The Textbook of Non-Medical Prescribing

Dilyse Nuttall, Jane Rutt-Howard, Dilyse Nuttall, Jane Rutt-Howard

• Publisher: Wiley-Blackwell
• Year: 2019
• Print ISBN: 9781119520474
• eBook ISBN: 9781119520504
• Edition: 3
• Topic: Medicine
• Subtopic: Nursing

The Textbook of Non-Medical Prescribing is an authoritative and accessible overview of the vital skills, contemporary issues and essential knowledge relevant to both students and healthcare practitioners. Written as a response to the growing emphasis placed on prescribing in the modern health service, this text provides up-to-date information on safe and effective prescribing. This wide-ranging book helps students and trainees develop foundational knowledge of the key areas and prescribing competencies and provides healthcare professionals with a continued source of current information.

Now in its third edition, this text has been fully updated and revised to reflect changes in legislation, current practices and new guidelines. New and updated topics include independent prescribing for therapeutic radiologists, supplementary prescribing for dietitians, paramedics working in advanced roles to independently prescribe and the Royal Pharmaceutical Society's Competency Framework for all Prescribers.

• Provides up-to-date information essential to safe and effective prescribing in a clear, easy-to-understand style
• Discusses current issues and practices in pharmacology, prescribing and therapeutics and medicine management
• Links to the Royal Pharmaceutical Society's Competency Framework for all Prescribers for non-medical prescribers
• Presents learning objectives, key theme summaries, activities and numerous case studies
• Offers access to additional online resources including interactive exercises, quizzes, self-assessment tests and web links

The Textbook of Non-Medical Prescribing is an essential resource for students, nurses, dieticians, pharmacists, and allied health practitioners pursuing a prescribing qualification or looking for an updated refresher on the subject.

Chapter 1
Prescribing in Context

Dilyse Nuttall

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Learning objectives

After reading this chapter and completing the activities within it, the reader will be able to:

1. Identify the development and current context of non‐medical prescribing in the UK.
2. Critically analyse the implementation of non‐medical prescribing in relation to the different professional groups.
3. Evaluate the different types of prescribing and identify their appropriate application to practice.

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Non‐medical prescribing has been subject to ongoing development ever since its inception. This has resulted in changes in both the types of prescribing possible and the related terminology. This chapter explores the different qualifications available in non‐medical prescribing and discusses their application in the practice of various professionals, including nurses, midwives, pharmacists, and allied health professionals. The discussion incorporates explanation of independent prescribing and supplementary prescribing, differentiating between specific prescribers and making comparisons to highlight their individual benefits and restrictions.

The prescribing journey

The current position of prescribing has evolved from its origin in district nursing and health visiting to a well‐established element of everyday practice for a range of health professionals. This journey has not been as straightforward as many would have hoped, with individual professions having to undertake a period of limited prescribing before being able to use it in a manner that best supports their practice. The introduction of prescribing to the nursing profession was, in many ways, tentative, with the 1992 Medicines Act enabling only a small group within a very large workforce to undertake the necessary programmes of education. Furthermore, the limited formulary imposed a controlled and constrained introduction of prescribing. Nevertheless, this was a welcome development, the benefits of which became increasingly apparent and, ultimately, led to prescribing becoming available to more nurses and different professional groups.

The caution employed in the introduction of prescribing in nursing was, in part, due to the lack of a robust evidence base to support this new element of practice. Although many nurses interpreted this cautious approach as concern that they were more likely to make mistakes, a view unfortunately held by some medical colleagues (Day 2005), the profession has been able to develop an increasing evidence base to support the expansion of prescribing, with the advantages now widely recognised by non‐medical prescribers and doctors alike (Latter et al. 2010). Supported by government‐led consultations and evidence gathering from other professional groups and professional regulatory bodies, the necessity to introduce prescribing to other professional groups dictated the change in terminology from nurse prescribing to non‐medical prescribing.

Defining non‐medical prescribing

The issue of terminology in prescribing has often caused discord and confusion. The term ‘nurse prescribing’ remains an accurate description for nurses, with the Nursing and Midwifery Council (NMC) (2018) Standards for Prescribing Programmes continuing to identify nurses as such. Similarly, the terms ‘pharmacist prescriber’ and ‘allied health professional prescriber’ are used by the professional bodies governing these groups (General Pharmaceutical Council [GPhC] 2013; Health and Care Professions Council [HCPC] 2016a). However, the increasing number of professional groups with prescribing permissions means that guidance frequently acknowledges ‘non‐medical prescribers’ as the term which represents all non‐medical health professionals able to prescribe (Department of Health Northern Ireland 2018; NHS England 2018a; NHS Wales 2017; Scottish Government 2016a). Whilst there remains benefit in differentiation of professions within the broader context of non‐medical prescribing, from both a safety and a professional development perspective, the inclusive term ‘non‐medical prescribing’ promotes the multidisciplinary approach required for safe and effective prescribing, highlighted in Chapter 6.

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Activity box 1.1

Go to the government website relevant to your practice area and search for documents that outline the implementation of non‐medical prescribing for your professional group. Consider their content in relation to your practice:

• http://www.gov.uk/government/organisations/department‐of‐health
• www.scotland.gov.uk
• www.wales.gov.uk
• www.dhsspsni.gov.uk

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The non‐medical prescribing vision

In considering the context of non‐medical prescribing, it is of benefit to revisit the origins of nurse prescribing to consider its early ethos and vision. The Review of Prescribing and Administration of Medicines: Final Report (DH 1999a) identified five key principles within the terms of reference (Table 1.1). On examining these principles and making comparison with policy and guidance supporting the current position of non‐medical prescribing, it is evident that these principles remain steadfast. The Department of Health (DH) (2008), in the document Making the Connections: Using Healthcare Professionals as Prescribers to Deliver Organisational Improvements, clearly identified the benefits of non‐medical prescribing and the opportunities for healthcare professionals to enhance their practice by making effective use of prescribing. The benefits of non‐medical prescribing presented for patients included increased access, increased capacity and improved choice for patients. This was supported by the professionals' ability to manage and complete episodes of care for patients, in a variety of settings, reiterating the messages from Medicines Matters (DH 2006b). Although the terminology and focus may have shifted slightly, the underpinning principles remain the same: safe and effective prescribing. In our current healthcare climate, there is a clear focus on the need to ensure services effectively support the needs of individuals, families, and communities (NHS England 2014; Northern Ireland Assembly 2016; Scottish Government 2016b; Welsh Government 2018) and prescribing is recognised as a valuable tool in this process.

Table 1.1 Key principles of the Crown report

Source: Department of Health (1999a). Licensed under Open Government Licence v3.0.

Patient safety

Effective use of resources

Skills and competencies of various health professionals

Changes in clinical practice

Public expectations

The complex nature of good prescribing was identified by the National Prescribing Centre (NPC) when they released their first Nurse Prescribing Bulletin (NPC 1999). The seven principles of good prescrib...

Table of contents

• Cover
• Table of Contents
• The Textbook of Non‐medical Prescribing
• Dedication
• Acknowledgements
• Notes on Contributors
• About the Companion Website
• Introduction
• Chapter 1: Prescribing in Context
• Chapter 2: Professional, Legal, and Ethical Issues in Prescribing Practice
• Chapter 3: Factors Influencing Prescribing
• Chapter 4: The Consultation Umbrella Supporting Effective Consultations
• Chapter 5: Essential Pharmacology for Non‐medical Prescribers
• Chapter 6: The Multidisciplinary Prescribing Team
• Chapter 7: Clinical Skills
• Chapter 8: Prescribing for Specific Groups
• Chapter 9: Enhancing Non‐medical Prescribing Through Reflective Practice, Evidence‐based Prescribing and Continuing Professional Development
• Patient Case Studies
• Health Professional Case Studies
• Index
• End User License Agreement