Developing the Nurse Practitioner
Role in Community Palliative Care
Leanne Davey
Nurse Practitioner, Palliative Care
Royal District Nursing Service
Northern Region
Collaborative Project
• Royal District Nursing Service &
• Melbourne CityMission Palliative Care
Service
• Development of Clinical Practice
Guidelines (CPG’s) & Medication
Formulary
Implementing the NP role in the
Community setting
• Appointment of Project Manager
• Key areas of work undertaken:
– Gaining an in-depth understanding of the Drugs, Poisons
and Controlled Substances Regulations 2006 (Vic) in order
to identify areas to be addressed
– Writing a Policy and Procedure to support the NP prescribing
& authorising rights
– Developing a Position Description
– Identifying equipment needed for the role
– Developing a specific set of codes
– Developing a comprehensive Communication Strategy
Policy and Procedure-Nurse Practitioner
role in medication and diagnostic tests
Policy and Procedure was derived from the
Drugs, Poisons and Controlled Substances
Regulations 2006 (Vic) and includes:
• Definitions of terms used in the policy
• General policy statement
• Processes in relation to:
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Prescribing medicines
Seeking consent to the NP prescribing
Disclosure of drug use
Oral instructions in an emergency
Schedule 8 permit and notification requirements
Policy and Procedure-Nurse Practitioner role
in medication and diagnostic tests (cont’d)
– Confirming prescriptions
– Authorising medicines
– Disposing of unused schedule 8 medicine
ampoules
– Transporting client medicines
– Authorising diagnostic investigations
– Communicating with doctors or hospital
Policy and Procedure-Nurse Practitioner
role in medication and diagnostic tests (cont’d)
– Referring to community based
service/inpatient for admission
– Giving advice to a Doctor
– Giving notification of a drug dependent
person
– Giving notification of fraudulent obtaining of
drugs and poisons
– Process where GP writes script and NP
writes authorisation in the home
Position Description
• Job purpose
• Key Position functions
- Clinical Practice
- Quality Management
- Research and Continuous Improvement
- Collaboration and Partnership Approach
- Professional Development
• Skills/knowledge/attributes
• Qualifications
Equipment to support NP role
• Private prescription pad
• Electronic access to copy of:
– Therapeutic Guidelines
– MIMS online, and
– Australian Medicines Handbook
• Nurse Practitioner stamp
• Prompt card
Activity Codes
• Activity codes developed to reflect
practice
• Codes exclusive to NP role
• Data terms and definitions for codes
developed to reflect and capture the
extended practices
• Supporting evidence for the NP role
Communication with internal &
external Stakeholders
Communication strategy included:
• Developing letters to introduce the role
• Arranging visits to Pharmacies and
GP’s
• Writing articles for newsletters
• Developing a road show presentation
• Producing Business cards
Issues to address
• Carrying of drugs by NP
• Inability to access PBS
• Expense of private scripts
Strategies to address the challenge
• Decision not to carry drugs
• Costing of medications on private script
• Forging relationships with Pharmacies,
the Pharmacy Board and Guild
• Development of private prescription pad
• Authorising medications in collaboration
with the GP or specialist
Demonstrating Continuing Competency
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Professional portfolio
Development of new activity codes
Clinical Supervision
Review/update CPG’s every 2-3 years
Conclusion
• Sharing of information/experience
• Consult/contact
• Process for using RDNS forms &
documentation
-Written request to Sharon McNeil,
RDNS Policy Officer
-Need to acknowledge RDNS on
form/documentation