Module Description Title Code Level Credit rating Pre-requisites Type of module Aims Comments/notes Supplementary Prescribing (1) NA3112 6 30 All podiatrists, physiotherapists, and radiographers entrants to this programme must meet the following requirements: Be registered with the Health Professions Council in one of the relevant Allied Health Professions Be professionally practising in an environment where there is an identified need for the individual to regularly use supplementary prescribing Be able to demonstrate support from their employer/sponsor including confirmation that the entrant will have appropriate supervised practice in the clinical area in which they are expected to prescribe Have an approved medical practitioner, normally recognised by the employing/Health Service commissioning organisation a) as having experience in a relevant field of practice, b) training and experience in the supervision, support and assessment of trainees, c) who has agreed to; o Provide the student with opportunities to develop competencies in prescribing o Supervise, support and assess the student during their clinical placement Have at least 3 years relevant post-qualification experience. Programme providers must ensure through preprogramme assessment or from clear documented evidence that candidates have appropriate background knowledge and experience and are able to study at academic level 6 Extensive over one semester The aim of these modules is to develop podiatrists, physiotherapists, and radiographers to undertake the advanced professional role of Supplementary Prescriber, accepting personal and professional accountability for related decision making and patient outcomes. The students, throughout these modules, will critically review the evidence for treatments, developing treatment and CMPs; utilize specialist skills in physical examination and clinical diagnosis; apply diagnostic and creative skills to problem solving around assessment of patients, their treatments and outcomes. Learning outcomes/objectives The module will enable the practitioners to meet the outcomes specified by the NPC; namely to: 1. understand the responsibility that the role of Supplementary / Independent prescriber entails, be aware of their own limitations and work within the limits of their professional competence – knowing when and how to refer / consult / seek guidance from another member of the health care team 2. develop an effective relationship and communication, assessing and consulting as appropriate with patients, carers, other prescribers and members of the health care team and understand their roles in the medicines use process 3. describe the patho-physiology of the condition being treated and recognise the signs and symptoms of illness 4. use effectively and interpret common diagnostic aids e.g. stethoscope, sphygmomanometer 5. select and use diagnostic aids relevant to the condition(s) for which the practitioner intends to prescribe, including monitoring response to therapy 6. apply clinical assessment skills to: inform a working diagnosis formulate a treatment plan the prescribing of one or more medicines if appropriate carry out a checking process to ensure patient safety. monitor response to therapy, review the working/differential diagnosis and modify treatment or refer / consult / seek guidance as appropriate 7. take a thorough and accurate history, including medication history (including over-the-counter, alternative and complementary health therapies) to (in conjunction with 6) inform a diagnosis and choice about treatment 8. 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 9. identify and critically appraise sources of information, access advice and decision support and demonstrate how they will use them in patient care taking into account evidence based practice and national/local guidelines where they exist. 10. recognise, evaluate and respond to influences on prescribing practice at individual, local and national levels 11. prescribe, safely, appropriately and cost effectively 12. work effectively within a prescribing partnership 13. maintain accurate, effective and timely records in the patients notes and ensure that other prescribers and health care staff are appropriately informed, and comply with national guidance as appropriate e.g. adverse drug reaction reporting 14. demonstrate an understanding of the public health issues related to medicines use 15.demonstrate an understanding of the legal, ethical and professional framework for accountability and responsibility in relation to prescribing 16.work within clinical governance frameworks that include audit of prescribing practice (including any near misses) and personal development 17.participate regularly in CPD and maintain a record of their CPD activity 18.understand and apply knowledge of drug actions in prescribing practice 19.develop a clinical management plan within legislative requirements and develop effective working partnerships with the Independent Prescriber(s) (supplementary prescribing only) Content On completion the prescriber should demonstrate concordance with the NPC’s competencies for Prescribing. 1. Consultation, decision-making therapy selection, monitoring of therapy selection, and referral Accurate and effective communication and consultation with professionals, other prescribers, patients and their carers Building and maintaining an effective relationship with patients, parents and carers taking into account their values and beliefs Partnership working with the patient including concordant approach and the importance of explaining why medication has been prescribed, side effects and other relevant information to enable patient choice Understands own limitations A knowledge of the range of models of consultation and their applications Development and documentation of a treatment or clinical management plan including referral to the independent prescriber and other professionals Principles of diagnosis and the formulation of a working diagnosis, principles and methods of patient monitoring, further investigation and referral for diagnosis. Management options including non-drug treatment Autonomous working and decision making within professional competence Numeracy and drug calculations• Chemical and biochemical methods for monitoring the treatment of the condition(s) for which the practitioner intends to prescribe on qualification and responses to results. Clinical examination skills relevant to the condition(s) for which the practitioner intends to prescribe. Recognition and responding to common signs and symptoms that is indicative of clinical problems. Use of common diagnostic aids for assessment of the patient’s general health status; e.g. stethoscope, sphygmomanometer, tendon hammer, examination of the cranial nerves. Assessing responses to treatment against the objectives of the treatment plan/clinical management plan Working knowledge of any monitoring equipment used within the context of the treatment/clinical management plan Identifying and reporting adverse drug reactions Management options including non-drug treatment and referral 2. Influences on and Psychology of Prescribing Patient demand versus patient need including partnership in medicine taking, awareness of cultural and ethnic needs External influences, at individual, local and national levels. Awareness of own personal attitude and its influence on prescribing practice 3. Prescribing in a Team Context The role and functions of other team members The responsibility of the supplementary prescriber in developing and delivering the clinical management plan. The professional relationship between independent and supplementary prescribers and those responsible for dispensing Documentation and the purpose of records in communicating prescribing decisions to other members of the team. Structure, content and interpretation of medical records/clinical notes including electronic health records Interface between multiple prescribers and the management of potential conflict The framework for prescribing budgets/cost effective prescribing, audit and evaluation The responsibility of the Supplementary and Independent Prescriber in the development and delivery of the treatment / clinical management plan 4. Clinical pharmacology and applied therapeutics, including the effects of co-morbidity Clinical pharmacology 5. Pharmacodynamics and pharmacokinetics (including controlled drugs) Changes in physiology and drug response, for example the elderly, young, pregnant or breast feeding women and ethnicity Adverse drug reactions (including reporting), drug interactions (drug and disease) and drug related morbidity Patho-physiology of defined conditions for which the prescriber intends to prescribe. Selection and optimisation of drug regimen Natural history and progression of defined conditions for which the practitioner intends to prescribe. Impact of co-morbidities on prescribing and patient management Evidence-based practice and clinical governance in relation to prescribing The rationale for national and local guidelines, protocols, policies, decision support systems and formularies – understanding the implications of adherence to and deviation from such guidance Local and professional clinical governance procedures including Supplementary prescribing in the context of the local health economy e.g. application of local priorities to supplementary prescribing, prescribing guidance produced by PCT prescribing forum, health economy Area Prescribing Committees and priorities for health improvement. Principles of evidence-based practice and critical appraisal skills Reflective practice and continuing professional development – role of self and organisation. Development and maintenance of professional knowledge and competence in relation to condition(s) for which the practitioner intends to prescribe Auditing, monitoring and evaluating prescribing practice Risk assessment and risk management Audit and systems monitoring Analysis and learning from medication errors and near misses The Medication Use Process 6. Legal, policy, and professional and ethical aspects Policy context for prescribing Professional Ethics and Practice Guidance, especially in relation to the supply and administration of medicines Legal basis for prescribing, supply and administration of medicines Medicines regulatory framework including Marketing Authorisation, the use of unlicensed medicines and “off-label” use. Application of the law in practice, professional judgment, liability and indemnity Maintenance of professional knowledge and competence in relation to the conditions for which the supplementary prescriber may prescribe. Accountability and responsibility to the employer or commissioning organisation, awareness of local complaints procedures Informed consent with particular reference to patient’s with learning disabilities, mental illness, critical illness; those requiring emergency treatment, and children Prescription pad security and procedures when pads are lost or stolen Writing prescriptions Record keeping, documentation and professional responsibility Confidentiality, Caldicott and Data Protection, and Freedom of Information Suspicion, awareness and reporting of fraud or criminal behaviour, knowledge of reporting and ‘whistle blowing’ procedures Compliance with guidance arising from the Shipman inquiry Professional competence, autonomy and accountability of Supplementary Prescribing Practice 7. Prescribing in the public health context Duty to patients and society Public health policies, for example the use of antimicrobials and resistance Inappropriate use of medicines including misuse, under and over-use Inappropriate prescribing, over and underprescribing Patient access to healthcare and medicines Use of medicines in populations, and in the context of health priorities Teaching and learning strategies Keynote lectures, self-directed learning, critical reflection, portfolio, case analysis of treatment scenarios, group discussion, problem-based learning. The students will be encouraged to use studentcentral with electronic learning materials on: clinical pharmacology ethics and law in prescribing skills in consultation and assessment on-line submission and blogging Learning support on-line chat support sessions Teaching, supervision and support by lecturers and personal tutors. Supervision, support and shadowing opportunities by Designated Medical Practitioner Reading list Bickley, L.S. 2009 Bates’ Guide to Physical Assessment and History Taking. Lippincott Williams & Wilkins. Brookes, D. & A. Smith. 2006 Non-Medical Prescribing in Healthcare Practice: a Toolkit for Students and Practitioners. London: Palgrave. Beauchamp, T.L. & J.E. Childress. 2009 Principles of Biomedical Ethics. 6th ed. Oxford: Oxford University Press. Clinical Evidence. 2003. 9th ed. London: BMJ Publishing. Courtenay, M & M. Griffiths (eds.) 2005. Independent and Supplementary Prescribing: an Essential Guide. Cambridge: Cambridge Press. Courtenay, M. & Griffiths, M (eds) 2010. Medication safety: an essential guide. Cambridge University press. Dale, M.M. & Haylett, D.G. 2009 Pharmacology Condensed 2nd ed. Churchill Livingstone; Elsevier. Department of Health. 2006. Improving Patients’ Access to Medicines: A Guide to Implementing Nurse and Pharmacist Independent Prescribing within the NHS in England. London: DOH. Department of Health. 2005. Supplementary Prescribing by Nurses, Pharmacists, Chiropodists/Podiatrists, Physiotherapists and Radiographers within the NHS in England. London: DOH. Dimond, B. 2005. Legal Aspects of Medicines. Quay. Galbraith A. et al 2007 Fundamentals of Pharmacology 2nd ed. Pearson Prentice Hall. Jones, M. & Guatam, N. 2004 The hands-on guide to practical prescribing. Blackwell. Kumar, P. & Clark, M. (eds). 2009. Clinical Medicine. 7th ed. Saunders Elsevier. Lymn, J., Bowskill, D., Bath-Hextall, F., Knaggs, R. (eds) 2010 the new Prescriber. An integrated approach to medical and non-medical prescribing. Wiley-Blackwell. Morgan, R. & Johnson, M. 2000 Pharmacology for podiatrists. Blackwell Science. Neal, M.J. 2005 Medical Pharmacology at a glance. 5th ed. London: Blackwell Porth, C.M. & Matfin, G. 2009. Pathophysiology: concepts of altered health states. 7th ed. Lippincott, Williams & Wilkins Robinson, D. 2002. Clinical Decision-Making, a case study approach 2nd ed. Lippincott Swage, T. 2004. Clinical Governance in Health Care Practice. 2nd ed. Butterworth-Heinemann Assessment tasks The assessment regulations will conform to the University of Brighton General Examination and Assessment Regulations and the rules and regulations of the Undergraduate Professional Practice Framework. Competence will be demonstrated through assessment of both theory and practice. To facilitate this, each student will maintain a portfolio of assessment and achievement of the stated learning outcomes. A range of assessment strategies will be employed to test knowledge, decision-making and the application of theory to practice. These are dictated by the NPC and are listed in the 4 parts as follows: Examination (Part A) Objective Structured Clinical Examination (OSCE), a systematic examination of practice within a simulated clinical environment, including a pass/fail calculation element. (Part B) Final examination consisting of 30 multiple choice questions and an unseen written paper to test pharmacological knowledge, application to practice and analytical reasoning (nurses must achieve a minimum 80% pass for the multiple choice paper, a statutory body requirement): Coursework (Part C) Clinical Management Plans for the students’ specific client group (Part D) Review of portfolio (to include reflection, critical incident analysis, case studies etc., including a pass/fail calculation element) will include a record of the satisfactory completion of a minimum of 12 days or the equivalent (90 hours) of learning experience. The assessment of practice will be the responsibility of the prescribing medical practitioner providing support, teaching and supervision of the student. This portfolio is designed to provide evidence of the NPC’s Competencies for Supplementary / Independent Prescribers. Each part of the above examination and coursework elements of the assessment strategies carries an equal weighting and students must achieve the required pass or pass mark in each of the components, individual statutory body requirements apply differently depending on the profession. Brief description of module content and/or The final mark is calculated from the arithmetic mean of the mark from the four components (A – D). All 4 parts of the assessments are marked in accordance to separate marking criteria for the level of assessment (6 or 7) that the student has opted to be examined at. (See appendix 7 for the unseen written examination marking criteria). Certain elements are also graded pass or fail independent of the overall mark awarded. Therefore a pass mark awarded cannot compensate against a fail element. This module will enable Supplementary Prescribers to prescribe Prescription Only Medicines including aims (maximum 80 words) Area examination board to which module relates Module team Semester offered, where appropriate Site where delivered Date of first approval Date of last revision Date of approval of this version Version number Replacement for previous module Field for which module is acceptable and status in that field Course(s) for which module is acceptable and status in that course School home External examiner Controlled Drugs and off-label use in accordance with an individual patient’s Clinical Management Plan and the agreement of the medical practitioner and with the patient’s consent BSc(Hons) in Professional Practice Under Graduate Continuing Professional Development AEB, School of Nursing and Midwifery Maria Young (Module Leader: Podiatrist) Penny Lindley: Assistant Head - Continuing Professional Education, School of Nursing & Midwifery Kate Barnham: Former Student March 2010 cohort Independent Prescriber (Respiratory Nurse Specialist) Inge Bateman: Non-Medical Prescribing Lead & Clinical Nurse Specialist in Acute Pain Management Joanne Burgess: Former Student Sept 2006 cohort, Independent Prescriber (Mental Health Nurse) Peter Coyne: Information Adviser Sharon De Goeas: Senior Lecturer (Ethics) Dr. Les Ellam: Learning Technologies Adviser Mary Elliott: Independent prescriber, Lead Fracture Liaison Nurse Specialist, Visiting Lecturer for Physical Assessment Elements Sue Oliver: Former Student March 2010 cohort, Independent Pharmacist Prescriber Paula Rabin, Director of Radiography, Brighton and Sussex University Hospitals NHS Trust Samantha Taylor: Programme Administrator Stevan Monkley-Poole: Module Lead: Nurses Greg Scutt: Module Lead: Pharmacists 1 and 2 Falmer March 2011 Podiatry / Physiotherapy / Radiography School of Nursing and Midwifery Dr. Christine Thorp (01/04/2011 to 31/03/2015)