Module NHS-3136:
Independent Prescribing

Module Facts

Run by School of Health Sciences

40 Credits or 20 ECTS Credits

Organiser: Dr Lynne Williams

Overall aims and purpose

Independent prescribing is defined as Prescribing by a practitioner who is responsible and accountable for the assessment of patients with undiagnosed or diagnosed conditions and for decisions about the clinical management required including prescribing.

Nurses, pharmacists and physiotherapists working in primary and secondary care settings would benefit from this module. It would allow health care professionals, who have both the knowledge and expertise within their particular remit and area of practice, to be able to work autonomously providing improved patient care.

This course will enable nurses, pharmacists and physiotherapists to undertake a robust training programme, in order to develop as and to meet the standards set by the Nursing and Midwifery Council (NMC), General Pharmaceutical Council ( GPhC) and The Health and Care Professions Council ( HCPC) to become competent independent/supplementary prescribers . All participants of this course will receive both theoretical assessment , and a period of supervised practice under the guidance of a trained designated medical practitioner.

The designated medical practitioner (DMP) is a registered medical practitioner who normally has at least three years clinical experience in their relevant field of practice. The DMP will be responsible for determining whether the clinical learning outcomes have been met and whether the trainee prescriber has acquired certain competencies. The DMP will provide supervision, support and opportunities to develop competence in prescribing practice. The duration of this period will be no less than 12 days in practice, which equates to 90 hours, face to face clinical teaching. There will be the requirement of the employing organisation or GP practice to support both the student and the DMP .

Course content

Ways in which medicines are selected, and procured in order to optimise the contribution that medicines make to formulate the desired outcomes of patient care. Exploration of legal issues in relation to Independent/supplementary including local policies/procedures, safe handling/disposal, accountability and assessment of risk. Prescribing ( including unlicensed drugs). Independent/supplementary prescribing in relation clinical and physical examination skills utilising a variety of diagnostic tools eg sphygmomanometer and stethoscope, including Consultation/history taking and decision making.
Clinical Pharmacology and therapeutic actions to include:- Basic principles of drug handling-absorption, distribution, metabolism and excretion Pharmacodynamics and pharmacokinetics. Adverse Drug Reactions and interactions which influences the selection of drug regimes. Recognition of the differences that changes in physiology and drug response e.g elderly, young, pregnant or breast feeding may have on prescribed drugs. 20 Impact of co-morbidities on prescribing and patient conditions. Natural history and progression of defined conditions

Assessment Criteria

excellent

• Comprehensive knowledge of the prescribing issue identified ( LO 1,2,4,5,6,7) • Detailed understanding of the subject area (1,2,4,5,6,7,9) • Extensive relevant contemporaneous background study (LO 8,9) • Highly focussed answer and well structured (LO 4.5.6,7) • Logically presented and defended arguments • No factual/computational errors (LO 2,4,5,6) • Original interpretation • New links between topics are developed (LO 1,4, 5,9) • New approach to a problem • Outstanding quality in terms of presentation with accurate use of grammar • Potentially publishable quality in terms of presentation and context

threshold

• Demonstrates the grasp of the key concepts of prescribing and an ability to support an argument in a predominantly descriptive manner (LO 1,2,4,5,6,7) • Limited evidence of background study (LO 9) • Answer only poorly focussed on prescribing issue and with some irrelevant material (LO, 4 9) • Arguments presented but lack coherence • Several computational errors • No original interpretation • Only major links between topics are described • Limited problem solving • Many weaknesses in presentation and accuracy • For PGT - Insufficient to fulfil the associated learning outcomes

C- to C+

• Knowledge of key areas/principles of prescribing (LO 1,2,4,5,6,7) • Understands the main elements of the prescribing issue identified • Limited evidence of background study (LO 9) • Answer focussed on prescribing but also with some irrelevant material (LO 4, 9) • Arguments presented but lack coherence • No original interpretation • Only major links between topics are described • Some weaknesses in presentation and accuracy

good

• Strong knowledge ( LO 1,2,7) • Demonstrates understanding of the prescribing issue (1,2,4,5,6,7,9) • Evidence of extensive contemporaneous background study ( LO 8,9) • Focussed answer with good structure (LO 4,5,6) • Arguments presented coherently • Some limited original interpretation (LO 9) • Well known links between prescribing topics are described and analysed (1,2,7) • Problems addressed by existing methods/approaches • Good presentation with accurate communication

Learning outcomes

  1. Evaluate the role of the independent/supplementary prescriber in their field of practice, be aware of own limitations and work within their own professional competence, making appropriate referrals when indicated.

  2. Understand the pathophysiology of the conditions being treated, recognise the signs and symptoms of illness, take an accurate history and carry out a relevant clinical assessment where necessary, ensuring that patient’s records are both accurate and contemporaneous

  3. Use common diagnostics aids e.g. stethoscope, sphygmomanometer where appropriate.

  4. Apply clinical assessment skills to inform a working diagnosis, formulate a treatment plan, prescribing of one or more medicines, if appropriate and carry out a checking process to ensure patient safety. Determine the rational and justify the actions taken. Consult and seek guidance if appropriate.

  5. Work within a prescribing partnership by developing an effective relationship and effective communication with patients, carer, other prescribers and members of the health care team. Demonstrate a shared approach to decision making by assessing patients needs for medicines, taking account of their wishes and values and those of their carers when making prescribing decisions.

  6. Monitor and examine responses to therapy, and review the working/differential diagnosis and modify treatment or refer or seek guidance as appropriate.

  7. Evaluate the legal, ethical and professional framework for accountability and responsibility in relation to independent/supplementary prescribing/governance/cost efficiency.

  8. Participate regularly in continual professional development and maintain a record of this activity.

  9. Evaulate sources of information both research and evidence-based and consider how these will influence their prescribing practice on an individual , local and national level, by taking into account both individual and public health needs.

Assessment Methods

Type Name Description Weight
EXAM Numeracy/calculation exam

A numeracy /calculation examination - pass mark is 100%

10
EXAM Safe Prescribing Exam

Multiple Choice Exam about the theory and principles of prescribing practice

10
LOGBOOK OR PORTFOLIO NMP Portfolio

A structured portfolio which must contain all elements specified in the NMP Portfolio Document

40
ESSAY NMP Essay

3,000 word essay based around reflections on two different Case Studies which need to be focused on prescribing issues and that show development of safe prescribing practice and evaluation of evidence based practice in relation to prescribing practice.

40

Teaching and Learning Strategy

Hours
Lecture

Lectures 15 days x 6 hours

90
Private study

Private study

220
Fieldwork

12 days x 7.5 hours clinical hours working with DMP

90

Transferable skills

  • Literacy - Proficiency in reading and writing through a variety of media
  • Numeracy - Proficiency in using numbers at appropriate levels of accuracy
  • Computer Literacy - Proficiency in using a varied range of computer software
  • Self-Management - Able to work unsupervised in an efficient, punctual and structured manner. To examine the outcomes of tasks and events, and judge levels of quality and importance
  • Exploring - Able to investigate, research and consider alternatives
  • Information retrieval - Able to access different and multiple sources of information
  • Inter-personal - Able to question, actively listen, examine given answers and interact sensitevely with others
  • Critical analysis & Problem Solving - Able to deconstruct and analyse problems or complex situations. To find solutions to problems through analyses and exploration of all possibilities using appropriate methods, rescources and creativity.
  • Safety-Consciousness - Having an awareness of your immediate environment, and confidence in adhering to health and safety regulations
  • Presentation - Able to clearly present information and explanations to an audience. Through the written or oral mode of communication accurately and concisely.
  • Teamwork - Able to constructively cooperate with others on a common task, and/or be part of a day-to-day working team
  • Mentoring - Able to support, help, guide, inspire and/or coach others
  • Caring - Showing concern for others; caring for children, people with disabilities and/or the elderly
  • Management - Able to utilise, coordinate and control resources (human, physical and/or financial)
  • Argument - Able to put forward, debate and justify an opinion or a course of action, with an individual or in a wider group setting
  • Self-awareness & Reflectivity - Having an awareness of your own strengths, weaknesses, aims and objectives. Able to regularly review, evaluate and reflect upon the performance of yourself and others
  • Leadership - Able to lead and manage, develop action plans and objectives, offer guidance and direction to others, and cope with the related pressures such authority can result in

Resources

Resource implications for students

Protected release time for both taught and clinical time

Talis Reading list

http://readinglists.bangor.ac.uk/modules/nhs-3136.html