1. Prescribing the future for community children’s nursing Penny Franklin Lecturer/Non-medical Prescribing Lead: the University of Plymouth

2. Aim: To provide an overview of the past and current status of Non-medical Prescribing for community children’s nursing

3. Learning Outcomes At the end of the session participants will be able to: understand the Non-medical Prescribing Journey- where it has come from (brief history); recognise different prescribing rights and mechanisms; apply knowledge of prescribing to the care of children in the community.

4. Brief History Cumberledge Review 1986; Nurse Prescribing 1994; Crown Review 1998/9; Extended Formulary Nurse Prescribing 2001; Supplementary Prescribing 2003; Nurse Independent and Supplementary Prescribing 2006.

5. Who else is out there? Other Prescribers/ not nurses Doctors and Dentists as Independent Prescribers; Pharmacist Independent and Supplementary Prescribers; Physiotherapists, radiographers; Podiatrists and speech therapists as Supplementary Prescribers

6. Types of Non-medical Nurse Prescribers Nurse Independent prescribing -from the Community Practitioners’ Formulary for Nurse Prescribers (V100 and V150) V100 for nurses who hold a community specialist practice qualification-part of SPQ preparation V150 for nurses without a community specialist practice qualification for whom it would be appropriate to prescribe from the Community Practitioners’ Formulary- 10 days of face to face learning and 10 days supervised practice

7. Types of Non-medical Prescribers: continued Nurse Independent and Supplementary Prescribing (V300) 26 taught days at an accredited educational institution plus 12 days of supervised practice (DH, Medicines Matters, 2006)

8. Nurse Independent Prescribing Licensed drugs from anywhere in the BNF for Children. However many drugs are not licensed for use in children....

9. Supplementary Prescribing Voluntary partnership between Supplementary Prescriber and an Independent Doctor/Dentist prescriber, with the patients’/carers’ agreement and using an agreed clinical management plan. (DH, 2006)

10. Recent Developments Standards for Medicines Management- NMC February 2008; Replaces guidelines for the administration of medicine and available as a CD-rom from 17 th March

11. The Nursing and Midwifery Council standards of proficiency for nurse and midwife prescribers’ (NMC, 2006) ‘Only nurses with relevant knowledge, competence, skills and experience in nursing children should prescribe for children. This is particularly important in primary care (e.g. out of hours, walk-in clinics and general practice settings). Any one prescribing for a child in these situations must be able to demonstrate competence in prescribing for children and refer to another prescriber when working outside their level of expertise or level of competence.’

12. Only prescribe if clinically competent (NMC, 2006) Prescribers must fully understand the action of drugs in children and the differing physiology of children and young people. The NMC advises that registrants do not prescribe unless they have specific competence in children's nursing.

13. Additional Learning Outcome for Nurse/midwife Independent Prescribing programme. Participants on programme ‘must ensure that they can take an appropriate history, undertake a clinical assessment and make an appropriate decision based on that assessment to either diagnose or refer, having considered the legal, cognitive, emotional and physical differences between children and adults.’ (NMC, 2006)

14. Additionally Registrants must demonstrate recognition of the unique implications and developmental context of the anatomical and physiological differences between neonates, children and young people.’ (NMC Standards pg 6).

15. Preceptorship For registered prescribers who are new to prescribing for children+ if appropriate, additional education in making and assessment and diagnosis for children.

16. Responsibility It is the responsibility of the employer to ensure that the registrant is able to apply the prescribing principles to their own area of practice (NMC Standards, page 6).

17. More to come Home Office Consultation on the prescribing of controlled drugs by Nurse and Pharmacist Independent Prescribers- results awaited. http://www.homeoffice.gov.uk/documents/cons- 2007-indpreshttp://www.homeoffice.gov.uk/documents/cons- 2007-indpres

18. Prescribing for children in the community Out of hours and minor injury-mainly Nurse Independent prescribing General practice- minor illness/minor injury, complex conditions Public Health- smoking cessation, etc Long term conditions and more complex continuing care-Supplementary and or Independent prescribing

19. Supplementary Prescribing (Clinical management plans (CMPs)) The CMP must be developed in partnership between the independent medical or dental prescriber and the supplementary prescriber with the patient's agreement. It must be individualised and relate to specific medications for specific conditions, and be determined by the needs of the patient following diagnosis.

20. CMPs must take into account: The individual patient's unique medical history; Their current health status; Any other conditions they may have; Any current medication they are taking; whether prescribed or over the counter.

21. How does supplementary prescribing support community children’s nursing? Confidence and competence-development of expertise; Long term conditions; Clear framework for team prescribing; Controlled drugs which are not; listed/indicated for Nurse Independent Prescribers; Unlicensed medicines.

22. Childhood conditions where independent and Supplementary Prescribing can work Pain management Heart conditions Diabetes Other metabolic disorders Skin conditions Cystic fibrosis Juvenile rheumatoid arthritis, Asthma, Neonatal conditions, Diabetes Blood disorders

23. To find out more DH(2006) Medicines Matters: a guide to mechanisms for the prescribing, supply and administration of medicines. Association for nurse prescribing- http://www.anp.org.uk/ pfranklin@plymouth.ac.uk

24. References DHSS. (1986) Neighbourhood Nursing - A focus for care. Report of the Community Nursing Review. HMSO, London. DoH. (1998) Review of Prescribing, Supply and Administration of Medicines. A Report on the Supply and Administration of Medicines under Group Protocol. Crown Copyright. London. DoH. (1999) Review of prescribing, supply and administration of medicines. Final report. Crown Copyright, London. DoH. (2000) Consultation on proposals to extend nurse prescribing. DoH. (2002) www.doh.gov.uk/supplementaryprescribing/index.htmwww.doh.gov.uk/supplementaryprescribing/index.htm DH, (2006) Medicines Matters: a guide to mechanisms for prescribing, supply and administration of medicines. London. The Stationery Office.

25. References (continued) Nursing and Midwifery Council (2006). Standards of Proficiency for Nurse and Midwife Prescribers. London. NMC Nursing and Midwifery Council (2007) NMC Circular 22/2007. Prescribing for Children and Young People. NMC. London. Nursing and Midwifery Council (2008) Standards for Medicines Management: http://www.nmc-uk.org/Article.aspx?ArticleID=1658 accessed 09.03.08