Improving care quality through NMP in the delivery of mental health services Mike Caulfield MSc, PGCE, BSc, DipHE Advanced Nurse Practitioner for Acute Care/PICU (West) Cheshire and Wirral Partnership NHS Foundation Trust

Overview National drivers NMP Standards Organisational level Individual level

National Drivers NHS Plan (2000) –Need for organisation and delivery of patient centred services –Remove boundaries –‘Devolution of power’ –Increase information technology –Patient centred systems

The issue NHS Plan (2000) –1999 – 5500 patients over the age of 75 ready fro discharge from acute care but still occupying a bed –Nearly 25% were waiting for TTO medication to be prescribed by a ward doctor –More timely if prescribed by a nurse or pharmacist

Aims of NMP Improve patient care without compromising patient safety Make it easier for patients to get the medicines they need Increase patient choice in accessing medicines Make better use of the skills of health professionals Contribute to the introduction of more flexible team working across the NHS. (DOH 2006)

Standards Standard of safe and effective practice –Discharge their duty of care –Observe U.K. law –Operate within the limits of their professional competence –Maintain professional knowledge and competence –Obtain patient consent for treatment –Hold appropriate professional indemnity insurance.

Standards Standard of care – prescribing practice –Being adequately prepared for the role Attending approved prescribing training –Observing professional standards of care

Standards Standard of care – communication –Maintaining accurate, contemporaneous patient records –Being accountable for any care delivery that is delegated –Ensuring that colleagues understand the boundaries of prescriber roles, and specifically, Non-Medical Prescriber roles.

The organisational perspective Mental Health Trust –Undertakes the national guidance –MP16: Non medical prescribing policy –Endorsement Deputy director of nursing and therapies Chief Pharmacist Line Manager

Organisational Quality Objectives Adhere to NMP principles Set out an accountability framework for practice Outline the application process to become a non-medical prescriber –Psychopharmacology Ensure that all staff follow standard polices and procedures when prescribing Provide a standard for NMP within CWP that provides an auditable process –Inpatient Safety Metrics Ensure that all non-medical prescribers within CWP are aware of their roles, responsibilities and limitations.

Example of Audit Inpatient Safety Metrics –Medicines Management Accurate demographic information Legibility Prescription Information Omissions documented accurately Discontinuation Indication and Max Dose for PRN Reason for PRN clearly documented

Individual Level ANP and NMP within Acute Inpatient Care –Case load basis –Assessment Holistic assessment –Formulation –Intervention Nursing Pharmacological –Evaluation –Discharge/Signposting

NMP within recovery Collaborative working –Communication –Consultation Assessment process History taking –Patient Choice Previous prescriptions Information sharing

NMP within recovery Insight Concordance Psychosocial approach Regular review/evaluation Efficacy Side effects

NMP and the MHA Engagement Best Interest Prescribing Safe prescribing –HDAT –MDT working –Open dialogue –Carer liaison

Case Study 23 year old male H/O low mood, alcohol and drug use Previous admission 2014 –Diagnosis of mental and behavioural disorder due to alcohol – harmful use CBT 2011 Social stressors

Case study Admitted March 2015 –Low mood –Anxiety –Suicidal ideation, intent and plans –Alcohol use

Case Study History taking Assessment –Mood –Alcohol Use Formulation –Time line Mood preceded alcohol use

Prescribing Anti-depressant –Prescribed by GP –Non-effective –Psycho-edcuation –Evaluation –Amendments Detoxification –SADQ –Chlordiazepoxide

Outcome Abstinence Efficacy of anti-depressant Psycho-education –Medication –Alcohol use Accommodation –Voluntary work –Recovery

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