Download Guidelines for Designated Medical Practitioners 2015

The School Of
Nursing
And
Midwifery.
Faculty of Medicine, Dentistry and Health
School of Nursing and Midwifery
Independent/Supplementary Nurse/Midwife
Prescribing programme
Guidelines for designated
Medical Practitioners
1
September 2015
CONTENTS
Page no.
Introduction
3
Aims of Non Medical Prescribing
3
Support for the Designated Medical Practitioner
3
Programme structure
3
The University of Sheffield programme
4
2
Your role
4
Getting your colleagues involved
5
The student’s responsibility
5
What is in it for you?
5
The mentor assessment process
6
Mentoring your student
6
Monitoring learning and progress
7
Maximising learning and developing your student’s potential
7
Assessing consultation skills
7
The final interview
7
References and useful reading
8
Appendix 1
Models of mentor assessment
9
Appendix 2:
Nursing and Midwifery Council learning outcomes
10
Appendix 3:
Competencies to be achieved
11
3
Introduction
Welcome to the programme and thank you for agreeing to be a mentor assessor. This
handbook is intended to be a helpful guide to the process and should be used alongside
the National Prescribing Centre’s Training Non Medical Prescribers in Practice: Guidelines
for Designated Medical Practitioners found at
http://www.npc.nhs.uk/resources/designated_medical_practitioners_guide.pdf
We ask that you work closely with your student and meet regularly for review of progress.
Also, that relevant staff in the whole practice area, (GP surgery, A&E Department, Clinic,
etc.) know about the programme, so that as much help as possible is available to you as
supervisor and to the student. Your student has their own handbook, but please check
out each other’s understanding, to avoid any confusion.
Aims of Non Medical Prescribing

To make more effective use of the skills and expertise of groups of professions

To improve patients’ access to treatment and advice

To improve patient choice and convenience

To contribute to more flexible team working across the NHS
(National Prescribing Centre
2011)
Pre Course Preparation
Prior to the commencement of the course the NMC require that the DMP is suitably
prepared for their role and an audit of the practice environment is undertaken (if this has
not been undertaken within the previous 2 years). This handbook provides you with the
relevant information concerning student assessment and support. You can attend the
afternoon of the first study day of the programme when the practice assessment will be
discussed with students (please contact Derek Darling to confirm attendance). If you
haven’t supported a student on the programme within the previous 2 years then a practice
environment audit form has been enclosed which must be completed and returned prior
to the commencement of the programme. We advise that you meet with your student and
complete the form together. If you are supporting a student for the first time the
programme facilitator can arrange to speak to you in person or by telephone to clarify any
issues. We are then required by NMC regulations to re-audit the learning environment
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every two years if you support further students in undertaking this programme.
Contact during the programme
You can contact the programme leader or the student’s academic mentor at any time
during the programme. After completion of the intermediate interview you will be asked
to email the programme leader to confirm the student’s progress. Towards the end of the
programme a final interview will take place between the student and the DMP when the
practice record will be signed off. It is important that this takes place prior to the final
interview that takes place between the student and their academic mentor in the last week
of the programme when the portfolio and practice record will be reviewed. Any concerns
need to be conveyed to the academic mentor prior to this event. You can access the
University of Sheffield Independent/Supplementary Prescribing Course Mentors website,
where programme information, an FAQ section and a contacts list is available.
(www.sheffield.ac.uk/snm/dmp)
Programme Structure
This is an intensive 6 month programme. Your student will require 26 study days over a
period of 26 weeks. 12 days will be taught and 14 will be directed study. They will also
be expected to undertake 12 days equivalent (90 hours) of structured learning in practice,
which is an integral part of the programme, and which you will oversee.
On successful completion of the programme the nurse/midwife will have the Independent/
Supplementary Prescriber qualification recorded on the Nursing and Midwifery Council
Professional Register, and as soon as confirmation of that registration is received from the
NMC and the nurse or midwife is registered as an independent prescriber with the
employing NHS Trust/PCT, he/she will be able to prescribe from the formulary as an
Independent/Supplementary Prescriber. As you know, it doesn’t end there and it would
be most helpful if you would continue in an advisory supportive role.
The University of Sheffield programme
We aim to enable students to develop their ability to undertake a consultation and make
rational decisions about the treatment of their patient, based on the National Prescribing
Centre Seven Principles of Safe Prescribing. In order to achieve this, we will provide sessions
on pharmacology, consultation and decision making skills, legislation and policy and
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evidence-based practice, to name but a few. There is a blended learning approach in the
learning and teaching strategy, consisting of lectures, discussion, group work, seminar
presentations and case study formats. This is designed to assist students to learn in an
active way and apply learning to and from practice. Your student will be expected to bring
anonymised experiences and interesting cases/issues from practice to aid their own and
group learning. They will also discuss how they can implement theory and ideas generated
into their own practice. Be prepared to answer questions and discuss ideas!
Case study and assignment use promotes the acquisition of critical thinking alongside
the development of conceptual and problem solving skills. (See, for example: Dailey, 1992;
Sedlack, 1994; Pond, Bradshaw and Turner, 1991) and enables the student to relate theory
to practice and vice versa. The students own case studies are utilised to ensure that
student learning is grounded in the reality of personal practice.
Student led seminars enable students who are the ‘authority’ on a subject to share their
experience with others. (Oliver & Endersby 1999, Nicklin & Kenworthy 2000, Steinaker &
Bell 1979, Quinn 1998).
This method of learning has been valued highly by previous
cohorts, as there is always a wealth of knowledge and experience within this group of
often very experienced students. For those not used to undertaking presentations it is also
a safe environment to practice and develop the skills required.
Lectures and other sessions will be provided by a variety of specialist speakers from both
within and outside the university: doctors, pharmacist, experienced nurse prescribers, other
clinicians and university academic staff.
Guided study will provide a structured opportunity for learning in specific prescribing
areas.
Experiential learning, such as role play situations, will be utilised as appropriate to
develop and explore interpersonal skills, as well as a safe environment within which to
develop therapeutic skills and to express and reflect upon personal feelings;
A portfolio of learning will be used as a means of facilitating and recording critical
thinking and reflection and be used as evidence to support the student’s claim for
competence and thus the professional and academic awards.
Supervised clinical practice students will be required to undertake a minimum of 90
hours of supervised clinical practice within the working environment which needs to be
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logged. This can include:Any situation where the student can learn about the assessment and management of the
patient and their condition which may influence the prescribing scenario
Observation of the DMP; the consultations of other medics in the area, other nurse
prescribers, clinical nurse specialists;
Consultations and prescribing situations in which the student is being observed;
Observation and discussion with pharmacists;
Clinical situations where patient management is being discussed eg case conferences, MDT
meetings, ward rounds;
Observation of and discussion with persons involved in medicine management or clinical
governance structures;
Attendance at study days outside the prescribing programme;
Involvement in non pharmacolocical activities pertinent to the prescriber’s role eg health
promotion / healthy lifestyle advice;
Undertaking the practice assessment process.
Your role
Firstly, you are not alone. We are available for support and advice (please refer to contact
details at the end of this booklet). In addition, there are a number of other designated
medical practitioners working alongside students. Your role is as a guide, someone to be
there to answer questions and facilitate learning, show ‘how to’, let the student know when
they do something well or how to do it better. Be a role model, but make it real. We all
know what the world should look like, but also know how it actually is.
At the beginning of the programme you should undertake the initial interview. Between
you and the student identify activities (ways of learning) and evidence (concrete proof that
the learning has taken place) that will count towards the assessment. About half way
through the programme please arrange a formal review of the student’s learning
(intermediate interview) and revision of the action plan to achieve the outstanding
competencies. Please email the academic mentor to confirm the student’s progress.
In addition, we require that you assess them in practice at the end of the programme. The
final assessment must use the acid test: Do I consider that this nurse/midwife is a safe
and effective prescriber? At this time, you will have observed enough of their practice,
discussed sufficient cases and reviewed enough case notes to know if your student is safe.
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We only ask that you decide if the student is safe or unsafe and has achieved the required
competencies in practice. If at any time you have doubts or concerns please contact us.
Our contact address can be found on the back page of this handbook. Please do not
wait until the last week of the programme to voice your concerns. If we can deal with
problems early, the chances of your student achieving safe and effective prescribing
practice are much greater.
The student will have to undertake other forms of assessment including an OSCE and an
unseen written examination, which tests pharmacological knowledge and drug calculation
skills. The OSCE is marked on a pass / fail basis and includes writing a correct prescription.
Part 1 of the Unseen Examination is pharmacology based and the student must achieve
80% to pass. Part 2 is Drug Calculation and the student must achieve 100% to pass. The
student will also have to submit their portfolio of evidence to support claim to competence,
which has been developed throughout the programme. All the aspects of the assessment
have to be passed, but the student will have a second chance to resit any failed aspect.
Whilst guidance is given in developing the portfolio of evidence by the course leaders,
your help will also be invaluable. You will also be asked to verify the student’s portfolio.
This means confirming that the content of the portfolio reflects the student’s prescribing
practice.
Getting colleagues involved
It is important to get everyone in the practice area involved otherwise this will not work.
It is part of the student’s learning to be assertive and seek support, but they cannot be
expected to set this up single-handed. Your medical colleagues will need to be informed
that the nurse or midwife is undertaking the programme, and their role in being involved
in some teaching and learning activities. It is enormously helpful to have other people’s
perspectives on the student’s ability and progress. Also, when colleagues see what the
student is capable of, they can feel more confident in their competence and will accept
referrals accordingly.
The student’s responsibility
It is important that the student manages their own learning, although this does not mean
that they are expected to do it all themselves.
The student is expected to take
responsibility for documenting their learning activities with reflective entries in their
8
assessment of practice booklet. They may collect testimonial entries from yourself and
your colleagues involved in teaching and learning activities. They will also require at least
one testimony from a patient or their carer. They must also keep their paperwork available
for review by you and any colleagues involved in the teaching/learning experience. They
are also responsible for booking times and venues for the initial, intermediate and final
interview dates with you.
What’s in it for you?
At present, the student who works with you has a great deal of knowledge and expertise;
otherwise they would not be on this course. But as yet, you cannot utilise their skills to
their full potential, neither can the nurse or midwife achieve their full potential within their
sphere of competence and practice. How many times in a day do they have to interrupt
you in order to sign a prescription or review investigations with them? It is very frustrating
for both you and the nurse or midwife that the inability to issue the prescription has
caused inconvenience for the patient and wasted valuable time. Once the student has the
prescribing qualification, and feels competent, further role development will occur. They
will still need to consult with you over certain things or ask you to review a particular
patient, but it will probably be because there is a situation outside of their sphere of
practice and competence they cannot deal with rather than something simple, which they
are currently not experienced to deal with. In the long term you should find that your role
changes and you should have more time with your patients and the practice area is running
more efficiently and effectively.
The Mentor Assessment Process
This starts before the programme commences. The better planned the process is, the
more likely it is to be successful. For the student to be considered for the programme
they will have to have the agreement of the NHS Trust Non Medical Prescribing Lead that
they will have access to the prescribing budget and will prescribe once qualified, support
from their manager and a named mentor assessor for the duration of the programme
(you). We also strongly advise the student to seek the support of an experienced non
medical prescriber in their clinical area, to act as a co-mentor. Once the student is accepted,
review their workload and working practices will help by adding a slot to each session so
that particular patients could be discussed or consultations shared, there will be almost no
slippage in appointment times and it becomes part of the culture.
9
Once the student has commenced the programme, interview dates should be set. Ensure
enough time is set aside in order to do this successfully with adequate privacy and no
interruptions. The initial interview should review the current situation and set an initial
learning contract. It is important to do this as assumptions are easily made. The student
may perceive that they need additional learning in areas that you believe they already
have competence and conversely, you may not be fully aware of some aspects of
competence. The action plan can be written by the student or be a joint effort between
the student and the DMP. However the DMP must sign to confirm that the action plan is
appropriate to the learning needs of the student.
The first interview is also a form of negotiation regarding how the mentor will meet need;
when it will happen; where this will take place; who will be involved and what is to be
supervised and assessed. This programme depends to a great extent on the practice area
as well as the student’s needs.
Mentoring your student
We don’t ask that you spend most of the time shadowing them or for them to shadow
you. At the start of the programme they will want to observe you, and perhaps your
experienced colleagues, undertaking consultations, examinations etc. If the student can
gain a fairly broad perspective of consultation styles and consultation cases they will be
more likely to find a method that is comfortable (and works) for them. This can be in
short bursts, not necessarily for a full session. The student will log their time to make sure
they meet the requirements of the programme. During the programme the student will
not be expected, or allowed to prescribe in their own right. For models of mentoring
and assessment please see Appendix 1.
Once the programme is under way you can spend time observing the student’s
consultation practice. Again, full sessions are not expected. It is important that they know
just where they are doing well and how to progress. As you both become more confident
in the student’s improvement, they will consult you, or a colleague, for advice and opinion
on specific cases. Also, allow for opportunistic learning and involve the student when you
have a patient with a relevant presenting problem or an interesting prescribing scenario.
It can also be useful to demonstrate cases outside the student’s future remit, so that they
can see the difference and define the limits of their competence.
10
It is useful to review the notes after each supervised practice session and make comments
accordingly. Again, compare thoughts with any colleagues who have been involved. When
you consider that the student has achieved competence in any aspect of prescribing
practice and has sufficient evidence to support competence in that element, it can be
signed off. There is no need to wait until the final interview. It sounds a lot of work, and
it does take commitment, but the benefits should soon outweigh the work it takes over
the next 6 months.
Monitoring Learning and Progress
It is important to regularly review the student’s learning progress. This is done informally
through your discussions about patients, review of the notes, direct observation and
questioning. We do ask that there is also a formal process for assessing learning, through
the intermediate interview, for which sufficient time is available. It is at this point that
we ask you to review the student’s learning and progress to date to see that they will have
enough time and resources to complete and achieve the competencies successfully.
Maximising learning and developing your student’s potential
We all want your student to do as well as possible. Although the practice assessment is
pass/fail, future prescribing practice depends on how good the learning experience has
been. Aim to involve them in and be responsible for their learning as much as possible.
Between you, you may have new ideas for mentoring and learning experiences. If they
work, or even if they do not, others can learn from the experience. Again, involve as many
colleagues as is appropriate and obtain feedback from them and your student.
Your
student will write up anonymised case studies, critically analyse aspects of prescribing
practice arising from the case studies, and discuss critical incidents and reflections on
learning.
In addition (and with the patient’s permission) they may wish to record
consultations for review and analysis. Although often daunting, these can be effective
tools for learning. They are also less demanding on time at peak periods.
The student will need appropriate feedback in order to monitor their own progress.
Encourage the team to be involved. Also expect comments by your student on your
supervision! Be candid with each other. We can only emphasise that effective mentorship
enables you to be confident in your student’s ability as a prescriber.
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Assessing Consultation Skills
We teach students to be systematic in their approach to patient consultations. Look for a
good history, assessment (including examination if warranted), working in partnership with
the patient and shared decision-making. There should be evidence of consideration of
differentials and alternative courses of action.
Look for how the student could have
improved their work as well as assessing what the student has achieved. Do question and
test out any assumptions. This should be no different from the way you work with junior
doctors. We expect similar standards; just expect a slightly different approach as your
student will bring a strong nursing background and perspective to this area of practice.
The bottom line is: ‘Is this practitioner a safe prescriber?’
The final interview
This final formal meeting is to review learning and practice in order to make a decision
and verify competence in each aspect of each competency. The student must bring you
the relevant evidence. If you are happy with all aspects of their practice and consider the
student to be safe and effective, and can perform consistently and in line with the identified
standards, then they should pass. When you sign the final interview you will also be signing
to verify the student’s portfolio. If you have any concerns over a particular aspect then you
should raise this before the final meeting, so that you and the student can work together
on this area of practice.
If your student has failed to meet the standard required in any aspect, discuss your
concerns at this interview and make plans to remedy the situation. A student has only
two attempts at the assessment and we will agree a resubmission date. If they fail at the
second attempt then they are deemed to have failed the programme.
Please ensure that you sign (not initial) each competency domain at intermediate and final
interview. The portfolio and practice assessment record will be reviewed by the academic
assessor at the end of the programme. If the required signatures are missing the
Assessment of Practice booklet will be returned to the student for completion and return
to the University within seven days. It is the student’s responsibility to ensure the document
is complete before submission.
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Please note that the NMC Standards (2006) stipulate that if a student fails to correctly
answer any question that may result in direct harm to the patient/ client they must be
referred, eg failure to ask about medication history, allergies, any over the counter
medication, or incorrect dosage / strength.
Thank you once again for agreeing to be a mentor assessor and for the support you
are offering your student
CONTACT DETAILS
Programme Leader
Derek Darling
Telephone: 0114 2222041
E-mail: [email protected]
Programme Facilitator / Lecturer
Rachel Jokhi
Telephone:0114 2222043
E-mail: [email protected]
Programme Co-ordinator
Tina Allsopp
Telephone: 0114 2222033
Email: [email protected]
All the above people are based at:
The University of Sheffield
School of Nursing and Midwifery
Barber House Annexe
3a Clarkehouse Road
SHEFFIELD
S10 2LA
References / Useful reading
National Prescribing Centre (2011) Training Non-Medical Prescribers in Practice. Guidelines
13
for Designated Medical Practitioners:
http://www.npc.nhs.uk/resources/designated_medical_practitioners_guide.pdf
Nursing and Midwifery Council (2006) Standards of Proficiency for Nurse and Midwife
Prescribers:
http://www.nmcuk.org/Documents/Standards/nmcStandardsofProficiencyForNurseAndMid
wifePrescribers.pdf
Appendix 1
Models of Mentor Assessment
a) Firstly, a ‘frontloading’ model, whereby the mentoring is more of a direct approach
at the beginning, gradually reducing to a less direct approach and availability. It
would contain time to discuss and review notes throughout. The advantage of this
model is that the student quickly learns what is required of them. There would be
time to observe and be observed at the beginning with perhaps mid and final point
observations of a consultation for assessment purposes. The disadvantage is the
time required at the outset.
b) An hour at the beginning or end of a session in order to plan or review work. This
would lead to a reduced length of sessions on the protected practice days. The
advantage is that clear time would be set aside for discussion. The disadvantages
would be that as the working day progresses, patients tend to become a blur.
Unless there is time for the student to make notes for themselves, they may miss
valuable learning points. The mentor would still have to be ‘available’ to the student
as needed.
c) Time throughout the identified session for review and support. The advantage is
that questions can be answered quickly and some notes can be reviewed as needed.
In addition, rather than the doctor’s involvement just being the prescription, there
is time for quick discussion regarding the choice of medication, proposed benefit
etc. The disadvantage is that the student (and to a lesser extent, the mentor) would
need longer between patients during the sessions. This would involve briefing
receptionists or other staff and may increase the workload on other members of
staff for the duration of the programme.
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d) Some form of workload compensation on educationally led practice days. This may
mean consultations of, say, 15 minutes instead of 10 minutes or perhaps a reduced
number of patients to be seen in the session. As above, some shortening of the
session to allow for access to evidence and literature to support decision-making.
This model has many advantages as with c) above and carries the same
organisational issues. Some employers may initially be reluctant to support this,
but this potentially brings the greatest benefits and has most educational merit,
especially if combining with the ‘frontloading’ model.
e) The contract between you at first interview will identify the mechanism adopted to
ensure these days are different from the usual day’s work.
f)
Time during some sessions away from patients to ensure that the learning log is
completed and skills are being reviewed.
g) Any combination of the above suggested models may be used or a suitable design
of your own that meets the needs of both the student and mentor.
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Appendix 2
Nursing and Midwifery Council Learning outcomes
Aim
The education programme aims to prepare nurses, midwives to prescribe safely,
appropriately and cost-effectively as an independent/supplementary nurse prescriber.
Learning outcomes
The learning outcomes of the programme are set at degree level and enable the
practitioner to:
•
assess and consult with patient/clients, clients, parents and carers
•
undertake a thorough history, including medication history and current medication
(including over-the-counter, alternative and complementary health therapies) to
inform diagnosis
•
understand and apply the relevant legislation to the practice of nurse/midwife
prescribing
•
critically appraise, use sources of information/advice and decision support systems
in prescribing practice
•
understand the influences that can affect prescribing practice, and demonstrate your
understanding by managing your prescribing practice in an ethical way
•
understand and apply knowledge of drug actions in prescribing practice
•
demonstrate an understanding of the roles and relationships of others involved in
prescribing, supplying and administering medicines
•
prescribe safely, appropriately and cost effectively
16
•
practise within a framework of professional accountability and responsibility
•
develop a clinical management plan within legislative requirements (supplementary
prescribing only)
•
If prescribing for children, demonstrate appropriate history taking, undertake a
clinical assessment and make an appropriate diagnosis, having considered the
legal, cognitive, emotional and physical differences between children and adults.
Reference
The Nursing and Midwifery Council (2006)
‘Standards of Proficiency for Nurse and Midwife
Prescribers. London, NMC. Available at
http://www.nmcuk.org/Documents/Standards/nmcStandardsofProficiencyForNurseAndMidwifePre
scribers.pdf
Appendix 3
COMPETENCIES TO BE ACHIEVED
(These are based on the Single Competency Framework published by the National
Prescribing Centre (2012))
1. Knowledge
Has up to date clinical and pharmaceutical knowledge of own area of practice.
2. Options
Makes or reviews a diagnosis, generates treatment options for the patient and follows
up management.
3. Shared decision making
Establishes a relationship based on trust and mutual respect. Recognises patients and
carers as partners in the consultation,
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4. Prescribing Effectively
Is aware of own limitations. Does not compromise patient safety
5. Professional
Ensures prescribing practice is consistent with scope of practice, organisational,
professional and regulatory standards, guidance and codes of conduct.
6. Always improving
Actively participates in the review and development of prescribing practice to optimise
patient outcomes.
7. The healthcare system
Understands and works within local and national policies, processes and systems that
impact on prescribing practice. Sees how own prescribing impacts on the wider
healthcare community.
8. Information in context
Knows how to access the relevant information.
Can use and apply information in
practice.
9. Self and others
Works in partnership with colleagues for the benefit of patients. Is self aware and
confident in own ability as a prescriber.
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