Royal Pharmaceutical Society updates prescribing competency framework

Adobe Spark (1)The Royal Pharmaceutical Society (RPS, 2016) has published an update to the Competency Framework for all Prescribers to ensure health professionals prescribe safely and effectively.

Originally published in 2012, the framework was developed to offer a common set of competencies for prescribing, regardless of professional background. As a result, it is relevant to all prescribers, including doctors, pharmacists, nurses, dentists, physiotherapists, optometrists, radiographers, podiatrists and dietitians. However, the framework should be contextualised to reflect different areas of practice and levels of expertise.

Ash Soni, President of the RPS, said:

‘Both the number of medicines prescribed and the complexity of medicine regimens are increasing. The challenges associated with prescribing the right medicines and supporting patients to use them effectively should not be underestimated.

‘There’s lots of evidence to show that much needs to be done to improve the way we prescribe and support patients in effective medicines use. This guide will be invaluable and I’m delighted the RPS has coordinated the update.’

The initial framework was published by the National Prescribing Centre and the National Institute for Health and Care Excellence (NICE). For the update, the RPS was approached by NICE and Health Education England to carry out the work on behalf of all prescribing professions. Additionally, the RPS was asked to ensure the framework had UK-wide applicability.

A project steering group of prescribers across all professions and patients updated the framework. This involved a 6-week consultation of the draft policy, where hundreds of organisations and individuals responded.

The framework has been endorsed by the UK’s Chief Pharmaceutical Officers—Keith Ridge, Rose Marie Parr, Andrew Evans and Mark Timoney—who said:

‘The single competency framework provides a means for all prescribers to become equipped to support patients to achieve the best outcomes from their medicines.

‘This update will ensure individuals can continue to benefit from access to resources which help them continually improve their practice and work more effectively.

‘We commend the updated framework and encourage prescribers, professional bodies, education providers and regulators to use it to support their role in delivering safe and effective care.’

How the competencies are separated

The framework comprises 10 competencies split into two areas: the consultation and prescribing governance. Within each of these competency areas, statements describe the activity or outcomes that prescribers should be able to demonstrate.

The consultation

The first competency concerns assessing the patient. It promotes taking an appropriate medical, social and medication history, before undertaking an appropriate clinical assessment.

The second competency involves the prescriber considering the options for the patient. This includes both non-pharmacological and pharmacological approaches to treatment, and weighing up the risks and benefits to the patient of taking medicine.

The third competency is about reaching a shared decision with the patient/carer, so the patient/carer can make informed choices and agree on a plan that respects the patient’s preferences.

The fourth competency is the prescribing itself. The framework states the medicine should be prescribed only with ‘adequate, up-to-date awareness of its actions, indications, dose, contraindications, interactions, cautions, and unwanted effects.’ Where appropriate, medicines should be prescribed within relevant frameworks, such as local formularies or care pathways.

The fifth competency concerns providing information to the patient/carer about their medicines. This includes what the medicine is for, how to use it, possible unwanted effects and how to report them, and expected duration of treatment.

The sixth and final competency in the area of consultation is monitoring and reviewing. Here the prescriber should establish and maintain a plan for reviewing the patient’s treatment. The effectiveness of treatment and potential unwanted effects should be monitored.

Prescribing governance

The seventh competency, and first under the area of prescribing governance, concerns prescribing safely. It highlights that the prescriber should prescribe within their own scope of practice and recognise the limits of their own knowledge and skill.

The eighth competency comprises prescribing professionally, and ensuring the prescriber maintains confidence and competence to prescribe. This includes accepting personal responsibility for prescribing and understanding the legal and ethical implications.

The ninth competency focuses on improving prescribing practice through reflection. It also stresses the importance of acting on feedback and discussion.

The tenth and final competency involves prescribing as part of a multidisciplinary team to ensure continuity of care across care settings. Part of this concerns establishing relationships with other professionals based on understanding, trust and respect.

Putting the framework into practice

The framework can be used for a variety of reasons by prescribers to help them improve their performance and work more effectively. The following examples are highlighted in the framework:

  • To inform the design and delivery of education programmes; for example, through validation of educational sessions (including rationale for need) and as a framework to structure learning and assessment
  • To help health professionals prepare to prescribe and provide the basis for ongoing education and development programmes, continuous professional development and revalidation processes. For example, use as a framework for a portfolio to demonstrate competency in prescribing
  • To help prescribers identify strengths and areas for development through self-assessment, appraisal and as a way of structuring feedback from colleagues
  • To inform the development of education curricula and relevant accreditation of prescribing programmes for all prescribing professions
  • To provide professional organisations or specialist groups with a basis for the development of levels of prescribing competency; for example, from recently qualified prescriber through to advanced prescriber
  • To stimulate discussions around prescribing competencies and multidisciplinary skill mix at an organisational level
  • To inform organisational recruitment processes to help frame questions and benchmark candidates’prescribing experience
  • To inform the development of organisational systems and processes that support safe effective prescribing; for example, local clinical governance frameworks.

The RPS is liaising with the professional bodies and organisations of the other prescribing professions to encourage uptake of the framework, which will be reviewed again in July 2020.

References

Royal Pharmaceutical Society (2016) A Competency Framework for all Prescribers. http://www.rpharms.com/support-pdfs/prescribing-competencyframework.pdf (accessed 1 August 2016)

Taken from Nurse Prescribing, published 12 August 2016.

Dental Nursing News February 2016

DN News FebPatients test positive for Hepatitis C

dental nurse who spoke out about hygiene conditions at a dentist’s surgeries in Ayrshire—sparking an HIV scare for 5600 patients—was told by the practice manager: ‘no one has caught anything yet,’ a disciplinary hearing has heard.

The nurse, who remains anonymous and is identified only as ‘Dental Nurse One’, contacted the NHS Ayrshire and Arran health board on 16 September 2013, after she was told of the routine reuse of equipment in an area known for high drug dependency.

Dentist Alan Morrison is accused at a General Dental Council Committee of failing to sterilise instruments between treating patients and reusing dirty gloves at his clinics in Cumnock and Drongan.

An investigation was launched into the dentist’s practices after the nurse blew the whistle, sacrificing her new job. At a hearing in London, the nurse recalled how she was offered a job on the spot, but was told by the practice manager, Lorraine Kelly, of procedures that put patients at risk.

‘She then told me that, “We would do things a bit differently here”…She proceeded to tell me that the practices reuse gloves and matrix bands and did not sterilise aspirators.’

The nurse said that she was shocked at Mrs Kelly’s remarks but that the manager replied in a ‘flippant manner’ that ‘no one’s caught anything yet.’ The whistleblower went on to say: ‘Both practices are in areas of high levels of drug use and therefore are likely to have contact with patients with blood-borne viruses. Although Mr Morrison was not present in this conversation, it was obvious he was aware of procedures and practices as owner of the practices and a practising dentist.’

Many patients underwent testing as a result of being sent a letter. No patients had contracted HIV, however four adult patients tested positive for Hepatitis C. Of these, three had evidence of chronic infection and one showed signs of a previous infection.

It emerged at a health board meeting that two of the patients had received dental treatment on the same day.

However, it could not be established whether the infection was picked up from the practice or from outside their dental treatment.

Mr Morrison has admitted falsifying invoices for medical supplies handed to NHS investigators, which showed phoney purchases of single-use equipment, including matrix bands, but denies the rest of the allegations.

Morrison and Kelly are accused of failing to adhere to infection control guidelines and of being dishonest during the health investigation.

NHS England guide to unscheduled care

NHS England has published a quick guide to unscheduled dental care to help provide practical tips for dental providers and commissioners, and relieve pressure on frontline services.

Within the guide, dental health professionals are advised to ensure accessibility of services by keeping their NHS Choices profile and Directory of Services profile up to date, and ensuring their answerphone provides correct details for signposting to 111 for urgent dental care.

To relieve winter pressures on services, it is recommended that patients are encouraged to seek oral care early. Winter campaign materials should be used to promote oral health and seek early advice for oral symptoms, social media and practice websites should be used to provide information about oral health and access to services, and patients should be advised about taking good care of their own oral health.

The guide goes on to say that self-care advice and management of pain is essential during times when dental treatment services are not available. The dental case mix should be managed by suitably trained dental care professionals (DCPs), who should have the capability to book treatment slots directly with dental providers. Where DCPs cannot provide advice, it is recommended that there should be a mechanism for them to refer to a pharmacist or seek additional clinical advice.

The effective triage of patients with dental problems is also emphasised within the guide. It is noted there are a number of options for triage that could be used and the configuration will depend on local requirements, such as the Dental Nurse Triage service that is being procured in London. This service will receive patient information via NHS 111; return calls and carry out a clinical telephone triage using established dental algorithms; and provide information, reassurance and advice to callers and allocate patients to same day, next day treatment slots or signpost to an NHS dental service.

The service will be delivered by trained and experienced dental care professionals, and is planned to operate between 6pm and 8am during the week. It is also planned to operate 24 hours during weekends and bank holidays. The service will have a phased implementation from 1 April 2016 and align with NHS providers in London.

BDA suspends strike action

The British Dental Association (BDA) suspended industrial action planned for 26–28 January in support of the British Medical Association (BMA), as it seeks to rekindle talks to resolve the differences over the proposed new contract for hospital juniors in England.

The BDA has been following the BMA’s lead in disputing the proposed contract, and supporting hospital junior dentist members to ensure a safe and fair junior contract is put in place. BDA junior hospital dentists took action on 12 January, protesting against the erosion of patient safety and the potential impact on dentists’ working lives.

An announcement from the BDA on the proposed contract, said: ‘We feel it removes vital safeguards for both dentists and their patients. We want to ensure dentists are protected from being required to work excessive hours in a week. We oppose the plans for the extension of standard time from the current 7am to 7pm, Monday to Friday to 7am to 10pm, Monday to Saturday, as we don’t feel this values dentists’ time appropriately.

‘We also object to the proposals on pay progression, which may mean some dentists are discouraged from entering specialist training, due to the plans to increase pay only when a trainee moves to the next stage of training and responsibility. We feel this particularly disadvantages those with families, because of the financial worries of taking time out of training for maternity leave or to work part time. It will also discourage those already in training from undertaking research or retraining in a preferred specialty, to the long-term detriment of the NHS.’

Further action for a full withdrawal of labour is still planned for Wednesday 10 February 2016.

Sound bites

Parliament calls for ‘complete overhaul’ of the General Dental Council (GDC). Members of the House of Commons debated the Section 60 Order which, if laid, will allow the GDC to introduce case examiners into its fitness to practise (FTP) process. This followed a debate in the House of Lords on the same subject, during which Shadow Health Minister Lord Hunt repeatedly called for resignations within the GDC.While the debates in both Houses were held to discuss these changes to the Dentists Act 1984, the main focus of the discussions was the performance, and the fitness to regulate, of the GDC. Shadow Health Minister Justin Madders raised the need for a ‘complete overhaul’ of the GDC, calling it the most expensive and least efficient of the health regulators, and noting the lack of confidence the profession has in the GDC.

The National Institute for Health and Care Excellence (NICE) has published new guidelines on oral health promotion in general dental practice, placing a focus on giving patients the ability to make an informed decision about their care. The guidelines cover how general dental practice teams can give advice about oral hygiene, the use of fluoride, as well as how areas such as diet, smoking, smokeless tobacco and alcohol intake affect oral health in order to help patients make informed decisions about their own care and encourage preventive treatments. Dr Ben Atkins, a dentist and Trustee of the British Dental Health Foundation, was a member of the committee for the NICE guidelines. Dr Atkins said: ‘These guidelines outline a patient-centred approach to ensure patients who are using the services are actively involved in discussions and able to make informed decisions about their care.’

Taken from Dental Nursing, published 29 January 2016.

DN_Feb_2016_News_DPS

NICE issues new draft guidelines on heart attack treatment

The National Institute for Health and Care Excellence (NICE) is updating its guidance on the care of people who have survived heart attacks, including new advice on the secondary prevention of myocardial infarctions.

The draft guideline, which was published on June 13 for public consultation, contains a number of important new recommendations aimed at improving the care given to hundreds of thousands of people in England and Wales who have survived heart attacks.

The guidelines were first issued in 2007 and recommended that patients took part in cardiac rehabilitation programmes to increase the chances of a healthy recovery, but because the uptake of these courses was low, the new guidelines call for interventions to ensure more patients benefit from the programmes.

Among the new recommendations issued by the organisation include a focus on the use of interventional procedures such as using stents rather than drugs as a means of widening blocked or narrowed coronary arteries.

Another notable revision to the guidelines is its removal of the advice that patients eat oily fish, or take omega-3 fatty acid capsules or omega-3 fatty acid supplemented foods in the hope of preventing further heart attacks.

It is felt that the impact these foods would have had on preventing heart attacks would be minimal when compared to new treatments that are now available.

Instead, the guidelines call for a more Mediterranean style diet. Some of the products this would encompass, include more bread, fruit, vegetables and fish, and less meat, while replacing butter and cheese with products based on plant oils.

The draft guidelines also includes recommendations on the use of drugs following a heart attack that reflect new findings on treatments to prevent blood clots (antithrombotic therapy) and on the use of drugs to reduce blood pressure and control heart rhythm and rate such as angiotensin-converting enzyme (ACE) inhibitors and beta-blockers.

Professor Mark Baker, director of the centre for clinical practice at NICE, said: ‘Healthcare professionals should ensure that a programmed of education and activity to help people recover from a heart attack and lead their lives as normally as possible, is designed to motivate people to attend and complete it.’

Taken from Journal of Paramedic Practice, published 25 June 2013.