Portfolio of Evidence 2014-15 - University of Bolton · PDF file1 Academic Group: Health and...

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Academic Group: Health and Community Studies

Non-Medical Independent and Supplementary Prescribing

Portfolio of Evidence HE6 / HE7 for AHPs / Nurses / Pharmacists

C O N F I D E N T I A L

Start date: …………………………………………………………………… Student Number: ...................................................................................... DMP Name: ................................................................................................ Personal Tutor: ………............................................................................... Submission date: …………………………………………………….………

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CHECKLIST FOR SUBMISSION OF PORTFOLIO: Page number:

Statement of confidentiality

Statement of ownership

Statement of good character (2, beginning and end of course)

Personal Development Plan

Introduction to Portfolio

Web based learning outcome activities learning contracts and supporting evidence:

LO1, Assessment and consultation

LO2 History taking

LO3 Applying legislation to prescribing practice

LO4 Sources of appropriate supporting evidence

LO5 Influences on prescribing practice

LO6 Pharmacology

LO7 Roles and responsibilities

LO8 Prescribing safely: Three critical case study reflections and prescribing for children scenario including for each (4 in total):

o Prescription o P-formulary o Completed assessment template o Patient/carer feedback form

LO9 Professional accountability and responsibility

LO10 Critical analysis of Independent and Supplementary Prescribing and sample CMP

OSCE assessment documentation and copy of digital email submission receipt (LO1,2,4)

Completed reflective practice log signed by DMP (90 hours)(LO1-10)

DMP verified Competency Assessment Document

DMP verified Final Statement of Clinical Competence

Mark:

PASS / REFER

Please ensure you have included all the evidence outlined above when you submit your Portfolio for summative assessment. This Portfolio template is available on Moodle.

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Introduction

The assessment of the NMP course requires the submission of a 5000 word (HE6) or 6000 word (HE7) Portfolio of Evidence demonstrating the application of theory to practice in meeting the learning outcomes; professional body (NMC) requirements and the National Prescribing Centers Single Competency Framework for all prescribers (NPC 2012). The Portfolio of Evidence is marked and internally moderated by the programme team, and then externally moderated by the named External Examiner. The programme team will verify the portfolio of evidence by stating whether you have provided relevant and sufficient evidence to meet all the learning outcomes for the NMP programme.

There are some specific exercises which you must complete and insert into this Portfolio as per the contents list and following pages.

You are also required to submit any other appropriate supporting evidence which helps to demonstrate your achievement of the learning outcomes, for example:

Up to date research/journal articles for products/conditions you will prescribe for

Local and national guidelines (however complete copies of local guidelines or NICE guidelines are not required as the reference will suffice)

Copies of certificates of competence if relevant (not originals).

*The entire portfolio must be written at the appropriate academic level ie. HE6/HE7*

Please note, the NMC stipulate that if you fail to correctly answer any question that may result in direct harm to a patient / client, you must be referred. This includes failure to ask about:

medication history

allergies

any over the counter medication

incorrect dosage Furthermore in respect of prescribing for children and young people if there is any doubt about your ability to demonstrate knowledge skill and competence in any of the areas stipulated, further training in relevant aspects of the legal, cognitive, emotional and physical differences between children and adults and in taking an appropriate history, undertaking a clinical assessment and making an appropriate diagnosis for a child, will need to be undertaken prior to completing a prescribing course.

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Statement of Confidentiality

I declare that the contents of this Portfolio have been anonymised so as not to compromise patient/staff confidentiality. You can provide supplementary evidence to support your competence (i.e. reflections from practice, prescriptions, CMPs, minutes of meetings, audits etc.), however you must not include Trust / employer documentation unless it is in the public domain or you have written manager approval. All identifying logos etc must be removed before submission of the portfolio. Please refer to the confidentiality guidelines provided in the University Student Handbook as any breach of confidentiality may result in a refer/fail.

Signed_______________________________________ Date_________________________________________

Statement of Ownership

I declare that the whole of this work produced is the result of my own individual effort. I declare

that no part of this portfolio has been taken from existing published or unpublished material

without due acknowledgement and that all secondary material used herein has been fully

referenced. This work has not been submitted for any previous award.

Signed_______________________________________ Date_________________________________________

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NURSES ONLY: STATEMENT OF GOOD HEALTH & GOOD CHARACTER

The Nursing & Midwifery Council Good Health Good Character Guidance (NMC, 2008 p. 10) states that, “Programme providers should have processes in place to make sure that all students declare their good character and good health annually over the course of their programme”. “Good health” means that a person must be capable of safe and effective practice without supervision. It does not mean the absence of any disability or health condition.” (NMC, 2008, p. 5-6) “Good character” is based on a person’s conduct, behaviour and attitude, as well as any conviction and cautions that are not considered compatible with professional registration and that might bring the profession into disrepute. A person’s character must be sufficiently good for them to be capable of safe and effective practice without supervision” (NMC, 2008, p.5) You are be reminded that it is your responsibility to notify the university if your health or disability status changes during the course or you have a charge, conviction or caution that may affect your ability to practice safely and effectively (NMC, 2008, p. 9). You are thus required to self declare your good health and good character on commencement of this programme.

Independent and Supplementary Non Medical Prescribing for Nurses (V300)

NMC PIN Number:.................................................................. Expiry Date:.......................................... I ………………………………………………………………………………………………………………..........(Full name of student) declare that my health & character is of a standard that enables me to deliver safe and effective Practice. Signature……………………………………………………………………………………Date……………………………………..

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Introduction to Portfolio

Job title/role

Prescribing role: (brief outline of your proposed prescribing role, conditions and products. Specify and provide a rationale for the three conditions which you will prescribe for in this portfolio)

Evidence of competence to prescribe for the above conditions eg. specific qualifications, duration in post etc.

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Learning Outcome 1: HE6: Assess and consult with patients/clients, parents and carers. HE7: Integrate skills and knowledge when undertaking a systematic assessment and consultation with

patient/clients, parents and carers. LEARNING CONTRACT

Plan of action (what will you need to do to achieve the learning outcome, discuss with your DMP): Reflection on Action: (what do you now know as a result of this learning and how will you apply this to your prescribing in practice? Include supporting evidence eg. legislation, theory, guidelines, research, protocols etc) EVIDENCE PROVIDED:

Digital recording of your OSCE in practice and completed assessment document

Case study reflections

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Learning Outcome 2: HE6: Undertake a thorough history, including relevant physical examination medication (including over-the-counter, alternative and complementary health therapies) to inform diagnosis. HE7: Undertake a thorough history, and physical examination, including medication history and current medication (including over-the-counter, alternative and complementary health therapies) and evaluates findings to inform diagnosis. LEARNING CONTRACT Plan of action (what will you need to do to achieve the learning outcome, discuss with your DMP): Reflection on Action: (what do you now know as a result of this learning and how will you apply this to your prescribing in practice? Include supporting evidence eg. legislation, theory, guidelines, research, protocols etc)

EVIDENCE PROVIDED:

Digital recording of your OSCE in practice and completed assessment criteria (place in one sealed poly wallet here)


Completed and signed Clinical Skills Work Book (pharmacists only)

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Learning Outcome 3: HE6: Understand and apply the relevant legalisation to the practice of independent and supplementary prescribing. HE7: Critically discuss and evaluate your own prescribing practice within the relevant legal, professional and ethical frameworks to the practice of independent and supplementary prescribing. LEARNING CONTRACT

Plan of action (what will you need to do to achieve the learning outcome, discuss with your DMP): Reflection on Action: (what do you now know as a result of this learning and how will you apply this to your prescribing in practice? Include supporting evidence eg. legislation, theory, guidelines, research, protocols etc)

EVIDENCE PROVIDED:


Web based NMP activities

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Learning outcome 3 activity: Read the following sections of the Web based NMP programme: Applying the Legal Frameworks for Non-Medical Prescribing Personal Accountability and Responsibility as a NMP Accountability and Responsibility to Employing Organisations Prescribing safely, appropriately and cost effectively Decision making Then read your own Code of Conduct / Ethical standards and Frameworks for professional AND prescribing practice, and answer the following questions (100 words each):

1. What should you ensure if you accept a referral from another health professional for a patient who requires a prescription?

2. How would you act if there was a significant or immediate risk to a patient’s life and

they refused to give consent for treatment?

3. What action would you take if you thought a patient’s safety was at risk because of a colleague’s conduct, performance or health?

4. What would you do if you had a conscientious objection that was relevant to your professional practice?

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Learning Outcome 4: HE6: Critically appraise, and use sources of information/advice and decision support systems in prescribing practice. HE7: Critically review and utilise sources of information and research evidence to support decision making within prescribing practice. LEARNING CONTRACT


EVIDENCE PROVIDED:


Supporting evidence/research for conditions and/or products in case study reflections

List of useful prescribing resources/evidence

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Learning Outcome 5: HE6: Understand the influences that can affect prescribing practice, and demonstrate your understanding by managing your prescribing practice in an ethical way. HE7: Demonstrate critical awareness of the influences that can affect prescribing practice, by managing your prescribing practice in an ethical way. LEARNING CONTRACT Plan of action (what will you need to do to achieve the learning outcome, discuss with your DMP): Reflection on Action: (what do you now know as a result of this learning and how will you apply this to your prescribing in practice? Include supporting evidence eg. legislation, theory, guidelines, research, protocols etc)

EVIDENCE PROVIDED:


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Learning Outcome 6: HE6: Understand and apply knowledge of drug actions in prescribing practice. HE7: Critically examine and apply knowledge of drug actions in prescribing practice. LEARNING CONTRACT Plan of action (what will you need to do to achieve the learning outcome, discuss with your DMP): Reflection on Action: (what do you now know as a result of this learning and how will you apply this to your prescribing in practice? Include supporting evidence eg. legislation, theory, guidelines, research, protocols etc)

EVIDENCE PROVIDED:

Appropriate prescriptions attached to case study reflections

P-formularies attached to case study reflections

Pass mark achieved in pharmacology exam

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Learning Outcome 7: HE6: Demonstrate an understanding of the roles and relationships of others involved in prescribing, supplying and administering medicines. HE7: Critically review and demonstrate an understanding of the roles and relationships of others involved in prescribing, supplying and administering medicines. LEARNING CONTRACT Plan of action (what will you need to do to achieve the learning outcome, discuss with your DMP): Reflection on Action: (what do you now know as a result of this learning and how will you apply this to your prescribing in practice? Include supporting evidence eg. legislation, theory, guidelines, research, protocols etc)

EVIDENCE PROVIDED:


Completed activity

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Please complete the following activity in relation to Learning Outcome 7:

Looking at your own prescribing team and the relationships within it, please respond to the following questions: (100 words each)

1 Define the role and boundaries of the other members of your prescribing team in relation

to prescribing, supplying and administering medicines.

2 Do any of the above responsibilities within your team overlap and are there any omissions

that need to be addressed?

3 What support and advice do you expect from the other members of your prescribing team

and what support do they expect from you in return?

Read the following sections of the Web based NMP programme: Prescribing in Multi-Professional Teams Factors that influence prescribing Professional Relationships in Prescribing Partnerships How will it Work for Me? Access the following document by selecting them from the Resources on the Course website, the World Wide Web or a medical library and then answer the questions that follow below. Supplementary Prescribing by Nurses, Pharmacists Chiropodists/Podiatrists, Physiotherapists and Radiographers within the NHS in England - a Guide for Implementation updated May 2005 Improving patients’ access to medicines: A guide to implementing nurse and pharmacist independent prescribing within the NHS in England (April 2006)

Further Reading: Belbin, R.M 2000 Beyond the Team (Oxford: Butterworth Heinemann)

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Learning Outcome 8: HE6: Prescribe safely, appropriately and cost effectively for all age groups. HE7: Demonstrate application of safe, appropriate cost effective prescribing for all age groups. LEARNING CONTRACT Plan of action (what will you need to do to achieve the learning outcome, discuss with your DMP): Reflection on Action: (what do you now know as a result of this learning and how will you apply this to your prescribing in practice? Include supporting evidence eg. legislation, theory, guidelines, research, protocols etc)

EVIDENCE PROVIDED:

Pass mark achieved in numeracy exam


Patient/client feedback forms

Accurate prescription writing

Appropriate responses to child scenario on next page

Accurate child’s prescription and P-formulary

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Please complete the following activity in relation to LO8, prescribing for children When prescribing for children you must provide evidence of your ability: “to take an appropriate history, undertake a clinical assessment and make an appropriate decision based on that assessment to either diagnose or refer, having considered the legal, cognitive, emotional and physical differences between children and adults”. Further, the assessment must demonstrate: “recognition of the unique implications and developmental context of the anatomical and physiological differences between neonates, children and young people.’ (NMC Circular 22/2007). Although this is a specific NMC requirement, all non medical prescribing students are required to complete this activity as a mark of good practice. Before completing the activity, it is recommended that you read the NPC Prescribing for Children bulletin and/or any other suitable publication in relation to prescribing for children. The bulletin is available on this link: http://www.npc.nhs.uk/merec/other_non_clinical/resources/merec_bulletin_vol11_no2.pdf

http://www.npc.nhs.uk/merec/other_non_clinical/resources/merec_bulletin_vol11_no2.pdf

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Please type your responses to the following questions here, utilising appropriate up to date theory, research and evidence to underpin each response (100-150 words each, maximum 1000 words).

1. How would you adapt your assessment, communication and consultation style in order to gather appropriate information from the child? Underpin the rationale for your approach with supporting literature.

2. What key factors would you need to consider when undertaking a clinical assessment of

the child and why? It may help to consider the legal, professional and ethical aspects that underpin clinical assessment in respect of a child of this age.

3. Explain how you would confirm the diagnosis in this case in order to make a safe prescribing decision. Underpin your explanation with reference to the evidence base.

4. What developmental and physiological factors do you need to consider if you are to

prescribe for the child?

5. What treatment could you prescribe for the child? Justify your choice, eg. what is the evidence base supporting your decision making.

6. Reflect on your ability to prescribe for a child in your area of practice, even if this is not currently part of your role.

7. Handwrite a prescription for the product you are to prescribe using a sample FP10, and

complete a P-formulary for the product.

Please respond to each of the above questions sequentially and insert the child‟s prescription and p-formulary here.

CHILD SCENARIO: 22 month old Harry has sprained his right ankle having jumped off a chair. His x-rays yesterday show no bony injury. He has been fitted with an elastic stocking for support. He weighs 12 kg.

Mum has returned to the clinic with Harry requesting pain relief for him. He complains of „foot hurting‟ and will not walk or weight bear. He has not slept all night.

On examination today his right ankle is swollen and slightly bruised. He is

apyrexial, all other observations are normal. – Diagnosis: right ankle sprain.

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Learning Outcome 9: HE6: Practice within a framework of professional accountability and responsibility. HE7: Critically review own prescribing practice within a framework of professional accountability and responsibility. LEARNING CONTRACT Plan of action (what will you need to do to achieve the learning outcome, discuss with your DMP):

Reflection on Action: (what do you now know as a result of this learning and how will you apply this to your prescribing in practice? Include supporting evidence eg. legislation, theory, guidelines, research, protocols etc)

EVIDENCE PROVIDED:


Appropriate responses to LO9 activities below

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Learning Outcome 9 activity:

Find the relevant local/national/legal guidelines and/or policies in relation to the following and

then respond to the questions below: (100 words each)

1. Make a list of your responsibilities and organisational requirements regarding

prescription/pad security.

2. Locate, print or download an example prescription use recording log/form that you

could use in your role as a prescriber for use when you are a qualified prescriber.

3. List the actions that you and your employing organisation should take to control

prescription pad issue and deal with loss or suspected theft.

4. Articulate your understanding in relation to remote prescribing utilising your

organisational and professional body requirements/limitations.

5. Articulate your accountability when prescribing off label and unlicensed prescribing

utilising your organisational and professional body requirements/limitations.

6. State what actions you should take in the event a patient suffers a serious adverse

reaction/allergy to a product you have prescribed.

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Learning Outcome 10: HE6: Develop a clinical management plan within legislative requirements. HE7: Critically review and demonstrate knowledge of the legislation in relation to independent and supplementary prescribing and develop a clinical management plan. LEARNING CONTRACT


EVIDENCE PROVIDED:

Critique of Independent and Supplementary Prescribing and their application to your own area of prescribing practice

Completed sample CMP


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Please complete the following activity in relation to LO10

Read the following documents and then write a critical analysis of Independent and Supplementary Prescribing and their application to your area of practice (250 words) And then Complete a sample legal CMP ideally of relevance to your own prescribing area using the following template (further guidance for completing this is available on Moodle).

Improving Patients’ Access to Medicines: A Guide to Implementing Nurse and Pharmacist Independent Prescribing within the NHS in England Department of Health 2006

http://webarchive.nationalarchives.gov.uk/20130107105354/http://dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4133747.pdf

Supplementary Prescribing by Nurses, Pharmacists, Chiropodists/Podiatrists, Physiotherapists and Radiographers within the NHS in England, A guide for implementation 2005

http://webarchive.nationalarchives.gov.uk/20130107105354/http://dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4110033.pdf

http://webarchive.nationalarchives.gov.uk/20130107105354/http:/dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4133747.pdf




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SAMPLE CMP (You must complete all fields as this is a legal document, use appropriate pseudonyms, a completed example is provided on Moodle)

Name of Patient:

Patient medication sensitivities/allergies:

Patient identification e.g. ID number / date of birth:

Independent Prescriber(s):

Supplementary Prescriber(s)

Condition(s) to be treated

Aim of treatment

Medicines that may be prescribed by SP:

Preparation

Indication

Dose schedule

Specific indications for referral back to the IP

Guidelines or protocols supporting this Clinical Management Plan: (title, source and date) Frequency of review and monitoring by: Supplementary prescriber:

Frequency of review and monitoring by: Supplementary prescriber and independent prescriber:

Process for reporting ADRs:

Shared record to be used by IP and SP: (State system in use eg. Vision etc)

Agreed by independent prescriber(s)

Date Agreed by supplementary prescriber(s)

Date Date agreed with patient/carer

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Reflective Practice Log – You are required to provide a reflective practice log of

a minimum of 90 hours (at least 45 of these must to be spent with your DMP, the remainder can be spent with other doctors/Advanced practitioners of relevance to your role) to reflect learning gained in practice and application of theory to practice.

Use your log as a basis to evidence and reflect upon your learning as this will help you to:

Identify your achievement of the learning outcomes in University and in practice

Direct your subsequent learning (for example, through the use of learning contracts and

independent study)

Assist you in evaluating your progress, and inform your DMP’s final verification of

competence to prescribe within your area of practice

These entries should also form the basis of reflective discussions with your DMP. You

will select three patients (in addition to the child scenario above) whom you have consulted whilst under the supervision of your DMP in practice on which to write the three case study critical reflections using the templates provided. These case study reflections will demonstrate your competence to prescribe safely, effectively and appropriately in your own clinical area. For each of the critical reflections you are required to incorporate the learning outcomes for the module and use appropriate supporting theoretical and clinical evidence/research. For each of the three reflections you must complete the following:

o Patient assessment template o Prescription o P-formulary o Completed patient feedback form with DMP comments and signature.

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REFLECTIVE PRACTICE LOG ACTIVITY – Brief reflection of prescribing experience /learning gained in practice; eg. Conditions and products prescribed etc. Minimum of 90 hours, 45 of which must be with your DMP.

Learning outcome number

HOURS/RUNNING TOTAL

DATE

TOTAL HOURS (90) (please submit a paper copy)

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TEMPLATES

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1. Consider the patient: (NPC Principles of Good Prescribing Framework 1999)

Patient name and dob/age

Presenting Complaint (PC)

History of presenting complaint (HPC) (use appropriate assessment tool eg. PQRST)

Clinical findings and observations (signs and symptoms, clinical observations, wound assessment etc)

Past medical history

Past surgical history

Prescribed Medication history (Name, Dose, Frequency, Reason Started, whether effective)

Over the counter products (complementary, herbal and illicit etc.)

Allergies (To what and state nature of reaction)

Adverse reaction (To what and state nature of reaction)

Family history:

Social history:

Home Situation

Occupation

Hobbies

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Pets

Recent Travel

Alcohol

Smoking

Recreational Drugs

Sexual History

Systems Enquiry (Provide details where appropriate, or state not applicable only if this is the case)

Cardiovascular

Respiratory

Gastrointestinal

Genitourinary

Nervous system

Endocrine

Musculoskeletal

Skin hair & Nails

Other

Working diagnosis (pathophysiology and evidence to support diagnosis)

2. Consider the appropriate stratey: consider your competence to prescribe, legal, ethical and professional issues.

3. Consider the choice of product/ treatment plan (apply EASE to product, using up to date supporting evidence/guidelines used)

4. Negotiate a contract to achieve concordance with the patient

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(communication and consultation skills, how was the patient involved in decision making, what information was given to the patient eg. dose schedule, duration of treatment, when to start/stop the medication etc)

5. Review and outcome (by who, when, where and why; was the treatment effective)

6. Record keeping (where and why)

7. Reflection on scenario: (you may use a reflective model of your choice to structure your reflection, approx. 750-1000 words) Student signature: ….................................................................. DMP signature: …....................................................................... Date: ….........................................................................................

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FP10 – prescription writing sample/aide memoire Prescriptions must demonstrate 100% accuracy including numeracy Prescribed indication: ……………….back pain……………………………….

Age: 21 D.O.B. 3.6.1993 Remember: legal requirement to state age in years/months and date of birth if under 12 years of age

Name: eg. Joe Bloggs Address: 3 Bolton Parade, Bolton, BL1 5AB NHS NO : 987654321

No of days treatment

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Remember PSDRQ: Product name spelt correctly and formulation Strength/ size/formulation available as per BNF Dose schedule as per BNF/local guidelines Route of administration Quantity to be dispensed by pharmacist Score blank space through (if any)

Example: Paracetamol tablets 500mg tablets 2 tablets to be taken every 4-6 hours - Maximum daily dose 8 tablets Oral 16 tablets

Signature:

A. Prescriber

Prescriptions must be signed

Date: 3.6.1993 Date prescription written must tally with patients date of birth

Practice Code : 23FFXY001 Independent/Supplementary Prescriber 6E5431ZZ Bolton Practice Bolton, BL3 5AB Tel: 01200 900300

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FP10 TEMPLATE Prescriptions must demonstrate 100% accuracy including numeracy Remember PSDRQ Prescribed indication: …………………………………………………………….

Age D.O.B.

Name: Address: NHS NO : 987654321

No of days treatment

Signature:

Date:

Practice Code : 23FFXY001 Independent/Supplementary Prescriber 6E5431ZZ Bolton Practice Bolton, BL3 5AB Tel: 01200 900300

(Photocopy as required)

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PERSONAL FORMULARY (complete all fields)

Chemical Name (Generic)

Brand Name/s

Presentation/Formulation/s (colour of liquid/tablets, strength, tablets, capsules, lotion, granules, cream etc)

Indications / Uses (clinical condition/s)

Dosage & Administration (frequency, length of treatment)

Contra-indications (when the product should not be used)

Cautions (to be considered if the product can be used with careful monitoring eg. liver and/or renal failure, breastfeeding, pregnancy, elderly etc.)

Interactions (with other medications the patient may be taking including OTC, herbal, illicit)

Side Effects

Package Quantities

Cost

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Pharmacodynamic properties (how the drug works and the effect it has on the body)

Pharmacokinetic properties (how drugs move through the body during Absorption, Distribution, Metabolism, Excretion)

Additional notes (e.g special instructions for administration, storage, patient monitoring, pregnancy, breastfeeding, age (neonate/elderly) etc)

References

(Photocopy as required)

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NON MEDICAL PRESCRIBING (LO1, 2 and 4) – PATIENT/CARER FEEDBACK FORM

Care delivery by students Please ensure that patients/service users are informed of their right to refuse to care being delivered by a prescribing student. This form is designed to enable you to give your views on how the student Non-Medical Prescriber performed in their recent contact with you. Whilst it is offered to you, you do not have to complete it. However, your views are very important as they will help the student to learn about how they develop successful working relationships with service users.

Please answer Yes or No and add any comments that you would like at the bottom. During the contact with the student:

1. Did you feel that the student conducted him/herself in an appropriate manner?

Yes No

2. Did the student listen to what you had to say?

Yes No

3. Were your views taken into account when considering treatment options and your future care?

Yes No

4. Did the student treat you with respect?

Yes No

5. Is there anything else you would have liked the student to tell you about the proposed treatment?

Yes No

Thank you for your feedback, it is greatly appreciated.

Student reflection and any identified new learning needs: (250 words approx.) DMP comments:

Date: (Photocopy as required, paper copies may be submitted)

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NMP CPD ACTION PLAN EXAMPLE - Complete this towards the end of your course to demonstrate how you will maintain and/or develop your competence during the first 6 months post qualifying as a Non-Medical Prescriber.

Area of competence

Action plan Date of completion Evidence

EXAMPLE ONLY: To develop competence to prescribe for asthmatic patients

Revise A&P of respiratory system; Attend asthma course/update etc; Observe asthma specialist nurse/doctor in clinic; Research up to date treatment and products for asthma patients; Develop P-formularies for asthma inhalers; Develop respiratory clinical examination skills;

1/1/15 Now have good working knowledge of A&P of respiratory system; Attended asthma course/update (date) and now understand pathophysiology of asthma; P-formulary developed for asthma products: a,b,c, etc; Now understand how inhalers work and able to prescribe competently for asthmatic patients; Now able to clinically examine asthmatic patients in order to make a safe and accurate diagnosis.

Keep up to date with prescribing developments

Subscribe to prescribing websites/journals/attend conferences, practice update etc.

1/1/15 Regularly receive updates from relevant websites, read journals, update practice etc.

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NMP CPD ACTION PLAN TEMPLATE - Complete this towards the end of your course to demonstrate how you will maintain and/or develop your competence during the first 6 months post qualifying as a Non-Medical Prescriber. (500 words)

Area of competence Action plan Date of completion Evidence

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NPC Single Competency Framework for all Prescribers (2012) The NPC Single Competency Framework (illustrated below) outlines out what good prescribing looks like and comprises three domains, each of which has three dimensions of competency. Each of the competency dimensions contain statements which describe the activity or outcomes all qualified prescribers should be able to demonstrate. All of the competences are relevant to all prescribers however some of the statements may be more relevant to some prescribers than others. You should consider how each of the statements applies to your own prescribing area.

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Non-Medical Prescribing

Competency Assessment Document

&

Statement of Competencies

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Achieving prescribing competencies

Read each of the domains and competencies on the following pages and score yourself in relation to your current prescribing knowledge at the

start of the module (Start score) using the table below. This should be completed within the first week of starting the module. Scores of 1 and 2 will form the focus for your learning and Personal Development Plan whilst on the module (complete the PDP template

provided at the back of this Portfolio of Evidence). You should take this with you to your meetings with your Practice DMP so that you can demonstrate your progress and he/she can help you to plan further activities/experiences to meet your learning needs whilst in practice.

In the last week of the module you are required to score yourself again (End score) to demonstrate your achievement as a competent (level 3)

non-medical prescriber in your own field of practice within the areas outlined in the introduction to your Portfolio of Evidence. (please submit a signed paper copy) You are required to achieve at least level 3 for each competency statement on completion of the module.

Taxonomy Score

Novice 1

Advanced beginner 2

Competent 3

Proficient 4

Expert 5

(Taken from Benner (1984) From novice to expert: excellence and power in clinical nursing practice. London: Addison-Wesley)

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Domain A: The consultation

NPC competency 1: Knowledge Has up-to-date clinical, pharmacological and pharmaceutical knowledge relevant to own area of practice.

Programme learning outcomes: 4, and 6

Competence Start score 1-5 End score 1-5

1. Understands the conditions being treated, their natural progress and how to assess their severity.

2. Understands different non-pharmacological and pharmacological approaches to modifying disease and promoting health, identifies and assesses the desirable outcomes of treatment.

3. Understands the mode of action and pharmacokinetics of medicines and how these mechanisms may be altered (e.g. by age, renal impairment), and how this affects treatment decisions.

4. Understands the potential for adverse effects and how to avoid/minimise, recognise and manage them.

5. Uses up-to-date information about relevant products (e.g. formulations, pack sizes, storage conditions, costs).

6. Applies the principles of evidence-based practice, including clinical and cost-effectiveness.

7. Aware of how medicines are licensed, sourced and supplied, and the implications for own prescribing.

8. Knows how to detect and report suspected adverse drug reactions.


9. Understands the public health issues related to medicines and their use.

10. Appreciates the potential for misuse of medicines.

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11. Understands antimicrobial resistance and the roles of infection prevention, control and antimicrobial stewardship1 measures.

Initial Formative Assessment DMP Signature: …………………............................ Student Signature: ...…………............................. Date: ……………………........................................

Mid point Formative Assessment

DMP Signature: …………………............................ Student Signature: .…………............................. Date: ……………………........................................

Final Summative Assessment

DMP Signature: …………………............................ Student Signature: ..…………............................. Date: ……………………........................................

DMP Comment:

Student comment:

Date: ……………………………………….

Date: ………………………………………

1 Antimicrobial stewardship - Advisory Committee on Antimicrobial Resistance and Healthcare Associated Infection (ARHAI)

http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@ab/documents/digitalasset/dh_123969.pdf

http://www.dh.gov.uk/ab/ARHAI/index.htm

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NPC competency 2: Options Makes or reviews a diagnosis, generates management options for the patient and follows up management.

Programme learning outcomes: 1, 2, 6 and 8


12. Takes an appropriate medical history and medication history which includes both current and previously prescribed and non-prescribed medicines, supplements and complementary remedies, and allergies and intolerances.

13. Undertakes an appropriate clinical assessment using relevant equipment and techniques.

14. Accesses and interprets relevant patient records to ensure knowledge of the patient's management.

15. Makes, or understands, the working or final diagnosis by considering and systematically deciding between the various possibilities (differential diagnosis).

16. Requests and interprets relevant investigations.

17. Considers all treatment options including no treatment, non-pharmacological interventions and medicines usage.

18. Assesses the effect of multiple pathologies, existing medication, allergies and contraindications on management options.

19. Assesses the risks and benefits to the patient of taking or, not taking a medicine or treatment.

20. Where a medicine is appropriate, identifies the different options.

21. Establishes and maintains a plan for reviewing the therapeutic objective, discharge or end point of treatment.

22. Ensures that the effectiveness of treatment and potential unwanted effects are monitored.

23. Makes changes to treatment plan in light of on-going monitoring and patient's condition and preferences.

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Programme learning outcome : 10

NPC competencies – supplementary prescribing


24. Communicates information about medicines and what they are being used for when sharing or transferring prescribing responsibilities/information.

25. Reviews diagnosis and generates management options for the patient within the clinical

management plan. Always follows up management.

26. Reviews medical history and medication history which includes both current and previously

prescribed and non-prescribed medicines, supplements and complementary remedies, and

allergies and intolerances.

27. Reviews the clinical condition using relevant equipment and techniques.

28. Reviews the working or final diagnosis.

29. Where a medicine is appropriate, identifies the different options in the clinical management plan.

30. Makes changes within the clinical management plan in light of on-going monitoring and the

patient’s condition and preferences.

Initial Formative Assessment DMP Signature: ………………............................ Student Signature: …………............................. Date: ……………………........................................


DMP Signature: ………………............................ Student Signature: …………............................. Date: ……………………........................................


DMP Signature: …………………............................ Student Signature: …………............................. Date: ……………………........................................

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DMP Comment:

Student comment:

Date: ……………………………………….

Date: ………………………………………

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NPC competency 3: Shared decision making (with parents, care-givers or advocates where appropriate) Establishes a relationship based on trust and mutual respect. Recognises patients as partners in the consultation.

Programme learning outcomes: 1, 2, 5 and 8


31. Identifies and respects the patient’s values, beliefs and expectations about medicines.

32. Takes into account the nature of peoples’ diversity when prescribing.

33. Undertakes the consultation in an appropriate setting taking account of confidentially, dignity and respect.

34. Adapts consultations to meet needs of different patients (e.g. for language, age, capacity, physical or sensory impairments).

35. Deals sensitively with patients' emotions and concerns about their medicines.

36. Creates a relationship which does not encourage the expectation that a prescription will be supplied.

37. Explains the rationale behind and the potential risks and benefits of management options.

38. Works with patients to make informed choices about their management and respects their right to refuse or limit treatment.

39. Aims for an outcome of the consultation with which the patient and prescriber are satisfied.

40. When possible, supports patients to take responsibility for their medicines and self-manage their conditions.

41. Gives the patient clear accessible information about their medicines (e.g. what it is for, how to use it, where to get it from, possible unwanted effects).

42. Checks patient’s understanding of and commitment to their management, monitoring and follow-up.

43. Understands the different reasons for non-adherence to medicines (practical and behavioural) and how

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best to support patients. Routinely assesses adherence in a non-judgemental way.

Initial Formative Assessment






DMP Comment:

Student comment:

Date: ……………………………………….

Date: ………………………………………

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Domain B: Prescribing Effectively

NPC competency 4: Safe - Is aware of own limitations. Does not compromise patient safety.

Programme learning outcomes: 3, 4, 5, 7, and 9


44. Knows the limits of their own knowledge and skill, and works within them.

45. Knows when to refer to or seek guidance from another member of the team or a specialist.

46. Only prescribes a medicine with adequate, up-to-date awareness of its actions, indications, dose, contraindications, interactions, cautions, and side effects (using, for example, the BNF/BNFC).

47. Accurately calculates doses and routinely checks calculations where relevant, for example for children.

48. Keeps up to date with advances in practice and emerging safety concerns related to prescribing.

49. Knows about common types of medication errors and how to prevent them.

50. Ensures confidence and competence to prescribe are maintained.

51. Makes accurate, legible and contemporaneous records and clinical notes of prescribing decisions.

52. Effectively uses the systems necessary to prescribe medicines (e.g. medicine charts, electronic prescribing, decision support).

53. Writes legible, unambiguous and complete prescriptions which meet legal requirements.

NPC competency: supplementary prescribing

Programme learning outcome 10: Utilise a Clinical Management Plan within the context of supplementary prescribing.

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54. Knows how and when to refer back to, or seek guidance from, the independent prescriber, another

member of the team or a specialist.




DMP Signature: ………………............................ Student Signature: ...…………............................. Date: ……………………........................................



DMP Comment:

Student comment:

Date: ……………………………………….

Date: ………………………………………

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NPC competency 5: Professional - Ensures prescribing practice is consistent with scope of practice, organisational, professional and regulatory standards, guidance and codes of conduct.

Programme learning outcomes: 3, 4, 5, and 9


55. Accepts personal responsibility for prescribing and understands the legal and ethical implications of doing so.

56. Makes prescribing decisions based on the needs of patients and not the prescriber’s personal considerations.

57. Knows and applies legal and ethical frameworks affecting prescribing practice (e.g. misuse of drugs regulations, prescribing of unlicensed/off label medicines).

58. Takes responsibility for own learning and continuing professional development.

59. Maintains patient confidentiality in line with best practice and regulatory standards and contractual requirements.

NPC competencies in relation to supplementary prescribing


60. Understands the scope of own prescribing responsibility in the context of a shared clinical management

plan.

61. Ensures that the patient consents to be managed by a prescribing partnership.

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DMP Comment:

Student comment:

Date: ……………………………………….

Date: ………………………………………

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NPC competency 6: Always improving Actively participates in the review and development of prescribing practice to optimise patient outcomes.

Programme learning outcome: 4 and 9


62. Learns and changes from reflecting on practice.

63. Shares and debates own and others prescribing practice, and acts upon feedback and discussion.

64. Acts upon colleagues’ inappropriate prescribing practice using appropriate mechanisms.

65. Understands and uses tools to improve prescribing (e.g. review of prescribing data, audit and feedback).

66. Reports prescribing errors and near misses, reviews practice to prevent recurrence.

67. Makes use of networks for support, reflection and learning.






DMP Signature: ………………............................ Student Signature: .…………............................. Date: ……………………........................................

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DMP Comment:

Student comment:

Date: ……………………………………….

Date: ………………………………………

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Domain C: Prescribing in context

NPC competency 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.

Programme learning outcomes: 3, 4, and 5


68. Understands and works within local frameworks for medicines use as appropriate (e.g. local formularies, care pathways, protocols and guidelines).

69. Understands the need to work with, or develop, safe systems and processes locally to support prescribing, for example, repeat prescribing, transfer of information about medicines.

70. Works within the NHS/organisational or other ethical code of conduct when dealing with the pharmaceutical industry.

71. Understands budgetary constraints and prioritisation processes at local and national level (health-care

resources are finite).

72. Understands the national frameworks for medicines use (e.g. NICE, SMC, AWMSG and medicines management/optimisation).

73. Prescribes generically where appropriate, practical and safe for the patient.

NPC competency in relation to Supplementary Prescribing


74. Understands the principles behind supplementary prescribing and how they are applied in practice.

Initial Formative Assessment Mid point Formative Assessment Final Summative Assessment

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DMP Signature: ………………............................ Student Signature: .…………............................. Date: ……………………......................................

DMP Signature: ………………............................ Student Signature: …………............................. Date: …………………........................................

DMP Signature: ……………............................ Student Signature: …………............................. Date: …………………........................................

DMP Comment:

Student comment:

Date: ……………………………………….

Date: ………………………………………

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NPC competency 8: Information Knows how to access relevant information. Can use and apply information in practice.

Programme learning outcomes: 4 and 5


75. Understands the advantages and limitations of different information sources available to prescribers.

76. Accesses relevant, up-to-date information using trusted evidence-based resources.

77. Regularly reviews the evidence base behind therapeutic strategies.


DMP Signature: ………………............................ Student Signature: …………............................. Date: …………………......................................





DMP Comment:

Student comment:

Date: ……………………………………….

Date: ………………………………………

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NPC competency 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.

Programme learning outcome: 7


78. Thinks and acts as part of a multidisciplinary team to ensure that continuity of care is developed and not compromised.

79. Establishes relationships with other professionals based on understanding, trust and respect for each other's roles in relation to prescribing.

80. Recognises and deals with pressures that might result in inappropriate prescribing (for example, pharmaceutical industry, media, patient, colleagues).

81. Negotiates the appropriate level of support and supervision for role as a prescriber.

82. Provides support and advice to other prescribers where appropriate.

NPC competencies in relation to Supplementary Prescribing


83. Proactively negotiates with the independent prescriber to develop clinical management plans.

84. Relates to the independent prescriber as a partner.

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DMP Signature: ………………............................ Student Signature: …………............................. Date: …………………........................................

DMP Comment:

Student comment:

Date: ……………………………………….

Date: ………………………………………

Once you have completed the above at the beginning of the course, please complete a Personal Development Plan using the template provided on the next page. This will help you to structure your learning in order to meet the learning outcomes for the module.

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NMP Personal Development Plan

Name/Student No: Trimester:

Self-Assessment Need

Goals Resources (What resources will be

needed?)

Success Criteria (Evidence)

(How will I achieve it?)

Review Date

Results of Review (How will I know I have met

my plan successfully?)

Statement of Clinical Competence to undertake prescribing as an:

Independent and Supplementary Allied Healthcare Professional Prescriber

Student Prescriber’s Name: (print and sign)………..…………………………………………………………..………….....................…………………

Designated Medical Practitioner’s Name: (print) ………………………………………….……………………………………………………

The above named has undertaken the minimum supervision period of 12 days (90 hours) to complete the practice component of the Non-Medical Prescribing programme. I have assessed the above as meeting all of the programme competencies, and to be a safe Independent and Supplementary prescriber. DMP name (please print) and signature: .....................................................………………………………………………………………………

Qualifications: ……………………………………………………………………..................................................................................…

Date of Assessment: ………………………………………………………………………

Hospital or Practice Stamp:

(please submit a signed paper copy)


Independent and Supplementary Nurse Prescriber




Qualifications: ……………………………………………………………………..................................................................................…





Independent and Supplementary Pharmacist Prescriber




Qualifications: ……………………………………………………………………..................................................................................…




Portfolio of Evidence 2014-15 - University of Bolton · PDF file1 Academic Group: Health and...

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Transcript of Portfolio of Evidence 2014-15 - University of Bolton · PDF file1 Academic Group: Health and...