...This paper aims to explore the role of the V100 nurse prescriber. The development of nurse prescribing will be outlined, followed by a reflective case study in which ethical and legal implications will be discussed and finally a reflective conclusion will be drawn. Where appropriate the paper will be written in the first person (Webb 1992). Nurse prescribing was first recommended, by the RCN, in 1980 and became part of the government’s policy agenda in 1986 with the Cumberlege Report (DH 1986). Further, the Crown Report (DH 1989) advocated prescribing by trained community nurses from a limited formulary. Legislation was introduced in 1992 -The Medicinal Products: Prescription By Nurses Act, 1992 followed by secondary legislation, Medicinal Prescriptions By Nurses etc which came into effect in 1994 - providing a legal basis to allow nurses to prescribe (Dimond 2002). Nurse prescribing using the Nurse Prescribers’ Formulary (NPF) was introduced nationally in 1998 following the success of eight demonstration sites set up four years earlier (Luker et al 1998). A second Crown Report (DH 1999) recommended the establishment of two groups of nurse prescribers: independent and supplementary. In 2000 the government announced proposals to extend nurse prescribing further to allow prescribing from an extended formulary following more intensive pharmacological training (DH 2000). In the case study the patient’s name, address, date of birth and gp’s details have been changed...
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...UNIVERSITY OF THE WEST OF SCOTLAND NURSE PRESCRIBING V150 CASE STUDY COURSE: NURS09125 BANNER NUMBER: B00113677 DATE OF SUBMISSION 13/12/10 COURSE LEADER FRANCES DOWNER WORD COUNT: 3745 CONTENTS PAGE 1. INTRODUCTION & GENERAL OVERVIEW, Pgs3-4. 2. ASSESSMENT PROCESS, Pgs 5-8 3. TREATMENT OPTIONS, Pgs 9-12. 4. EVALUATION, Pgs 13-16 5. CONCLUSION. Pg 17 6. COPY OF PRESCRIPTION, Pg 18 7. REFERENCE SECTION, Pgs 19-23 8. BIBLIOGRAPHY, Pg 24. INTRODUCTION In the following case study, the author will discuss the issues surrounding a seventy-year-old female with a chronic neuropathic ulcer on the sole of her right foot and the rationale and implications of prescribing in the community setting. The author a (trainee nurse prescriber) will display the need for a robust assessment, exploring all areas of health and well-being in order to achieve a safe outcome. The author will further follow current guidelines and be mentored by a senior nurse prescriber throughout the process. The aim of the case study is to display the implications involved in issuing a nurse prescription if deemed appropriate. With regard to writing a prescription as a qualified practioner, the author will adhere to the guidance within the Nursing and Midwifery Council (NMC 2006a) standards for safe prescribing. To protect this patient’s identity and maintain confidentiality, she will be referred to as Mrs X throughout the...
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...Patient Group Directions December 2009 A practical guide and framework of competencies for all professionals using patient group directions National Prescribing Centre Patient Group Directions 2009 Acknowledgements Editors John Wright Business Manager - Non-Medical Prescribing Department of Health Gillian Arr-Jones National Pharmacy Advisor Care Quality Commission Angela Bussey PGD Website Pharmacist Editor London and South East Medicines Information Service, Guy’s and St Thomas’ NHS Foundation Trust Mary Golding Associate Director Community Health Services East & South East England Specialist Pharmacy Services Sandra Wolper Associate Director Community Health Services East & South East England Specialist Pharmacy Services Liz Mellor Clinical Governance Lead Pharmacist Leeds Teaching Hospitals NHS Trust Anne Fittock Non-Medical Prescribing National Advisor National Prescribing Centre Production Colin Bowers Web and Publications Officer (Corporate) Merissa Bellew Web and Publications Manager Published by: National Prescribing Centre Ground Floor, Building 2000 Vortex Court Enterprise Way Wavertree Technology Park Liverpool L13 1FB Tel No: (0151) 295 8671 Fax No. (0151) 220 4334 Websites: www.npc.co.uk www.npci.org.uk Contributors © National Prescribing Centre National Prescribing Centre Patient Group Directions 2009 Contents 1 Introduction 1.1 Purpose of this document 1.2 Audience for the document 02 03 03 03 06 06 07 07 08 11 11 11 12 12 13 14 15 15 16...
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...1648 1 Law, Accountability and Ethics in prescribing During my supervised practice in an outpatient clinic the non-medical prescriber I was with was asked by a colleague to prescribe for a patient on her behalf. In my role as a vascular clinical nurse specialist, I run nurse led clinics working alongside other nonprescribing colleagues seeing patients with peripheral vascular disease, this can range from patients with leg ulcers or diabetic foot ulceration with wound infections to patients with intermittent claudication, Abdominal Aortic Aneurysm or varicose veins, all of whom may or may not need medications or wound management treatments prescribed. It is very likely that during these clinics once I qualify as a non-medical prescriber I will be asked the same. In this essay I will explore the issues of law, accountability and ethics raised by prescribing on behalf of others. The legal system of England and Wales has two branches of law; criminal and civil Criminal Law: Statues are acts of parliament which are presented via the House of Commons moves to the House of Lords where amendments are made, returns to House of Commons, for final discussion when complete the Bill is given Royal Assent and passes into law. Criminal law involves offences against the state, it is usually the Crown that brings the action against the defendant (Gagan 2010 cited by Courtnay & Griffin). In terms of non-medical prescribing there are two important statues The Medicines...
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...Assessment 6 Change Management Proposal Recent evidence and current trends show both nursing and medical professions have a lack of understanding in certain aspects of safe prescribing and safe administration of medicines. The concept of prescribing and the ability to calculate is the basic requirement of all qualified medical and nursing professions We are proposing over a three year period to run an inter professional collaborative working programme, whereby both student nurses and doctors will come together on a regular basis in a teaching environment to work alongside each other to gain the following skills: • Patient safety in relation to drug administration • Patient safety in relation to drug prescribing • A clearer understanding of each others role • Practical experience in drug administration and drug prescribing in a non –threatening environment • Insight into pharmacology and pharmokinetics and it’s importance in prescribing and administration of drugs. This three-year study we propose to write up and evaluate and hope to publish with the intention to produce learning materials and educational packs to be marketed at later date Rationale for Change Project Medications Errors within any health care setting can have severe consequences not only for the patient but financially for the organisation if litigation comes about. Medication errors can be defined as “any incorrect or wrongful administration of a medication...
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...legal, ethical and professional considerations. The Chief Executive Officer of a small non-profit community hospital were on vacation in the Bahamas, the are was hit by a large snow storm, in this case, many of the hospitals health care providers were unable to make it to work, as a result. This paper will explain how the employees reacted, and how the patients ethically, legally and professional suffered from the unexpected incident. While the Chief Executive officer of a small non-profit community hospital was vacationing in the Bahamas, the area was hit by a large snow storm. Many of the hospitals health care providers were unable to make it in to work, 3-11 and 11-7 shifts. As a result the patients units were understaffed and days shift personnel were required to remain on duty until relieved. During this snow storm, several patients sustained minor injuries from falls out of their bed, and one patient died after being given the wrong medication, the nurse on duty also left the hospital to go to Wendy’s to buy dinner, after one year, the families of these patients sued the hospital on the behalf of their deceased relatives. The three legal considerations are, during the snow storm, many of the hospital health care providers were unable to make it to work, and patients were not attended properly, probably because of shortage of staff in the community hospital. The patience also suffered minor injuries resulting from falling down from the beds....
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...Islands. • We exist to safeguard the health and wellbeing of the public. • We set the standards of education, training and conduct that nurses and midwives need to deliver high quality healthcare consistently throughout their careers. • We ensure that nurses and midwives keep their skills and knowledge up to date and uphold the standards of their professional code. • We ensure that midwives are safe to practise by setting rules for their practice and supervision. • We have fair processes to investigate allegations made against nurses and midwives who may not have followed the code. b Standards for medicines management Introduction The Nursing and Midwifery Council (NMC) is the UK regulator for two professions: nursing and midwifery. The primary purpose of the NMC is protection of the public. It does this through maintaining a register of all nurses, midwives and specialist community public health nurses eligible to practise within the UK and by setting standards for their education, training and conduct. One of the most important ways of serving the public interest is through providing advice and guidance to registrants on professional issues. The purpose of this booklet is to set standards for safe practice in the management and administration of medicines by registered nurses, midwives and specialist community public health nurses. Standards for medicine management replace the Guidelines for the administration of medicines 2004, although many of its principles remain...
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...Provide the requirements that must be met in your state in order to practice as an Advanced Practice Nurse (Family Nurse Practitioner). As a prospective Georgia Nurse Practitioner (NP), I must hold a degree at the master's level or higher approved by the Board. National certification is a requirement to practice in the advanced role as well as for continued practice and completion of continuing education hours. State licensure law requires physician delegation for at least one element of my practice. Does your state have independent practice or is a physician required as a collaborator or delegator? My state of Georgia does not have independent practice and physician involvement in delegation is required for any aspect of practice. I am authorized to perform advanced functions and certain medical acts allowed within my scope of practice as delegated by the physician via the nurse protocol agreement. What are the requirements you must meet in order to obtain prescribing privileges ? The physician must submit the written nurse protocol agreement to the Board of Medicine (BOM) for approval for me to have written prescriptive authority. The written agreement is mutually signed by me and the physician where the physician delegates to me the authority to perform certain medical arts. The protocol agreement is to be written and reviewed...
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...most common form of dementia is Alzheimers, affecting well over 5 million people nationally. Institutionalization is common amongst this population as the disease begins to progress, typically bringing on behavioral and psychological symptoms of dementia (BPSD) including agitation, aggression and depression. This population is recognized as vulnerable and fragile, both mentally and physically. Many frequently have physical comorbidities along with dementia. This issue of suffering from comorbidities brings on the prescribing of multiple medications, which over time interact and accelerate their functional decline (Kolanowski, Fick, Frazer, Penrod, 2009). Due to the lack of beneficial effects when weighted against both short and long term adverse effects of various medications used to treat BPSD, majority of practice guidelines advocate for non-pharmacological approaches to be used as the first line of treatment of BPSD. The effects resulting from prescribing medications such as neuroleptics, antidepressants, benzodiazepines, mood stabilizers to dementia patients can include parkinsonism, sedation, oedema, chest infections, cognitive deterioration,...
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...these uncorrected prescriptions that end up getting to patients. If someone does not catch these errors whether it is the pharmacist, being asked by the patient, why there receiving this drug, because they thought doctor said something else. Therefore, the pharmacist may check it. In a hospital, setting a nurse may look at a chart and question the drug, and call and verify. However, many times no one questions it until the patient has a reaction, or what he or she are being treated for gets worse. Along with communicating with the prescribers, their offices, hospitals, patients, pharmacists also have to be up to date on the all laws, federal and state, and be watchful for those that try to fill fraudulent or altered scripts. Research suggests that there would be significant benefits if all prescribers would follow the same procedures for writing prescriptions, such as using computer generate prescriptions or E-scribe, because there would be a decrease in prescription writing errors, pharmacy mistakes and prescription fraud. Pharmacies call prescribers offices to clarify prescriptions information, on average 150 million times yearly. That’s what makes E-prescribing a valuable tool, it would monitor for drug interactions, by letting the prescriber know if there is a conflict with other medications (meds) the patient may be on, and gets rid of illegible prescriptions. (Anderson, 2006) Anderson (2006) states there are 530,000 drug reactions that injured outpatients, under...
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...Social prescribing in general practice: adding meaning to medicine ‘There are few things we should keenly desire if we really knew what we wanted.’ Francois de la Rochefoucauld (French writer 1613–1680) Social prescribing is about expanding the range of options available to GP and patient as they grapple with a problem. Where that problem has its origins in socioeconomic deprivation or long-term psychosocial issues, it is easy for both patient and GP to feel overwhelmed and reluctant to open what could turn out to be a can of worms. Settling for a short-term medical fix may be pragmatic but can easily become a conspiracy of silence which confirms the underlying sense of defeat. Can or should we try to do more during the precious minutes of a GP consultation? Where there are psychosocial issues GPs do suggest social avenues, such as visiting a Citizens Advice Bureau for financial problems, or a dance class for exercise and loneliness, but without a supportive framework this tends to be a token action. The big picture difficulty with leaving underlying psychosocial problems largely hidden in the consulting room is the medicalisation of society’s ills. This ranges from using antidepressants for the misery of a difficult life, to the complex pharmaceutical regimes prescribed to patients with obesity and type 2 diabetes. This sort of medicalisation may help immediate problems (including driving the economy through jobs in the healthcare industries) but it is not enough if our society...
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...nursing in which nurses are required to practice at an advanced level in a specific area of interest. APN extends the boundaries of nursing’s scope of practice and contributes to nursing knowledge, and the development of the profession (Canadian Nurses Association, 2008). In order to become an APN, the nurse must obtain a master’s or doctoral degree from an accredited university in an area of concentration designated for advanced practice nursing. According to Joel (2009), there are currently four major groups of APNs: certified registered nurse anesthetist, certified nurse midwives, clinical nurse specialists, and nurse practitioners. APN focus on critical thinking, educating the public, diagnosing and treating illnesses, and prescribing medications to name a few. This paper will discuss the future of the nurse practitioner and how I, as a future adult-gerontology primary care nurse practitioner, will advocate for my patient population. Philosophy and Beliefs of Nurse Practitioners Due to the fact that nurse practitioner is a branch of advanced practice nursing, the two professions often share many of the same philosophic beliefs. The overall philosophy of both professions is centered on four key concepts of person, society, health and nursing; whereas, the core philosophy for nurse practitioners is that of individualized care where focus is on patients’ conditions, as well as, the effects of illness on the lives of the patients and their families (Health Communities, 2001). The...
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...inter-professional collaboration with MD? Nurse practitioners are registered nurses who have an advanced education (Master’s Degree at minimum) and the ability to provide a wide range of health services, similar to those of physicians. These services allow preventative and acute healthcare services to patients of all ages. An NP’s services can include, performing physical examinations, diagnosing and treating common and chronic acute health issues, ordering and interpreting x-rays and laboratory tests, and prescribing and managing medications. NP’s also provide health education and promote healthy lifestyle behaviors and illness prevention. An NP’s scope of practice can very from state to state depending on the state laws that govern their practices; some of the most rigorous laws and restrictions being from California. (Buppert, C. 2012). A Clinical Nurse Specialist is a clinical expert who also has an advanced education and shares some of the same abilities and practices of an NP. They can also provide direct patient care services including, health assessment, health promotion, and prevention, as well as the management of health issues. However, CNS’s specialize in areas of nursing that improves nursing care through education, consultation, and research. The roles of CNS’s contain five major components consisting of expert clinical practice, clinical leadership, consultation, education, and research. (Buppert, C. 2012). A Clinical Nurse Specialist (CNS) is an expert clinician...
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...Introduction There is a need for Advanced Practice Registered Nurses to have expanded ability to offer comprehensive complete care to the public. Republican Senator Cary Pigman who is also a medical doctor has recognized the necessity of this need. He has put forth a bill that would enable nurse practitioners the ability to practice without restrictions within the scope of their practice. He has introduced this bill as well as others to support the ability of nurse practitioners to offer comprehensive care to their patients. All Registered Nurses and Nurse Practitioners need to support these efforts so that we can provide needed primary care services within Florida. HB 547 expresses many changes that are needed in Florida today in medical care. The bill requests the reduction of supervision required for nurse practitioners. One major point in the bill is that nurse practitioners would be enabled to provide care independently of a physician. This bill also would enable nurse practitioners to prescribe medication including narcotics independently. This would alleviate the need for primary care providers to seek other treatment that they may require if nurse practitioners were able to fully treat their patients without restrictions’. There is a primary care shortage in Florida and nurse practitioners routinely fill that void and with this bill enacted it would enable those patients to receive comprehensive care by one provider instead of multiple visits to specialists to...
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...October 14, 2012 Ethical Frameworks in Practice Patients should feel at ease when giving personal information to their physician or nurse (Burkle & Cascino, 2011). Patients may resist offering pertinent information if they feel their confidence may be betrayed. Confidentiality can only be broken when it involves a gunshot wound, injuries resulting from child abuse or an infectious disease, which would put the community at risk. Such is the case presented in Nathanson’s article titled: “Betraying trust or providing good care? When is it okay to break confidentiality?” (2000). The article addresses an ethical dilemma presented in an episode of NBC’s ER. Nurse Carol Hathaway promises two reluctant teenage patients who are seeking care, that anything they tell her will remain confidential, even from their parents and anyone else. Agreeable to this, the girls divulge they have been sexually active with multiple partners and suspect they have been exposed to a sexually transmitted disease (STD). Tests were performed on the teenager for STD’s and receive Pap tests to detect any cervical abnormalities. The test results confirm, Andrea, is positive for the human papillomavirus (HPV) and cervical cancer. Promising Andrea confidentiality, Nurse Hathaway knows she must break the promise or potentially endanger herself and the community. Nurse Hathaway is faced with ethical consequences if she breaks confidentiality with her patient. Of these consequences are reluctance to disclose...
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