1. The nurse’s role & responsibilities
Ann Norman
RCN Professional Lead - Learning Disability Nursing & Criminal Justice Nursing

2. Why does this apply to me?
Nurses:
Administer medication including PRN
Prescribe medication
Observe and monitor effects
Assess and devise care plans to support people who may be experiencing behaviour distress and presenting challenges to services
Work closely with the person and their family supporting medication management including self administration
Use their own professional judgement and leadership

3. Facts
Between :
13% of people with learning disabilities (around 23,800 people) were being prescribed anti-psychotic medication in the absence of a psychotic illness
10% were been prescribed anti-depressants in the absence of depressive illness (roughly 19,500 people) (Glover and Williams 2015)

4. Medication – safeguarding aspect
Inappropriate use of any form of restrictive physical intervention or restraint can constitute assault or negligence. This is also true of chemical restraint where its use is not appropriately. (BILD).
NMC ‘by act or omission…’
Overuse of medication in places like Winterbourne View has brought this issue into sharp focus.
We are not ‘demonizing’ medication use when it IS necessary.

5. Revalidation for nurses
Revalidation is the new process that all nurses and midwives in the UK will need to follow to maintain their registration with the NMC.
Taking effect from April 2016, revalidation is straightforward and will help you to demonstrate as a nurse or midwife that you practise safely and effectively. It will encourage you to reflect on your role and your practice
RCN resources available from the website.

6. NMC Code of Conduct Prioritise people
You put the interests of people using or needing nursing or midwifery services first.
You make their care and safety your main concern and make sure that their dignity is preserved and their needs are recognised, assessed, and responded to.
You make sure that those receiving care are treated with respect, that their rights are upheld and that any discriminatory attitudes and behaviours towards those receiving care are challenged. (RCN – ‘Raising concerns, raising standards’ guidance )

7. So what about the inappropriate use of psychotropic medication?
Is this in the interest of the person?
Don’t be afraid to use YOUR skills and YOUR judgement
Make sure you work collaboratively
Raise your concerns professionally and give your reasons clearly
Seek advice when you are not sure

8. How can nurses help?
Nurses have opportunity to support the person, and their behavioural needs, in ways that are not reliant on the inappropriate use of medication.
Nurses work closely with the person and their family and are able to provide support through the process of reducing the use of inappropriate medication.
Nurses often accompany people to outpatients or primary care where prescriptions are issued or amended.
Nurses can help gather resources and support for the person and their family to reduce the risk of crisis and enable them to manage behavioural distress. Good assessment and care planning to attend to behavioural needs in a positive way.

9. RCN Resources to help you
Accountability and delegation
Quality & Safety bulletins ( incl. revalidation pages)
Principles of Nursing Practice
Publications
RCN Advice guides: general guidance, care homes, CDs, Babies and CYP, neuroleptic & anti- psychotic meds
RCN forums expertise and networks
RCN regional teams
RCN professional leads