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2016/17 Undergraduate Module Catalogue

HECS3103 Independent and Supplementary Prescribing for Nurses and Midwives

30 creditsClass Size: 30

Module manager: Catherine Gill
Email: C.Gill@leeds.ac.uk

Taught: 1 Jan to 30 Sep, Semesters 1 & 2 View Timetable

Year running 2016/17

Pre-requisite qualifications

Current registration with the Nursing and Midwifery Council (NMC) as a General Registered Nurse/Midwife
Certified evidence of ability to study at Level 3 (normally has obtained 120 credits at level 2).
At least three years' experience as a practising nurse, midwife or specialist community public health nurse. Of these three years, the year immediately preceding application to the programme must have been in the clinical field in which the applicant intends to prescribe. For part time applicants the following formula will be applied: WT = 47 weeks x 37.5 = 1762.5. Students must have worked the part time equivalent of 1762.5 over the previous 2 years.
Support of and evidence from the employer that the applicant:
- is competent to take a history, make a clinical assessment and make a diagnosis in their own field of practice OR is undertaking an appropriate programme of study to enable them to do so
- has demonstrated appropriate numeracy skills (Appendix 1)
- is in a role where there is a clinical need to justify prescribing
- is in a role that enables them to prescribe, and that the necessary infrastructure will be in place to allow them to do so
- a current Criminal Records Bureau check

Support of the Non-Medical Prescribing Lead from the sponsoring organisation e.g. a primary care organisation or NHS Trust.

Have a named Designated Medical Practitioner (DMP) who:
- has 3 years recent prescribing experience
- is within a GP practice and is either vocationally trained or is in possession of a certificate of equivalent experience from the Joint Committee for Post-graduate Training in General Practice Certificate or is a specialist registrar, clinical assistant or a consultant within a NHS Trust or other NHS employer
- has the support of the employing organisation or GP practice to act as the DMP
- will provide supervision, support and opportunities to develop competence in prescribing practice
- has some experience or training in teaching and/or supervising in practice
- Normally works with the trainee prescriber

Satisfactory application and interview

This module is mutually exclusive with

HECS3188Ind. Supplementary Prescribing
HECS5120MIndep't Prescribing for Nurses
HECS5146MIndependent and Supplementary Prescribing for Pharmacists

This module is not approved as a discovery module

Module summary

This module prepares nurse and midwives for the advanced role of Independent and Supplementary prescribing. It is taught interprofessionally with pharmacists and this is the most frequently mentioned 'ositive' element mentioned in the module evaluations. The module is 38 days in length over a period of up to 26 weeks including 12 days of clinical practice. The University taught element is completed within the first 13 weeks for all students. It is intensive, stimulating and at the leading edge of change for nurses, midwives and pharmacists. A multidisciplinary approach has been used in the development of this module with lecturers drawn from a range of academic, research and clinical backgrounds.

Objectives

The education programme aims to prepare nurses and midwives to prescribe safely, appropriately and cost-effectively as an independent/supplementary nurse prescriber.
These objectives are based in the main on the Nursing and Midwifery Council 'Standards of proficiency for nurse and midwife prescribers' 28.4.06. These are further expanded in the skills section.
The module objectives are that on completion the practitioner should be able to:

1. critically discuss and demonstrate the ability to assess and consult with patients/clients, parents and carers and assess their need for medicines
2. undertake a thorough history, including medication history and current medication (including over-the-counter, alternative and complementary health therapies) to inform diagnosis
3. conduct a relevant physical examination of patients with those conditions for which they may prescribe and apply clinical assessment skills to inform a working diagnosis and to formulate a treatment plan
4. recognise the unique implications involved in the assessment of children in all of the above domains and if appropriate, undertake an assessment based on consideration and comprehension of the legal, cognitive, emotional and physical differences between children and adults
5. understand and critically apply knowledge of drug actions in prescribing practice
6. prescribe safely, appropriately and cost effectively
7. develop a Clinical Management Plan (CMP) within legislative requirements
8. monitor response to therapy, review the working/differential diagnosis and modify treatment or refer / consult / seek guidance as appropriate
9. analyse, apply and evaluate the relevant legislation to the practice of nurse/midwife prescribing
10. critically appraise, use sources of information/advice and decision support systems in prescribing practice
11. identify and examine the influences that can affect prescribing practice, and demonstrate an understanding by managing prescribing practice in an ethical way
12. critically analyse the roles and relationships of others involved in prescribing, supplying and administering medicines
13. critically evaluate the legal, ethical and professional framework for accountability and responsibility and practice within these parameters

Learning outcomes
Legislation that underpins prescribing:
- Works within the relevant legislative framework.
- Understands the principles behind independent and supplementary prescribing and how they are applied to practice
- Able to use the adverse reaction reporting mechanisms

Principles of prescribing:
- Understand the impact of prescribing in the wider delivery of care.
- Understands how medicines are licensed and monitored

Team working principles and practice:
- Able to work and communicate as part of a multidisciplinary prescribing workforce
- Reviews diagnosis and generates treatment options within the clinical treatment management plan

Philosophy and psychology of prescribing:
- Understand the complexity of the external demands and influences on prescribing

Up to date clinical and pharmaceutical knowledge:
- Makes an accurate assessment and diagnosis and generates treatment options
- Relevant to own area of expertise

Principles of drug dosage, side effects, reactions and interactions:
- Able to prescribe safely, appropriately and cost effectively
Communication, consent and concordance:
- Able to work with patient/clients as partners in treatment
- Proactively develops dynamic clinical management plans
- Able to assess when to prescribe or make appropriate referral
- Able to refer back to a medical practitioner when appropriate
- Aware of policies that have an impact on public health and influence prescribing practice

Relationship of public health requirements to prescribing:
- Able to articulate the boundaries of prescribing practice in relation to the duty of care to patient/clients and society

The Code of professional conduct:
- Able to apply the principles of accountability to prescribing practice

The lines of accountability at all levels for prescribing:
- Able to account for the cost and effects of prescribing practice
- Regularly reviews evidence behind therapeutic strategies

Drug abuse and the potential for misuse:
- Able to assess risk to the public of inappropriate use of prescribed substances

Requirements of record keeping:
- Understand where and how to access and use patient/client records

Lines of communication:
- Able to write and maintain coherent records of prescribing practice
- Able to communicate effectively with patient/clients and professional colleagues

Leadership skills:
- Able to advise and guide peers in the practice of prescribing

Roles of other prescribers:
- Able to articulate and understand the roles of other key stakeholders in prescribing practice

Relationship of prescribers to pharmacists:
- Understand the requirements of pharmacists in the prescribing and supply process

Clinical governance requirements in prescribing practice:
- Link prescribing practice with evidence base, employer requirements and local formularies

Audit trails to inform prescribing practice:
- Demonstrate ability to audit practice, undertake reflective practice and identify continuing professional development needs

Skills outcomes
The skills outcomes detailed * are linked to individual objectives. On successful completion of this module, practitioners should be able to:

1. critically discuss and demonstrate the ability to assess and consult with patients/clients, parents and carers and assess their need for medicines
* Critically evaluate and deliberate patients' needs for medicines, taking account of their wishes and values in prescribing decisions;

2. undertake a thorough history, including medication history and current medication (including over-the-counter, alternative and complementary health therapies) to inform diagnosis
* Utilise a critical reflective approach to information gathering, interpretation and application to diagnosis

3. conduct a relevant physical examination of patients with those conditions for which they may prescribe and apply clinical assessment skills to inform a working diagnosis and to formulate a treatment plan
* Critically discuss the pathophysiology of the condition being treated and recognise the signs and symptoms of illness

4. recognise the unique implications involved in the assessment of children in all of the above domains and if appropriate, undertake an assessment based on consideration and comprehension of the legal, cognitive, emotional and physical differences between children and adults understand and critically apply knowledge of drug action in prescribing practice

5. understand and critically apply knowledge of drug actions in prescribing practice

6. prescribe safely, appropriately and cost effectively
* Demonstrate a reflective approach to continuing professional development of prescribing practice

7. develop a clinical management plan within legislative requirements
* Develop and document a clinical management plan within legislative requirements in the context of a prescribing partnership with an independent prescriber and the patient

8. monitor response to therapy, review the working/differential diagnosis and modify treatment or refer / consult / seek guidance as appropriate

9. analyse, apply and evaluate the relevant legislation to the practice of nurse/midwife/pharmacist prescribing

10. critically appraise, use sources of information/advice and decision support systems in prescribing practice
* Identify sources of information, advice and decision support and explain how they will use them in prescribing practice taking into account evidence based practice and national / local guidelines

11. identify and examine the influences that can affect prescribing practice, and demonstrate an understanding by managing prescribing practice in an ethical way
* Critically analyse, evaluate and respond to influences on prescribing practice at individual, local and national levels

12. critically analyse the roles and relationships of others involved in prescribing, supplying and administering medicines, particularly that of Medical Independent Prescribers
* Develop an effective relationship with Independent Prescribers, patients and the wider care team;
* Demonstrate the ability to communicate and consult effectively with patients/clients, parents and carers
* Appraise the responsibility that the role of both the independent and supplementary prescriber entails

13. critically evaluate the legal, ethical and professional framework for accountability and responsibility and practice within these parameters
* practise within a framework of professional accountability and responsibility
* in relation to Independent and Supplementary Prescribing;
* understand own limitations and work within the limits of professional competence


Syllabus

- Consultation, decision-making and therapy, including referral
- Influences on, and psychology of, prescribing
- Prescribing in a team context
- Clinical pharmacology, including the effects of co-morbidity
- Evidence-based practice and clinical governance in relation to nurse prescribing
- Legal, policy and ethical aspects
- Professional accountability and responsibility
- Prescribing in the public health context

Teaching methods

Delivery typeNumberLength hoursStudent hours
Supervised Practice126.5078.00
Class tests, exams and assessment53.0015.00
Lecture323.0096.00
Practical43.0012.00
Seminar42.008.00
Tutorial22.505.00
Private study hours125.00
Total Contact hours214.00
Total hours (100hr per 10 credits)339.00

Private study

Resources to support learning and teaching in the School of Healthcare are located in the University's Virtual Learning Environment (VLE). Students enter with their user name and password and can access a variety of materials and resources to help them with their studies. All lecturers and related papers pertaining to the prescribing course are available as are details of websites that students can visit to enhance their skills. These include interactive sites in numeracy related to drug calculations, pharmaco-dynamics, pharmaco-kinetics, pharmaco-therapeutics, concordance, pathophysiology and formative multiple choice questions.

Opportunities for Formative Feedback

Tutorials with individual and group feedback
Case analysis with verbal feedback
Formative OSCE and written examination in week 10
Portfolio - Use of a portfolio of prescribing to facilitate application of theory to practice during
Reflection:
Prescribing logs
Reflective accounts
Ongoing support by academic supervisor who visits both the student and DMP in practice
Ongoing review by DMP

Methods of assessment


Coursework
Assessment typeNotes% of formal assessment
Portfolio3000 words; the portfolio forms the main framework for recording supervised hours and independent study. It includes a prescribing log, supervised practice time log and evidence of prescribing competency100.00
Total percentage (Assessment Coursework)100.00

The portfolio forms the main framework for recording supervised hours and independent study. It includes a prescribing log, supervised practice time log and evidence of prescribing competency in various forms such as: - prescribing contacts - case studies - reflective accounts - witness testimonies - policies/procedures authored or co authored by the student - records of meetings, visits, discussion - clinical management preparation - protocol or guideline development and use (EBP) - adverse drug reactions review The portfolio is marked as a Pass or Fail by the DMP who signs to verify the students' achievement of each competency indicator. Academically the portfolio is assessed as a pass or fail with one graded element that gives the overall mark for the module. Students are required to write a 3000 reflective piece linked to the development of competence evidenced in the portfolio. Students are instructed to select one of the prescribing (or non prescribing) consultation episodes from their prescribing contact sheets and critically examine each of the following areas of the consultation: - The outcomes of their assessment of the patient/client - Their decision making in terms of prescribing (or non prescribing) of an identified medication as part of the clinical medication plan - The factors that may have influenced their (prescribing) decision making in this case. These factors may include patient related factors, results of monitoring, research evidence, professional, legal, ethical, policy or economically related factors. - Evaluate the overall consultation Additionally the Portfolio must include a numerical assessment. This will take the form of a drug calculation constructed by the students' DMP related to the context of the students practice. A prescription linked to this calculation is necessary to demonstrate competence in this area. Students must achieve a 100% pass (NMC Standard 11) assessed and verified by the DMP. If the student's achievement is below expectation and the DMP cannot declare a pass at a competency level of 100%, the student will be required to inform their academic supervisor who will contact the DMP and arrange to visit the DMP and the student in practice. Based on this meeting the student will be given feedback on the areas which are below expectation and advice on what action is required to achieve a satisfactory standard in these areas. A further two attempts at the assessment may be permitted. This will not normally occur before a period of 6 weeks has elapsed. If the student is successful at the second / third attempt they will be awarded a pass but the overall course mark will be reduced to the minimum allowed for a pass. University assessment and examination rules state this is 40 at Level 3. If the student is unsuccessful on the second attempt the student's academic supervisor may present the students' case to the University Module Assessment Board who may then recommend to the Examination Board that they are offered a third and final attempt. To ensure parity the DMP must meet the specific criteria needed to support the independent /supplementary prescribers' programme of preparation. These are detailed on page 2 of this document. The University holds a DMP register and DMPs are encouraged to attend an introductory day at the University. DMPs are then visited in practice by a member of the module team. DMPs are given two resources: 1. A University handbook detailing the formative and summative role of the DMP. The handbook provides clear explanation of the assessment guidelines and the role of the DMP in certifying competence. There are comprehensive instructions as to the design permutations of a drug calculation and the related prescription. Emphasis is made that students must achieve 100% pass 2. National Prescribing Centre publication: 'Training non-medical prescribers in practice'


Exams
Exam typeExam duration% of formal assessment
Standard exam (closed essays, MCQs etc)1 hr 0.00
Exam with advance information on questions1 hr 0.00
Practical Exam / OSCE0 hr 40 mins0.00
Total percentage (Assessment Exams)0.00

In the exam (both MCQ and SAQ) students must achieve 80% to pass (NMC Standard11). The OSCE consists of three 'stations' and in each the student is presented with a clinical scenario in which they interact with a simulated patient. Students have eight minutes for each station. Their performance is measured against specific criteria which are determined by the module team in advance of the examination. The number of criteria varies from station to station. One high risk area within each station is weighted more heavily and each high risk area is tested in every station. The overall pass mark for the OSCE is 70% and there is compensation between each station. However, the OSCE is designed to ensure that if within any one of the three areas there is evidence that practice would jeopardise patient safety then this results in the failure of the OSCE. All components must be passed, compensation is not permitted. In the event of failure of one or more element of the assessment up to 2 further attempts may be permitted. Re-sit or resubmission is only required for the element failed, however the overall module mark is reduced to the minimum allowed for a pass at Level 3; 40

Reading list

The reading list is available from the Library website

Last updated: 11/08/2016

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