Non-Medical Prescribing Programmed – Nursing Assignment Help

Assignment Task

Task

The Medicines Act is legislation dating from 1968, this legislation allows doctors, dentists, and other allied health professionals (AHP) to prescribe.  Since the legislation, there have been many developments within the National Health Service (NHS), that have required the legislation to be changed.  Nuttall & Rutt-Howard (2020) suggested that non-medical prescribing has been developing since 1968.  With the NHS changing at a fast rate, the increased need for advanced nursing roles in the would prove cost-effective. Creeden, Byrne, Kennedy & McCarthy (2015) concur, that the increase in specialist nursing through independent nurse prescribers (INP) can be utilised, to support increasing demands on the NHS.  Courtney & Griffiths (2010) also suggests that the delivery of care within the NHS is constantly changing. To meet the demands of this the use of non-medical prescribers (NMP) is either through advanced nurses or allied health professionals.  The Royal College Nursing (RCN) (2014) suggest that over the past decade nurse prescribing has grown, is and this mainly due to support and substantive legislation reforms that have encouraged the non-medical prescribing role.  Since recommendations from the Cumberlege report in 1986 put forward that community nurses could prescribe from a limited formulary. Pooler (2021) suggests that, since the publication of the report in 1986 to review the care that patients were given in their own homes and to give community nurses the right to prescribe. This would help reduce the general practitioner (GP) workload. Cumberledge also pushed for independent nurse prescribers to be able to prescribe from the British National Formulary (BNF). There are disadvantages to nurses and allied health professionals being able to prescribe, an increased prescribing workload can also put pressure on the NMP, there may be a higher chance of litigation.  McHale (2003) concurs that with greater responsibility there is a greater chance of litigation. 

The medicines act (1968) advocates those medicines should be constrained to what the medicine was licensed for, working within these constraints gives governance of safety, efficacy and gave protection to who prescribed the medication. A change in guidance came in 2009 when the Medicines and Healthcare Regulatory Agency (MHRA) gave licence for nurse prescribers to prescribe off licence, this gave nurse prescribers the freedom to prescribe medications off label within their clinical practice.  

The department of Health (DOH) (1999) made recommendations that other groups of allied health professionals (AHP) would be able to independently prescribe, which in turn would improve patient care and safety.  The NMP knowledge of the professional, legal and ethics enable them to have the ability to be a safe prescriber.   Prescribing rights for nurses can be seen as continuing development, the intention is to provide high standards of care, thus ensuring safeguarding the public. Nurses, midwives, and other allied health professionals work within their professional autonomy, holding a prescriber’s qualification significantly demanding a high standard of professional responsibility.   Nuttall & Rutt-Howard (2020) endorse this, by suggesting that accountability is misconstrued by healthcare professionals, and accountability is a measure of liability.  Evidence-based practice (EBP) is an integral part of all health care professionals continuing development.  Nuttall & Rutt-Howard (2020) advocate that it is clearly stated within the guidance from each of the non-medical prescriber’s codes of conduct that the NMP uses evidence-based practice.  With relevant training and access to a refined formulary to practise from non-medical prescribing to evolve, Creedon et al (2015) recognised that there has been a change in service provision, and this is due to the increased registration of the NMP.  The recognition of diversity of clinical roles within its, this has helped practitioners support the changing provision of care and this is apparent with the number of nurses wanting to train in advanced nursing skills, this was identified in the governments white paper that was published in 2006. Medical prescribers are required to work within their professional conduct.  The intention is to provide high standards of care to patients, thus safeguarding the public.  Allied health professionals work within a significant amount of professional autonomy and by holding a prescriber’s qualification, significantly demands a higher standard of professional responsibility.  

In 2001 the misuse of drugs act was produced, this was legislation that excludes certain activities with the prescribing of controlled drugs, their manufacture, supply, and possession.  Barber & Robertson (2020) suggest that there is a great deal of legislation surrounding the prescribing, storage, supply and storage and administration of drugs.  The misuse of drugs act (2001) has five attached schedules, the act suggests that the use of medicines should be constrained to their safety, efficacy and give legal protection to the prescriber.   

Learning Outcome 2

L6- 2  Critically review the importance and role of record-keeping in the context of medicines management and in developing clinical management plans. 
            Develop and evaluate a clinical management plan within the context of a prescribing partnership 

Record keeping is important as it forms good communication, and it documents the evidence of the nursing care that has been provided. NMC (2015) uphold this by suggesting that the accuracy of record-keeping is an integral part of safe practice.  Prideaux (2011) concurs with this by suggesting that good patient record keeping is linked with improvements in patient care and that poor quality documentation contributes to poor quality of care.  Owen (2005) also suggest that accurate documentation is an essential component to maintain continuity, information provide provides legal evidence.  Poole (2021) highlighted that accurate information shared between the multidisciplinary team as very important.  In 1989 the Crown report documented that good record keeping and communication between healthcare professionals and the patients.  Both are factors to provide high standards of care.  Changes within the NHS and how clinical notes are recorded has changed through the year with the advent of the digital age.  There are advantages and disadvantage to this, advantages are that documentation is legible and this leads to a reduction of trying to understand what has been written.  This also reduces the risk of incorrect medication prescriptions.  This is imperative especially with critical drugs and shows the correct doses.  Good record keeping is an essential part of the nursing role. Poole (2021), the healthcare record is a tool for communication in the team. It should give clear evidence of the care planned, the decisions, the delivery of care, and shared information. This now is usually in electronic form rather than written form. The move from written documentation to electronic forms can lead to better clearer documentation as no one should interoperate the words and this would reduce mistakes. No matter how the documentation is produced part of the nursing role is to ensure that the documentation is accurate.  Nurses are increasingly being held accountable for poor record keeping according to the NMC (2012), nurses are given sanctions or being removed from the MNC register. (appendix II).

Record keeping as part of the non-medical prescribing role is imperative since within clinical management plans the documentation needs to the accurate and legible for the team to understand and know what the management plan has decided.  When forming a clinical management plan clear and concise documentation that all members of the team can understand to form the prescribing partnership.  Palstow (2006) has suggested that clinical management plans are an agreement between a healthcare professional an independent prescriber and the patient.  Poole (2021) there are no restrictions which cannot be treated in a CMP, where possible the CMP should state agreed national or local guidelines.  These plans are advantageous for patients who attend clinics regularly and as there is a joint agreement the plan can be changed at any time. Nuttall & Rutt-Howard (2020) have suggested that the plan is effective if there is agreement on the three-way partnership.  Baird (2013) suggests the CMP needs to be in place and agreed prior to the independent begins prescribing.  (appendix III &IV).  

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Learning Outcome 3

Apply a rationale, the decision-making process supporting prescription and referral as a multi-professional team member and analyse the roles and relationships with others involved in prescribing, supplying, and administering medicines.Clinical decision making is made around evidence-based practice, by completing a consultation and examination of the patient which includes current medication, allergies, and the outcome the patient is wanting to achieve can lead to effective prescribing. (Appendix V) Evidence-based practice, local policies, and protocols are useful resources in prescribing. The multidisciplinary approach to prescribing whilst undertaking this course have given me valuable guidance and by using other members of the multidisciplinary team to gather information, to enable me to make informed choices. NMC (2018) have said that to strive in accomplishing best clinical practice in clinical prescribing are made for the individual care needs. They go further to advocate that clinical practice should be integral with the best evidence-based practice available. 

On completing a consultation and examination of the patient which should include current medications, allergies, and an outcome that patient wants to achieve can lead to effective prescribing. I then take this to my mentor and give a full clinical hand over of my findings including diagnosis and any medications I would prescribe and ongoing advice. Silverston (2019) recommend that advanced and uncertain nature of illness, safe management is ensuring safety netting advice is given. Safety netting a term that is used when giving patients advise at the conclusion of the consultation. Harris & Shearer (2013) suggests that the NMP takes a detailed medical history from the patient and then use the information to make an accurate diagnosis and subsequently to manage a diagnosis appropriately if the accurate information is not obtained from the patient, then the clinical decision making is floored. A patient-nurse rapport is essential in gaining trust and the ability to make the most effective diagnosis and safe prescribing.  By completing this and developing my own systematic approach to decision making will underpin my own going practise.  Also using EBP within my own remit of patients can keep me up to date with changing practises.(appendix VI)