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1. NCNM Open Day 27th November 2007 Nurse Prescribing Implications for the ANP Karen Brennan ANP STGH
Emily Lockwood ANP WRH
2. Brennan & Lockwood 2007 Role of ANP
Processes required for Prescribing
Impact on Patient Care
3. Brennan & Lockwood 2007 Advanced Nurse Practitioner Advanced Nursing Practice refers to a level of practice that maximises the use of experienced nursing skill and knowledge in meeting the requirements of the health service user
The ANP role is concerned with the provision of holistic autonomous timely clinical care
4. Brennan & Lockwood 2007 Current Practice “The basis of our health service should be that patients receive the right care from the right person in the right setting”.
Scope of Practice – notion being role expansion, with the emphasis on accountability & autonomy in practice.
5. Brennan & Lockwood 2007 Supply & Administration Guidelines “To provide, give, offer or sell a medicinal product to a patient or client under the directions of a registered medical practitioner as noted in an individual prescription or written instructions”
ABA & NCNM 2003 sought clarification
– Attorney General advised that other than controlled drugs the responsibility for procedures & controls applicable to medications rests within the hospitals & their management.
6. Brennan & Lockwood 2007
7. Brennan & Lockwood 2007 Gentamicin
CLASSIFICATION: Aminoglycoside antibiotic.
CLINICAL INDICATIONS: For the purpose of this guideline, Gentamicin is used as part of the antibiotic treatment of open fractures (local policy)
RECOMMENDED DOSE: 80mgs as a slow I/V bolus over minimum of 3 minutes, or infusion, once off dose if > 60kgs body weight, 60mgs once off dose if < 60kgs.
EXCLUSION CRITERIA: Pregnancy, renal impairment, > 65years of age, auditory problems, hepatic impairment, myasthenia gravis, hypersensitivity to gentamicin or any other Aminoglycosides, parkinsonism.
INCLUSION CRITERIA: Patients > 16 years of age , < 65 years of age. Patients agree to the administration of the medication under the protocol.
INTERACTIONS: Should not be used concurrently with other potentially nephrotoxic or ototoxic drugs: agalsidase beta, indometacin, Ciclosporin, Platinum chemotherapy agents, neuro-muscular blocking agents, Neostigmine, digoxin,Tacrolimus, and loop diuretics (eg Frusemide).
RARELY OCCURRING SIDE EFFECTS:Hypomagnesaemia on prolonged therapy, exacerbation of myasthenia gravis, pseudomembranous colitis, stomatisis, Otoxicity, nephrotoxicity, vestibular and auditory damage (at high doses or in the presence of renal impairment), transient elevation of LFTs, nausea, vomiting.
ADVERSE EFFECTS: All adverse effects must be reported to the Dr. on duty, to the Pharmacist, and to the Irish Medicines Board. An Incident/ Near miss form must be completed.
May only be supplied by Advanced Nurse Practitioners (Emergency) or Advanced Nurse Practitioner Candidates, who have participated in a recognised nurse prescribing Programme and competed IV cannulation and administration study days. Drug name, dose, route of administration, date and time must be entered on the relevant section of the patients record. A record of each patient must be kept, to facilitate audit of the efficacy of the administration.
8. Brennan & Lockwood 2007
9. Brennan & Lockwood 2007 Review of Nurses and Midwives in the Prescribing & Administration of Medicinal Products 2005
Joint Project: NCNM & An Bord Altranias
Identify benefits including:
Appropriate & safe
Convenience & greater accessibility
Improved compliance with medication
Appropriate clinical decisions
10. Brennan & Lockwood 2007 NCNM & ABA Following on from the review
Initiatives such as the provision of professional guidance in relation to agreed medication protocol & the development of an interactive e learning programme, (www.hseland.ie)
Development of Independent Nurse Prescribing
11. Brennan & Lockwood 2007 Legislative Changes
Irish Medicines Board (Miscellaneous Provisions)
Misuse of Drugs (Amendment) Regulations 2007
Medicinal Products (Prescription and Control of Supply)
Amendment) Regulations 2007
Nurses Rules 2007
Commitment to review in two years
12. Brennan & Lockwood 2007 Legal Authority This legislative change gives nurses the legal authority to prescribe medication following a programme of education.
Independently prescribe from a open formulary
Professional regulations dictate that prescribing be specific to area of practiceControlled Drugs
Schedule 8 restricted misuse of drugs (Amendment) Regulations 2007
& restrictions for prescribing schedule 4 & 5
Employer can set criteria
2007 first accredited module on nurse prescribing in Ireland facilitated RCSI & UCC.
13. Brennan & Lockwood 2007 Schedule 8 drugs Drugs for pain relief in Hospital
Morphine Sulphate, Codeine Phosphate
Drugs for palliative Care
morphine sulphate, hydromorphine, oxycodone, buprenorphine, fentanyl, methylphediate, codeine phosphate
Drugs for Midwifery
Drugs for neonatal care in hospital
Morphine sulphate, Fentanyl.
14. Brennan & Lockwood 2007 Site Development for NP
Identification of Key Stakeholders
Site declaration form
Prescribing policy document
Collaborative Practice Agreements
15. Brennan & Lockwood 2007 Site Declaration Form Identified essential criteria for site selection
policy for prescribing, risk management, quality assurance
Practice & Education Development:
collaborative practice agreements, named medical practitioner to develop CPA, mentoring arrangements,
drugs & thereupetics, firm commitment from management to support prescribing initiative,
Audit & Evaluation
16. Brennan & Lockwood 2007 Key Stakeholders The Nurse Prescriber
Drugs and Therapeutics Committee
Site Liaison Co-ordinator
Resourse & Implementation Group
17. Brennan & Lockwood 2007 Prescribing Policy Document Practice Standards
Prescribing for self, family & others,
Prescribing of unlicensed medications,
Prescribing by means of verbal, telephone, e-mail or fax,
Seperation of responsibilities in the Medication management process,
Influence of outside interests,
Communication & documentation,
Continuing professional development & continued competencies
18. Brennan & Lockwood 2007 Collaborative Practice Agreement (CPA)
Provides guidelines to the nurse/midwife, medical practitioner and health
service provider for development of the individual CPA
Details the RNP’s scope of practice including medication approval
Requires the review and approval of the employer and medical
practitioner working with nurse prescriber
For annual review
19. Brennan & Lockwood 2007 CPA Form An Bord Altranais Personal Identification Number
This is an initial collaborative agreement practice agreement (CPA) (only) when first applying for registration in the Nurse Prescriber Division) ?
Please tick the box to indicate your appropriate Division(s) on the Register:- ?
Provide brief details of academic and clinical practice experience.
Date of completion of education programme for prescriptive authority
Name of Third Level Institution:-
Employment Contact Details:- Place of Employment and Address:-
20. Brennan & Lockwood 2007 Collaborating Medical practitioner Information
Area of Medical Speciality:-
Medical Council Registration Number:-
CPA Commencement Date:-
Please specify date for review:
I declare that the above information, to the best knowledge, is true and accurate.
I declare that I have reviewed:-
1. The Hospital Policy and Procedure for Nurses/Midwives with Prescribing Authority.
2.The following An Bord Altranais documents:-
Practice Standards for Nurses and Midwives with Prescriptive Authority (An Bord Altranais 2007).
Competencies for Nurses and Midwives with Prescriptive Authority (An Bord Altranais 2007).
Requirements for Continued Competence (currently being developed).
As a Registered Nurse/Midwife prescriber, I agree to meet the requirements for continued competence as determined by An Bord Altranais and the health service employer.
Signature of Registered Nurse/Midwife Prescriber _
Signatures of Collaborating Medical Practitioner
_Signature of Authorised Representative of Health Service Employer
This document must be annually reviewed
21. Brennan & Lockwood 2007 Category of Medications Considered for Prescribing Current BHF
MDA Schedule 8
Proton Pump Inhibitors/antacid
22. Brennan & Lockwood 2007 Nurse Prescribing Changes to Clinical Practice Facilitates the provision of a complete episode of care,
Facilitates the delivery of holistic nursing care,
Legal and professional accountability,
Strengthens professional development.
23. Brennan & Lockwood 2007 Monitoring Registration with ABA
Annual review of CPA
Audit - Database
24. Brennan & Lockwood 2007 Conclusion With the introduction of prescriptive rights for Nurses and Midwives in Ireland it is evident that;
There is a requirement for legislative structures,
There is a requirement for support from policy makers and services managers,
A base of knowledge is essential,
The needs of the patient and the provision of quality nursing care must always determine the way in which nurses expand their professional role.
25. Brennan & Lockwood 2007 Education Programmes
UCC February 14th 2008 ( Rena Creedon)
RCSI 21st April 2008 (Chanel Watson)
Closing date for Applications
January 11th 2008
26. Brennan & Lockwood 2007 Eligibility Employment
Voluntary and statutory services of the HSE
Support from employer to undertake the programme
Nomination & confirmation of a designated medical practitioner mentor
3 years recent post registration clinical experience (within the past 5 years)
With equivalent of 1 year fulltime experience in specific area of practice
Competencies recognized at Level 8 (NQAI framework)
Evidence of further education
Possess a competent level of information technology literacy.
27. Brennan & Lockwood 2007 Recommended Reading Review of Nurses & Midwives in the Prescribing & Administration of Medicinal Products - Summary (An Bord Altranais & National Council for the Professional Development of Nursing & Midwifery, 2005)
The Introduction of Nurse and Midwifery Prescribing in Ireland : An Overview ( DOHC, HSE, ABA, NCNM, 2007)