Improving Prescribing Practice & Competence at Northern Devon Healthcare NHS Trust

Northern Devon Healthcare NHS Trust Improving Prescribing Practice & Competence: Using the national prescribing competency framework Matt Lund Non-Medical Lead (Pain Team) Sally Jarmain Non-Medical Prescribing Lead Presenter

Northern Devon Healthcare NHS Trust Overview RPS Competency Framework for all Prescribers: key messages How can organisations use the Competency Framework for all prescribers to support governance? How can individual practitioners use the Competency Framework for all prescribers to demonstrate competence? The new RPS Competency Framework for Designated Prescribing Practitioners .

Northern Devon Healthcare NHS Trust Why do we need a competency framework for prescribers? Inform the design and delivery of education programmes for prescribers Help identify areas for CPD once qualified Support organisational governance of prescribers Assure patients about the competencies of prescribers

Northern Devon Healthcare NHS Trust History 2001-2006 NPC published different frameworks for different professional groups 2012 NPC Single Competency Framework for all Prescribers

Northern Devon Healthcare NHS Trust NPC Single Competency Framework for all Prescribers (2012) http://www.pharmaceutical-journal.com/Pictures/580xAny/7/6/0/1067760_good-prescribing-14.jpg

Northern Devon Healthcare NHS Trust History 2001-2006 NPC published different frameworks for different professional groups 2012 NPC Single Competency Framework for all Prescribers 2016 RPS reviewed and published Competency Framework for all Prescribers

Northern Devon Healthcare NHS Trust RPS Competency Framework for all Prescribers (2016)

Northern Devon Healthcare NHS Trust History 2001-2006 NPC published different frameworks for different professional groups 2012 NPC Single Competency Framework for all Prescribers 2016 RPS reviewed and published Competency Framework for all Prescribers 2021 RPS reviewed and published updated version of the Competency Framework for all Prescribers

Northern Devon Healthcare NHS Trust Updated RPS Competency Framework for all Prescribers Assessing the patient (additional statements) 1.1 Undertakes the consultation in an appropriate setting. 1.2 Considers patient dignity, capacity, consent and confidentiality. 1.3 Introduces self and prescribing role to the patient/carer and confirms patient/carer identity. 1.4 Assesses the communication needs of the patient/carer and adapts consultation appropriately. 1.5 Demonstrates good consultation skillsand builds rapport with the patient/carer. 1.8 Identifies and addresses potential vulnerabilities that may be causing the patient/carer to seek treatment.

Northern Devon Healthcare NHS Trust Updated RPS Competency Framework for all Prescribers Competency domain 2 Consider the options Identify evidence-based treatment options available for clinical decision making

Northern Devon Healthcare NHS Trust Review of RPS Competency Framework for all Prescribers Identify evidence-based treatment options available for clinical decision making 2.5 Assesses how co-morbidities, existing medicines, allergies, intolerances, contraindications and quality of life impact on management options 2.6 Considers any relevant patient factors and their potential impact on the choice and formulation of medicines, and the route of administration. 2.7 Accesses, critically evaluates, and uses reliable and validated sources of information

Northern Devon Healthcare NHS Trust Review of RPS Competency Framework for all Prescribers Identify evidence-based treatment options available for clinical decision making (Further Information) a Non-pharmacological treatment approaches include no treatment, social prescribing and wellbeing/lifestyle changes. b Individual patient factors include genetics, age, renal impairment and pregnancy. c Relevant patient factors include ability to swallow, disability, visual impairment, frailty, dexterity, religion, beliefs and intolerances. d Evidence-based practice includes clinical and cost-effectiveness.

Northern Devon Healthcare NHS Trust Updated RPS Competency Framework for all Prescribers Competency domain 3 Reach a shared decision Present options and reach a shared decision

Northern Devon Healthcare NHS Trust Review of RPS Competency Framework for all Prescribers Present options and reach a shared decision (changes) 3.1 Actively involves and works with the patient/carer to make informed choices and agree a plan that respects the patient s/carer s preferences 3.2 Considers and respects patient diversity, background, personal values and beliefs about their health, treatment and medicines, supporting the values of equality and inclusivity, and developing cultural competence. 3.3 Explains the material risks and benefits, and rationale behind management options in a way the patient/carer understands, so that they can make an informed choice.

Northern Devon Healthcare NHS Trust Review of RPS Competency Framework for all Prescribers Prescribe (changes/additional statements) 4.1 Prescribes a medicine or device with adequate, up-to-date awareness of its actions, indications, dose, contraindications, interactions, cautions and adverse effects. 4.6 Prescribes appropriate quantities and at appropriate intervals necessary, to reduce the risk of unnecessary waste. 4.12 Follows appropriate safeguards if prescribing medicines that are unlicensed, off-label, or outside standard practice. 4.14 Effectively and securely communicates information to other healthcare professionals involved in the patient s care, when sharing or transferring care and prescribing responsibilities, within and across all care settings

Northern Devon Healthcare NHS Trust Review of RPS Competency Framework for all Prescribers Improve Prescribing Practice (additional statements) 9.4 Takes responsibility for own learning and continuing professional development relevant to the prescribing role. 9.5 Makes use of networks for support and learning. 9.6 Encourages and supports others with their prescribing practice and continuing professional development. 9.7 Considers the impact of prescribing on sustainability, as well as methods of reducing the carbon footprint and environmental impact of any medicine

Northern Devon Healthcare NHS Trust RPS Competency Framework as part of annual declaration

Northern Devon Healthcare NHS Trust RPS Competency Framework to expand scope of practice Assess the patient Identify evidence-based treatment options available for clinical decision making Present options and reach a shared decision Prescribe Provide information Monitor and review

Northern Devon Healthcare NHS Trust RPS Competency Framework to demonstrate competence Competency 1 - Assessment

Northern Devon Healthcare NHS Trust Competency 2 Consider the options Competency 3 Shared decision making Discussed pharmacological and non- pharmacological options Discussed options regarding analgesia inc. opioids, non-opioids, adjuvants - antineuropathics Once preferred option mutually agreed, discussed mechanism of action and possible side effects Discussed risks vs benefits

Northern Devon Healthcare NHS Trust Shared decision making aid

Northern Devon Healthcare NHS Trust Competency 4 - Prescribe Checked BNF and local formulary Documented in notes rationale and letter sent to GP within 24 hours

Northern Devon Healthcare NHS Trust Competency 5 Provide information Discussed medication action and side effects Advised regarding what to do if medication not effective or side effects Discussed non-pharmacological management

Northern Devon Healthcare NHS Trust Competency 6 - Monitor and Review Reviewed and some small improvement with duloxetine, felt that his mood was brighter however no real functional change. Next steps / options

Northern Devon Healthcare NHS Trust Governance - Competencies 7,8, 9, 10 Prescribed within own scope Prescribe Professionally Based on patients needs Improve prescribing practice - Reflection Prescribe as part of a team Advice and guidance from the team

Northern Devon Healthcare NHS Trust RPS Competency Framework for Designated Prescribing Practitioners Traditionally only doctors (DMPs) in this role- 2019 saw regulatory change Experienced independent prescribers Improve access to prescribing opportunities for the wider workforce Support DMPs by distributing the supervision workload Multidisciplinary learning remains key

Northern Devon Healthcare NHS Trust Designated Prescribing Practitioner Multi-professional framework = multiple titles for the role NMC = Practice Assessor and Practice Supervisor GPhC = Designated Prescribing Practitioner HCPC = Practice Educator Medics = Designated Medical Practitioner

Northern Devon Healthcare NHS Trust RPS Competency Framework for DPPs Image result for designated prescribing practitioner competency framework

Northern Devon Healthcare NHS Trust RPS Competency Framework for DPPs Personal Characteristics Professional Skills and Knowledge Teaching and Training Skills The DPP Delivering the Role Prioritising Patient Care Developing the Role Delivering the Role Learning Environment Governance Governance

Northern Devon Healthcare NHS Trust Local Implementation Process/structure should be the same for all DPPs regardless of profession NMP Policy NMP application Training session (University/Trust) Peer Support Reflection

Northern Devon Healthcare NHS Trust NMP application form For completion by the Designated Prescribing Practitioner (DPP) The DPP is responsible for establishing a learning contract with the student, overseeing their learning in practice and verifying their competence at the end of the NMP course. I can confirm that I am competent in areas 1-3 (personal characteristics, professional skills and knowledge, teaching and training skills) of the RPS Competency Framework for DPPs. I have been qualified as a prescriber for at least three years. I have employer support to undertake the role of DPP. I will attend an update on NMP training with the University/NMP Lead (if not able to attend handouts will be provided). Name: Signature: Email address: Date: For completion by the Designated Prescribing Practitioner (DPS) The DPS is responsible for acting as a role model, working alongside the student, providing support and giving feedback to the DPP on the progress of the student. I have been qualified as a prescriber for at least one year. I have employer support to undertake the role of DPS. I will attend an update on NMP training with the University/NMP Lead (if not able to attend handouts will be provided). Name: Signature: Email address: Date:

Northern Devon Healthcare NHS Trust Trust Training Online training session Overview of scope and legal remit of different prescribing professions Trust governance procedures Relevant policies and procedures Escalating concerns Support for DPPs (learning sets, reflection)

Northern Devon Healthcare NHS Trust Questions?