Non-medical Prescribing Course Research Articles

The complex challenge of prescribing as an advanced clinical practice physiotherapist

Non-medical prescribing (NMP) has been developing in the UK over the last couple of decades. As part of their NMP course, the author explores some of the legal, professional and ethical complexities that await them and other Health and Care Professions Council workers upon conclusion of the Royal Pharmaceutical Society's competency framework for all prescribers. Focus is primarily directed towards the application of NMP by an individual with physiotherapists background, working in an advanced clinical practice (ACP) role in paediatric intensive care. This commentary critiques some of the dilemmas that may present regarding legislation, regulation and the inability to prescribe controlled drugs independently. Solutions using clinical management plans are presented, alongside ideas for future development of prescribing ACPs.

The role of the designated prescribing supervisor: an evaluation

Aim To understand the experience of non-medical prescribers undertaking the role of designated prescribing supervisor with students on the non-medical prescribing course for the first time. Methods Questionnaire completed by 34 designated prescribing supervisors, followed by semi-structured interviews with 10 designated prescribing supervisors. Findings There were four themes identified from the data. These were: knowledge and experience prior to undertaking the designated prescribing supervisor role; how the role of designated prescribing supervisor was enacted in practice; interactions and engagements necessary to support the designated prescribing supervisor and underpin students' professional development; and the way in which the designated prescribing supervisor role supports personal growth. Conclusion Designated prescribing supervisors in this evaluation described their role as consisting of coaching, advice and pastoral support. The supervision which they provided tended to be unscheduled and informal. Designated prescribing supervisors valued the support they received from the University and their Employer. Undertaking the role of designated prescribing supervisors was described as beneficial to their continuing professional development, it enhanced job satisfaction and provided a greater sense of self-worth.

Medication review, polypharmacy and deprescribing: Results of a pilot scoping exercise in undergraduate and postgraduate education

Background: As part of tackling polypharmacy, effective medication review and safe deprescribing are key to World Health Organisation’s (WHO) 3rd Global Patient Safety Challenge. There is little information about whether this occurs consistently in pharmacy and medicine courses in England. Objective: To create a snapshot of medication review, polypharmacy and deprescribing educational activity in a small number of university courses for medicines, pharmacy and non-medical prescribing. Method: The authors undertook a pilot scoping exercise by emailing colleagues in schools of pharmacy and medicine across England about course inclusion of medication review and deprescribing. 11 universities, describing 17 programmes, responded (eight undergraduate pharmacy, four undergraduate medicine, four postgraduate medicine, one non-medical prescribing course). Data were categorised as: programme content, tools to support deprescribing, learning outcomes, and future intentions for deprescribing teaching. Results: The results suggested variation in what was being taught. Conclusion: In order to address both national and international agenda, the authors suggest that inclusion of training in this area and consistency of curricula are crucial to adequately equipping our future workforce to be fit for purpose.

Pharmacokinetics in paramedic prescribing

Pharmacokinetics is not only relevant to those undertaking a non-medical prescribing course but it is also important information for any paramedic, as a knowledge of pharmacokinetics is critical to understanding why our medications do what they do and how their effects may vary on a patient-to-patient basis.

Pharmacokinetics in paramedic prescribing

This instalment in the Prescribing Paramedic series introduces the concept of pharmacokinetics. This is not only relevant to those undertaking a non-medical prescribing course but it is also important information for any paramedic, as a knowledge of pharmacokinetics is critical to understanding why our medications do what they do and how their effects may vary on a patient-to-patient basis.

P22 Developing a pharmacology module for the paediatric non-medical prescribing course

IntroductionDemand from local NHS stakeholders identified a gap for a taught education course tailored to the niche requirements of paediatric healthcare staff wishing to become non-medical prescribers. This was seen as an excellent opportunity to review and develop the pharmacology module within the Non-medical Prescribing (NMP) course by giving it a paediatric focus.AimTo develop a pharmacology module with an emphasis on paediatric prescribing that meets the professional requirements of the General Pharmaceutical Council (GPhC), the Nursing and Midwifery Council (NMC) and the Health Care Professions Council (HCPC).MethodKnowledge of curriculum design and structure was utilised in developing the paediatric pharmacology module. This ensured that the underpinning theory of prescribing medicines safely for children was delivered at the right academic level. The content, delivery and learning outcomes were dictated by the Prescribing Competency Framework for All Prescribers (RPS, 2016).1 But the cognitive teaching and learning methods arose from the rigid expectation to meet the regulatory requirements of each professional body. To ensure consistency across the whole NMP programme, the structure of the pharmacology module assessments (both formative and summative) was kept the same. The summative (final) assessments consisted of a multiple choice question (MCQ) paper requiring the students to answer a total of twenty MCQs, with the pass mark set by the regulatory bodies at 80%; a drug calculations paper consisting of five questions with a 100% pass mark; and a 5 minute information giving OSCE (objective structured clinical examination). The whole module was looked at a fresh from a paediatric perspective. The content and timetable were compiled and reviewed jointly by a paediatric pharmacist and a paediatric nurse. Both were experienced academics already teaching on the NMP course. While some of the lectures were delivered by in-house university academic staff, the majority of the sessions were delivered by specialist paediatric guest lecturers who were actively working in their respective clinical fields. This ensured that the knowledge imparted to students was practical, current and relevant to prescribing for children.ResultsAll students had to be practising in paediatrics for a minimum period of two years and have evidence of studying at level 6 (graduate level) or equivalent. The target audience consisted of allied healthcare professionals specialising in paediatrics, including nurses, pharmacists, optometrists, physiotherapists, podiatrists, dieticians and therapeutic radiographers. However, the first cohort of 51 students comprised entirely of paediatric nurses. The majority of students passed each assessment first time. All students passed the 5-minute information giving OSCE, but 25% of the students had to re-sit the pharmacology MCQ paper and 17% had to re-sit the drug calculations paper. Following the resits the remaining students all passed except for one student who failed the course.ConclusionOverall, the course was well received, with positive feedback from most students and stakeholders. Valuable suggestions were also received for further improvements to the course and pharmacology module. These are currently being implemented with intake of students.ReferenceRoyal Pharmaceutical Society ( 2016) A competency framework for all prescribers. Available from: http://www.rpharms.com/Portals/0/RPS%20document%20library/Open%20access/Professional%20standards/Prescribing%20competency%20framework/prescribing-competency-framework.pdf [Accessed 25/6/19]

To prescribe or not prescribe?

Undertaking the non-medical prescribing course can be very daunting, yet rewarding. In this column, Michelle Bennett describes her journey on this course and in her first few months as a non-medical prescriber in children's pain management

274 Nurse prescribing for children with cystic fibrosis (CF). An initiative to improve service delivery

Children with CF often require medication, particularly antibiotics, at times when they are not being reviewed by the hospital medical team. These medications are usually prescribed by the child's GP at the request of the CF team. The CF Nurse Specialist (NS) team would assess the patients needs and discuss a course of treatment with the registrar, a faxed prescription request would then be made. This was time consuming and often resulted in a delay in prescription requests being generated hence the possibility of treatment being delayed. Prescriptions for the home intravenous antibiotic therapy service, which is organised by the CF NS, were also reliant on the availability of a registrar or consultant to prescribe. Whilst this did not usually result in delayed treatment it was often time consuming and inefficient. Following completion of a non-medical prescribing course and the subsequent registration of one of the CF NS, these prescribing functions were taken over by the CF Nursing team. In order to ensure that appropriate decisions were made, a tool for telephone consultations was utilised to document the prescribing decision. A review of the prescribing activity was undertaken prior to the initiative being implemented and repeated once it had been established in practice. This review found a reduction in time from prescribing decision being made to generation of prescription or fax from an average of 14 hrs to 1 hr 49minutes. This initiative therefore demonstrates a considerable efficiency saving, hence an improvement to service delivery.

Use and evaluation of a mentoring scheme to promote integration of non-medical prescribing in a clinical context.

BackgroundGrowing numbers of non-medical health professionals are attaining prescribing rights through post-registration non-medical prescribing (NMP) courses in the UK. However, not all implement prescribing post-qualification. This study evaluated the uptake and perceived usefulness of a mentoring scheme for two cohorts of NMP students at the University of Nottingham. The scheme paired students with qualified mentors with whom they had an opportunity to discuss the integration of prescribing theory into practice.MethodsMentors were allocated on days 2–5 of the course. Surveys were distributed to students who completed the NMP course [n = 63] and their mentors. Likert-scale and open-ended questions addressed: use, perceived usefulness, and positive and negative aspects of the mentoring scheme. Semi-structured interviews were conducted with both students (n = 6) and mentors (n = 3) to explore their experience of the mentoring scheme in more detail. Students were purposively selected for interview depending on their level of use of the mentoring system. Interviews were analysed using thematic analysis.ResultsThe response rates were 65.1% (n = 41) and 56.3% (n = 36) for students and mentors respectively. Just over half of students (57.1%) accessed their mentor. Having a sufficient support network was the key reason for not using the scheme. Students found mentors helpful for: moral support (68.2%); contextualising prescribing (71.4%); and helping them to think about implementing prescribing in practice (72.7%). Fewer mentors felt they helped in relation to contextualising (57.9%) or implementing prescribing (31.6%). Less than half the students and mentors surveyed agreed that they received/provided assistance related to the integration of prescribing theory into practice (38.1% and 42.2% respectively) and assistance with assignments (36.3% and 45.5% respectively).Interviews suggested that students found it difficult to focus on implementing prescribing because of the academic demands of their course, which impacted on uptake and use of the mentoring scheme. Students emphasised the importance of being paired with a prescriber who was successfully prescribing. Mentors benefited from sharing and refreshing their academic knowledge.ConclusionsStudents and mentors derived benefits from participation in this scheme. This intervention may be better as a post-qualification support resource when students are ready to consider their future prescribing practice.

An introduction to literature searching: helpful tips for aesthetic nurses

Aesthetic nurses taking on the non-medical prescribing course, which is more commonly known as the V300, will be required to complete a literature search. However, for those who have been out of education for some time, this can be quite a daunting task. In this article, the author will help aesthetic nurses to identify key information resources in the field of health studies, and perform effective information retrieval searches using online databases, electronic journals and electronic books.

A critical incident post injection of botulinum toxin to the glabellar and orbicularis muscles

This case study was originally written by the author in 2007 while she was undertaking her non-medical prescribing course. Despite her considerable experience in the field of medical aesthetics, reflecting on the case study of Neil resulted in positive and necessary changes to her practice. The case study served to illustrate the self-doubt that independent nurses often demonstrate in crisis. Complications can, will and do occur and the author hopes that readers will be able to learn from her experience and recognise the importance of the‘reflective tool’. The author also hopes that this case study will instil confidence in others to not only identify their own learning needs, but also celebrate their knowledge, ability and experience, making the non-medical prescribing course a true learning process.

The non-medical prescribing course: essential considerations for aesthetic nurses

There has been considerable recent press coverage around the cosmetic industry and standards of practice. For nurses working in the industry, this has focused particularly on their ability and methods of obtaining prescription only medications, such as botulinum toxin for chemical denervation. Any nurse or midwife administering or supplying injectable cosmetic medicinal products must follow the appropriate regulatory standards for practice. Updated guidance from the General Medical Council (2012) have made clear that remote prescribing and directions to administer should only be used in exceptional circumstances, and not as a routine means to administer injectable cosmetic medicinal products. These changes have lead many nurses working in the aesthetics industry to undertake the V300 non-medical prescribing (NMP) course. The NMP course is regulated by the Nursing and Midwifery Council and nurses wishing to undertake the course must demonstrate they meet the eligibility criteria, and that they have appropriate governance procedures in place to protect patient safety.

Core skills in medication management and assessment are key to the V300

Aleks Rutkowski maintains that being mentored by someone with experience in aesthetics is not essential for passing the non-medical prescribing course. Instead, she suggests that designated medical practitioners ought to be GPs who are working on a daily basis with people from all walks of life, and that a sound knowledge of pharmacology and assessment is essential for those specialising in aesthetics

Students’ perceptions of learning in practice for NMPs

Non medical prescribing (NMP) is integral to the modernisation of the NHS. Strong educational preparation of students in theory and practice is required to ensure patient and practitioner safety. This study takes an interpretive phenomenological approach to explore students’ perceptions of learning in practice and the effect of mentorship by their designated medical practitioner. A purposive sample of ten students from diverse clinical backgrounds, who had completed the NMP course from one HEI took part. The interviews explored specific themes including the time that students had with their mentors and the approach they took to learning and teaching. Students were asked if they perceived their mentor able and willing to give them the support they required to meet the prescribing competencies, as defined by the Nursing and Midwifery Council. Content analysis of the data was undertaken and presented using excerpts of transcriptions. The findings suggested that mentors and students had difficulties in getting quality time together, and mentors were not fully prepared in the course learning outcomes. Learning and teaching was largely directed by written course work, and mentors had limited knowledge of the prescribing competencies by which to assess the students. The study identified the need for further research into the difficulties of learning and teaching in practice for NMP students and their mentors. There is a need for greater collaboration between education, health care managers and medical practitioners to improve the standards of learning and teaching in practice for students in the future. It suggests that mentorship within the NMP course should be given greater recognition and that prescribing competencies should be generic to all prescribers.

10. Life after the non-medical prescribing course

10. Life after the non-medical prescribing course

Pharmacology as a foreign language: A preliminary evaluation of podcasting as a supplementary learning tool for non-medical prescribing students

BackgroundNurses and other health professionals in the U.K. can gain similar prescribing rights to doctors by undertaking a non-medical prescribing course. Non-medical prescribing students must have a thorough understanding of the pharmacology of prescribing to ensure safe practice. Pharmacology education at this level is complicated by the variation in students' prior subject knowledge of, and anxiety about, the subject. The recent advances in technology, particularly the potential for mobile learning, provide increased opportunities for students to familiarise themselves with lecture materials and hence promote understanding. The objective of this study was therefore to evaluate both the subjective (student perception) and objective (student use and exam results) usefulness of podcasts of pharmacology lectures which were provided as an extra learning tool to two cohorts (n = 69) of non-medical prescribing students.MethodsThe podcasts were made available to students through the virtual learning environment WebCT. Use of podcasts by two successive cohorts of nurse prescribing students (n = 69) was tracked through WebCT. Survey data, which was collected from 44 of these students, investigated patterns of/reasons for podcast use and perceived usefulness of podcasts as a learning tool. Of these 69 students, 64 completed the pharmacology exam. In order to examine any impact of podcasts on student knowledge, their exam results were compared with those of two historical cohorts who did not have access to podcasts (n = 70).ResultsWebCT tracking showed that 91% of students accessed at least one podcast. 93% of students used the podcasts to revisit a lecture, 85% used podcasts for revision, and 61% used the podcasts when they had a specific question. Only 22% used the podcasts because they had missed a pharmacology session. Most students (81%) generally listened to the entire podcast rather than specific sections and most (73%) used them while referring to their lecture handouts. The majority of students found the podcasts helpful as a learning tool, as a revision aid and in promoting their understanding of the subject. Evaluation of the range of marks obtained, mode mark and mean mark suggested improved knowledge in students with access to podcasts compared to historical cohorts of students who did not have access to pharmacology podcasts.ConclusionsThe results of this study suggest that non-medical prescribing students utilised podcasts of pharmacology lectures, and have found the availability of these podcasts helpful for their learning. Exam results indicate that the availability of podcasts was also associated with improved exam performance.

In praise of medical supervisors

In my experience, having talked to successful prescribing students and evaluating their learning experience, one of the most valuable components of the non-medical prescribing course is the 12 days of learning in practice. This is the time when nurses can step aside from their normal working role and take time to observe and reflect with their medical and nursing colleagues on prescribing issues and decision making in the practice setting. This experience forms the all-important link between theory and practice, and without it the course would be incomplete.