Non-Medical Prescribing Practice Based Learning and Assessment

NMP course: overview Theory: Practice: 12 days (90 hours) 9 days classroom attendance 16 days virtual attendance ½ day Viva/Practical Skills examinations Practice: 12 days (90 hours) Total 38 days over a 18/19 week period

Points to consider… Blended learning course, students require to fulfil all elements totalling 38 days Generic course Principles to be applied to student’s area of practice

Assessments Nurses and AHPs: Pharmacists: Pharmacology - Numeracy and pharmacology exam Work Based Learning - OSCE and viva Principles of Prescribing module - Competency Profile and portfolio Pharmacists: Practical Skills assessment / viva Competency Profile Portfolio

What is a designated medical practitioner expected to do? (NPC, 2005) Provide dedicated time and opportunities for student’s observation of the DMP’s own expert conduct of a consultation with patients and/or carers and the development of a management plan Allow opportunities for the student to carry out consultations whilst supervised by the DMP and suggest clinical management and prescribing options, which are then discussed with the DMP Plan a learning programme with opportunity for the student to meet learning objectives and gain competency – confirm this using learning contracts

What is a designated medical practitioner expected to do? (NPC, 2005) Facilitate learning by encouraging critical thinking and reflection by the student on their own practice Take opportunities to allow discussion of clinical management, when patient care and prescribing behaviour can be examined further Help ensure that the students integrate theory with practice

What is a designated medical practitioner expected to do? (NPC, 2005) Assessment Verification of competence of student to assume a prescribing role All practice documentation is retained for 7 years

DMP Mentor Role supporting Learning in Practice Personal formulary development Clinical skills (pharmacists only) Learning contracts Practice log Assessment of supervised consultations Competency profile

Legal parameters for Non-Medical Prescribing Independent Nurse prescribers (V300) – BNF (with exceptions for treatment of addiction) Independent Pharmacist prescribers – BNF (with exceptions for treatment of addiction) Supplementary prescribing AHP Supplementary prescribers AHP Independent prescribers (restrictions on use of CDs) Independent Community Nurse (V100, V150) prescribers - Nurse Prescribers’ Formulary

Supplementary prescribing Independent Prescriber (doctor or dentist) Supplementary (initially non-medical, dependent) Prescriber Tri-partite agreement including patient Clinical Management Plan Template Supplementary Prescriber prescribes within range stated on CMP Periodic review by Independent Prescriber

Personal (P) formulary Negotiate and identify priorities for prescribing practice During the programme develop competence and confidence in prescribing these medicines Identifies specific medicines (or may identify groups) No minimum or maximum number Add to this list by continuing negotiation

Personal (P) formulary Focus for learning during the programme Portfolio evidence should present only drugs identified in Personal Formulary Formulary relates to role and competence, registrant’s own boundaries to practice Cognisant of legal parameters for prescribing

Learning contracts Identify: What the student needs to know How they will acquire knowledge How new knowledge / new skill will be recognised and evaluated Suggest start with Learning Outcome 1 Develop a learning contract for each of the Learning Outcomes

Supervised clinical consultations Mid-point formative DMP must be present Opportunity for formative feedback Use guidelines provided Complete assessment record provided DMP to elicit patient views and record End-point summative (pharmacists) or OSCE (nurses and AHPs) DMP must be present Opportunity for assessment of competence Must be video-recorded Use guidelines provided Complete assessment record provided DMP to elicit patient views and record

Practical skills (pharmacists only) Identify clinical skills required (may include e.g. hand washing, accurate recording of temperature, pulse and blood pressure, venepuncture, respiratory examination) Theoretical principles Practise Confirmation of competence

DMP Mentor Role supporting Assessment in Practice Completion of practice logs Supervised consultation records Mid-point formative End-point summative (pharmacists) or OSCE (nurses and AHPs only) Competency profile

OSCE assessment in practice (nurse and AHP students only) Patient consultation Assessed by DMP (therefore DMP must be present) Video recorded Write accompanying prescription (marked by tutors) Submit by 26th April 2017 Programme team to review (prep for viva)

Competency profile Initial development by National Prescribing Centre (2012) Recent review published in July 2016 Competencies as: combinations of knowledge, skills, motives and personal traits related to effective performance

A competency framework for all prescribers (RPS, 2016) THE CONSULTATION PRESCRIBING GOVERNANCE Assess the patient Consider the options Reach a shared decision Prescribe Provide information Monitor and review Prescribe safely Prescribe professionally Improve prescribing practice Prescribe as part of a team

Student Competency Profile All competencies to be achieved Initial review by 6th February 2017 Mid-point, formative assessment by 20th March 2017 End-point, summative assessment by 16th May 2017 Submission by 16th May 2017 Is this completed appropriately for external scrutiny... ? (consider external examiners, investigating managers, courts...)

Role of the DMP mentor: summary Clinical expert, teacher and supervisor Supporting appropriate levels of confidence Formative feedback Assess competency as a prescriber in practice by Competency Profile (Nurse and AHP students only) - assess student’s competency as a prescriber in practice by O.S.C.E.

What should a DMP with doubts about the student’s competence? Discussion with student Contact with the student’s Personal Tutor Formation of action plan in conjunction with PT and student Review of action plan at specified intervals Discussion with student’s manager and / or NMP Lead Failing to fail??

Resources available Flow chart (timeline) OSCE criteria and guidelines (for nurses and AHP students only) NPC medical mentor’s guide (previously under review) Webfolio: http://tiny.cc/nmpmentorsguideuoc Student - who should be able to guide DMP Other DMP mentors Programme team

NMP Course Team Claire Callaghan, Nurse, Programme Leader claire.callaghan@cumbria.ac.uk Anna Billing, Nurse anna.billing@cumbria.ac.uk Kay Donnellon, Nurse kay.donnellon@cumbria.ac.uk Janine Hill, Nurse janine.hill@cumbria.ac.uk Mark Magas, Pharmacist mark.magas@cumbria.ac.uk Mark Stigant, Physiotherapist mark.stigant@cumbria.ac.uk

Information sources Supplementary prescribing http://webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/en/Healthcare/Medicinespharmacyandindustry/Prescriptions/TheNon-medicalPrescribingProgramme/Supplementaryprescribing/index.htm Prescribing controlled drugs changes http://www.dh.gov.uk/health/2012/04/prescribing-change/ Pharmacist independent prescribing FAQ (online archive) http://webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/en/Healthcare/Medicinespharmacyandindustry/Prescriptions/TheNon-MedicalPrescribingProgramme/Independentpharmacistprescribing/DH_4133943 Nurse prescribing FAQ (online archive) http://webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/en/Healthcare/Medicinespharmacyandindustry/Prescriptions/TheNon-MedicalPrescribingProgramme/Nurseprescribing/DH_4123003 Outline Curriculum Framework for Education Programmes to prepare Physiotherapists, Podiatrists and Therapeutic Radiographers as Independent/Supplementary prescribers and to prepare Diagnostic Radiographers and Dieticians as Supplementary Prescribers http://www.ahpf.org.uk/files/Outline%20Curriculum%20Framework.pdf A Competency Profile for all Prescribers http://www.rpharms.com/support-pdfs/prescribing-competency-framework.pdf Training Non Medical prescribers in practice http://www.webarchive.org.uk/wayback/archive/20140627112130/http://www.npc.nhs.uk/non_medical/resources/designated_medical_practitioners_guide.pdf