Date:. Practice address: