1. Extending nursing roles through protocols and standing orders workshop Gpnz/rnzcgp conference Auckland 4/9/2011 D5 12.00 – 13.00

2. Expected learning outcomes Participants will be aware of the risks and benefits or implementing protocols/standing order prescriptions in their primary care setting. Participants will be able to develop a protocol/standing order for implementation in their primary care setting.

3. Process Introductions what is your experience with SO care? (5 mins) Brief presentation about protocols / standing orders definitions and legislation. (10 mins.) Activity one – “evaluate”. In groups of 6-8 look at the standing order process and template, compare it to the legislation, are there any gaps? What else would you add? (15 minutes) Activity two – “create”. In groups of 6-8, develop a standing order around the prescription of flucloxacillin for impetigo MMR vaccine in a 4 yr old child. (15 min) Present to the larger group, compare standing order processes developed.(15mins.) Did we cover the bases?

4. What do you want to get out of this session ?

5. Protocols / standing orders definitions legislation Protocol – an agreed process for evaluation and management of specific patient groups. Standing order - a written agreement between a registered prescriber and another non prescribing health professional, allowing the administration of a medicine for a specific purpose to a defined population.

6. Medicines (Standing Order) Regulations 2002 A standing order is a written instruction issued by a medical practitioner or dentist, in accordance with the regulations, authorising any specified class of persons engaged in the delivery of health services to supply and administer any specified class or description of prescription medicines or controlled drugs to any specified class of persons, in circumstances specified in the instruction, without a prescription.

7. Davis P, Lightfoot R, Finn E, Lay-Yee R, Gribben B, McAvoy B. Practice nurses in the Waikato, 1991- 1992: What was their patient mix and pattern of care?. New Zealand Family Physician. 1999 1999;26:50-4. EncountersNurseGP Sole9017811 Shared2852346 Total118610157 % Shared24%23%

8. Jenkins-Clarke S, Carr-Hill R, Dixon P. Teams and seams: skill mix in primary care. J Adv Nurs. 1998 Nov;28(5):1120-6.

11. Outcomes when nurses use protocol driven care in primary care settings : safe, effective, and with high levels of patient satisfaction. Back Pain (1) Headaches (2) Dysuria, frequency, vaginal discharge (3) Diabetes (4) Chronic ear disease (5) Sore throats (6) URTI (7) Asthma (8) Heart Disease (9)

16. Legislation Must state the reason the so is necessary, the level of expertise required of the administrator, the arrangements for review of the encounter and the so process. Must be accompanied by a document supporting the use - a protocol. Must include details of monitoring, side effects, interactions, contraindications. Review by an agreed arrangement, not required for every encounter. Does not allow administrator to pp sign prescriptions. No limit on the medications covered, determined by the need and the training of the people involved.

17. “Debate” Develop a list of “pros and cons” to the use of standing orders. Consider implications for the patient, the nurse, the prescriber, and society.

18. Create A standing order for the provision of flucloxacillin to a 4 year old child who presents with a weepy non healing scab.

19. Evaluate Are you more aware of the risks and benefits or implementing protocols/standing order prescriptions in primary care settings? Are you able to develop a protocol/standing order for implementation in your primary care setting?