Module Outline (Level 7): Nurses and Pharmacists only

Field name / Comments/notes
Title / Independent and Supplementary Prescribing (2)
Code / NA783
Level / 7
Credit rating / 30
Pre-requisites / All nurse entrants to this programme must meet the following requirements:
  • Must be a registered first level nurse, midwife and/or specialist community public health nurse.
  • Must have at least three years’ experience as a practicing nurse, midwife or specialist community public health nurse and be deemed competent by your employer to undertake the programme. Of these three years, the year immediately preceding application to the programme must have been in the clinical field in which you intend to prescribe, e.g. neonates, mental health. Part-time workers must have practiced for a sufficient period to be deemed competent by their employer.
  • Must provide evidence via the Accreditation of Prior and Experiential Learning (APEL) process of your ability to study at minimum academic level 7. In addition, applicant will need to have written confirmation from:
  • Their employer of their support for applicant to undertake the preparation programme.
  • A designated medical practitioner who meets eligibility criteria for medical supervision of nurse prescribers and who has agreed to provide the required term of supervised practice. Supervisors will be expected to attend a preparation session at the University of Brighton, although it may be possible for these sessions to take place in the Trusts. The attendance of supervisors at one of these sessions is mandatory.
The selection of nurses who will receive prescribing training will be a matter for local decision in the light of local needs and circumstances. Applications will be forwarded by the Trusts/SHA to the University of Brighton for selection.
All pharmacist entrants to this programme must meet the following requirements:
  • Current registration with GPhC (General Pharmaceutical Council) &/or PSNI as a practicing pharmacist
  • Have at least two years appropriate patient orientated experience practising in a hospital, community or primary care setting following their pre-registration year
  • Identify an area of clinical practice and need in which to develop their prescribing
  • skills
  • Have up-to-date clinical, pharmacological and pharmaceutical knowledge relevant to their intended area of prescribing practice
  • Demonstrate how they reflect on their own performance and take responsibility for their own CPD;
  • Demonstrate how they will develop their own networks for support, reflection and learning, including prescribers from other professions
  • have a named medical practitioner, recognised the employing / commissioning Health Service organisation, who a) has experience in the relevant field of practice, b) training and experience in the supervision, support and assessment of trainee, c) who has agreed to provide the candidate with opportunities to develop competencies in prescribing; and supervise, support and assess the student during their clinical placement (supervisors will be expected to attend a preparation session as mentioned previously).
Pharmacists would normally be expected to complete the full training programme. All students are required to complete all assessments, including satisfactory completion of the period of learning in practice.
Type of module / Extensive over one semester
Aims / The aim of the module is to allow the practitioner to demonstrate advance scholarship in their discipline by developing individual nurse and pharmacist practitioners to undertake the advanced professional role of Prescriber (Independent and/or Supplementary), accepting personal and professional accountability for related decision making and patient outcomes.
The students, throughout this module, will critically evaluate the evidence for treatments; develop Treatment and Clinical Management Plans; utilize specialist and transferable skills in physical examination and clinical diagnosis; apply diagnostic and creative skills to problem solving around assessment of patients, their treatments and outcomes; and reflect on their own practice and that of others against that of excellence.
Learning outcomes/
objectives / The module will enable the practitioners to meet the outcomes / standards specified by the relevant statutory bodies[1]; namely to:
  1. have a comprehensive understanding of the responsibility that the role of Supplementary / Independent prescriber entails, be aware of their own limitations and work within the limits of their professional competence – knowing when and how to refer / consult / seek guidance from another member of the health care team
2. develop an advanced, effective relationship and communication, assessing and consulting as appropriate with patients, carers, other prescribers and members of the health care team; and understand their roles in the medicines use process
3. * thorough understanding of the patho-physiology of the condition being treated and recognise the signs and symptoms of illness
4. * select, use and interpret common diagnostic aids e.g. stethoscope, sphygmomanometer and develop new skills to an advanced level
5. * select and use diagnostic aids relevant to the condition(s) for which the practitioner intends to prescribe, including monitoring response to therapy and demonstrating originality in tackling and solving problems relating to diagnosis
6. * apply advanced clinical assessment skills to:
  • inform a working diagnosis
  • formulate a treatment plan
  • the prescribing of one or more medicines if appropriate
  • carry out a checking process to ensure patient safety
  • monitor response to therapy, review the working/differential diagnosis
  • critique and analyse all data collected and where appropriate propose new hypotheses and treatment options
  • modify treatment or refer / consult / seek guidance as appropriate
7. * take a thorough and accurate history in a systematic and creative manner, including medication history(over-the-counter, alternative and complementary health therapies) to (in conjunction with 6) inform a diagnosis and choice about treatment
8. * demonstrate self-direction as well as a shared approach to decision making by assessing patients ‘needs for medicines, taking account of their wishes and values and those of their carers when making prescribing decisions
9. identify and critically evaluate sources of information, access advice and decision support and demonstrate how they will use them in patient care taking into account evidence based practice and national/local guidelines where they exist
10. recognise, critically evaluate and respond to influences on prescribing practice at individual, local and national levels; and reflecting on the ethical dimensions of these influences
11. prescribe, safely, appropriately and cost effectively by application of evidence-based practice at individual patient level
12. work effectively within a prescribing partnership and to communicate their opinion to the ‘specialist’ audience, such as other independent prescribers
13. maintain comprehensive, accurate, effective and timely records in the patients notes and ensure that other prescribers and health care staff are appropriately informed, and comply with national guidance as appropriate e.g. adverse drug reaction reporting
14. demonstrate an in-depth understanding of the public health issues related to medicines use; and to evaluate strategies to protect the public
15. demonstrate an in-depth understanding of the legal, ethical and professional framework for accountability and responsibility in relation to prescribing
16. work within clinical governance frameworks that include audit of prescribing practice (including any near misses) and critically evaluate personal development
17. demonstrate independent learning abilities by participating regularly in CPD and maintain a critical and reflective record of their CPD activity
18. * understand and apply in-depth knowledge of drug actions in prescribing practice
19. develop a clinical management plan within legislative requirements and develop effective working partnerships with the Independent Prescriber(s) (supplementary prescribing only)
On completion the prescriber should demonstrate concordance with the NPC’s competencies for prescribing.
The above learning outcomes will reflect, where implicated*, the intended scope of prescribing practice in specialist areas, such as neonates, infants, children & young people; pregnant and lactating women; and older people when indicated by the students area of clinical practice. This will be through specific theoretical sessions and frameworks and competencies in the portfolio of clinical practice.
Content / 1. Consultation, decision-making therapy selection, monitoring of therapy selection, and referral
  • Accurate and effectivecommunication and consultation with professionals, other prescribers, patients and their carers
  • Building and maintaining an effective relationship with patients, parents and carers taking into account their values and beliefs
  • Partnership working with the patient including concordant approach and the importance of explaining why medication has been prescribed, side effects and other relevant information to enable patient choice
  • Understands own limitations
  • A knowledge of the range of models of consultation and their applications
  • Development and documentation of a treatment or clinical management plan including referral to the independent prescriber and other professionals
  • Principles of diagnosis and the formulation of a working diagnosis, principles and methods of patient monitoring, further investigation and referral for diagnosis.
  • Management options including non-drug treatment
  • Autonomous working and decision making within professional competence
  • Numeracy and drug calculations•
  • Chemical and biochemical methods for monitoring the treatment of the condition(s) for which the practitioner intends to prescribe on qualification and responses to results.
  • Clinical examination skills relevant to the condition(s) for which the practitioner intends to prescribe.
  • Recognition and responding to common signs and symptoms that are indicative of clinical problems. Use of common diagnostic aids for assessment of the patient’s general health status; e.g. stethoscope, sphygmomanometer, tendon hammer, examination of the cranial nerves.
  • Assessing responses to treatment against the objectives of the treatment plan/clinical management plan
  • Working knowledge of any monitoring equipment used within the context of the treatment/clinical management plan
  • Identifying and reporting adverse drug reactions
  • Management options including non-drug treatment and referral
2. Influences on and Psychology of Prescribing
  • Patient demand versus patient need including partnership in medicine taking, awareness of cultural and ethnic needs
  • External influences, at individual, local and national levels.
  • Awareness of own personal attitude and its influence on prescribing practice
3. Prescribing in a Team Context
  • The role and functions of other team members
  • The responsibility of the supplementary prescriber in developing and delivering the clinical management plan.
  • The professional relationship between independent and supplementary prescribers and those responsible for dispensing
  • Documentation and the purpose of records in communicating prescribing decisions to other members of the team.
  • Structure, content and interpretation of medical records/clinical notes including electronic health records
  • Interface between multiple prescribers and the management of potential conflict
  • The framework for prescribing budgets/cost effective prescribing, audit and evaluation
  • The responsibility of the Supplementary and Independent Prescriber in the development and delivery of the treatment / clinical management plan

Content (contd) / 4. Clinical pharmacology and applied therapeutics, including the effects of co-morbidity
  • Clinical pharmacology
  • Pharmacodynamics and pharmacokinetics (including controlled drugs)
  • Changes in physiology and drug response, for example the elderly, young, pregnant or breast feeding women and ethnicity
  • Adverse drug reactions (including reporting), drug interactions (drug and disease) and drug related morbidity
  • Patho-physiology of defined conditions for which the prescriber intends to prescribe.
  • Selection and optimisation of drug regimen
  • Natural history and progression of defined conditions for which the practitioner intends to prescribe.
  • Impact of co-morbidities on prescribing and patient management
5. Evidence-based practice and clinical governance in relation to prescribing (supplementary and independent)
  • The rationale fornational and local guidelines, protocols, policies, decision support systems and formularies – understanding the implications of adherence to and deviation from such guidance
  • Local and professional clinical governance procedures including
  • Supplementary prescribing in the context of the local health economy e.g. application of local priorities to supplementary prescribing, prescribing guidance produced by PCT prescribing forum, health economy Area Prescribing Committees and priorities for health improvement.
  • Principles of evidence-based practice and critical appraisal skills
  • Reflective practice and continuing professional development – role of self and organisation. Development and maintenance of professional knowledge and competence in relation to condition(s) for which the practitioner intends to prescribe
  • Auditing, monitoring and evaluating prescribing practice
  • Risk assessment and risk management
  • Audit and systems monitoring
  • Analysis and learning from medication errors and near misses
  • The Medication Use Process
6. Legal, policy, and professional and ethical aspects

Policy context for prescribing

  • Professional Ethics and Practice Guidance, especially in relation to the supply and administration of medicines
  • Legal basis for prescribing, supply and administration of medicines
  • Medicines regulatory framework including Marketing Authorisation, the use of unlicensed medicines and “off-label” use.
  • Application ofthe law in practice, professional judgment, liability and indemnity
  • Maintenance of professional knowledge and competence in relation to the conditions for which the supplementary / independent prescriber may prescribe.
  • Accountability and responsibility to the employer or commissioning
organisation, awareness of local complaints procedures
  • Informed consent with particular reference to patient’s with learning disabilities, mental illness, critical illness; those requiring emergency treatment, and children
  • Prescription pad security and procedures when pads are lost or stolen
  • Writing prescriptions
  • Record keeping, documentation and professional responsibility
  • Confidentiality, Caldicott and Data Protection, and Freedom of Information
  • Suspicion, awareness and reporting of fraud or criminal behaviour, knowledge of reporting and ‘whistle blowing’ procedures
  • Compliance with guidance arising from the Shipman inquiry
  • Professional competence, autonomy and accountability of Independent and Supplementary Prescribing Practice

Content (contd) / 7. Prescribing in the public health context
  • Duty to patients and society
  • Public health policies, for example the use of antimicrobials and resistance
  • Inappropriate use of medicines including misuse, under and over-use
  • Inappropriate prescribing, over and under-prescribing
  • Patient access to healthcare and medicines
  • Use of medicines in populations, and in the context of health priorities

Teaching and learning strategies / Keynote lectures, self-directed learning, critical reflection, portfolio, case analysis of treatment scenarios, group discussion, problem-based learning. The students will be encouraged to use studentcentral with electronic learning materials on:
  • clinical pharmacology
  • ethics and law in prescribing
  • skills in consultation and assessment
  • on-line submission and blogging
  • on-line chat support sessions

Learning support /
  • Teaching, supervision and support by lecturers and personal tutors.
  • Supervision, support and shadowing opportunities by DMP

Reading List / Bickley, L.S. 2009 Bates’ Guide to Physical Assessment and History Taking. Lippincott Williams & Wilkins.
Brookes, D. & A. Smith. 2006 Non-Medical Prescribing in Healthcare Practice: a Toolkit for Students and Practitioners. London: Palgrave.
Beauchamp, T.L. & J.E. Childress. 2009 Principles of Biomedical Ethics. 6th ed. Oxford: Oxford University Press.
Clinical Evidence. 2003. 9th ed. London: BMJ Publishing.
Constable, S., Winstanley, P., & Walley, T. 2007 Medical Pharmacology: a clinical core text for integrated curricula with self-assessment. Churchill Livingstone Elsevier.
Courtenay, M & M. Griffiths (eds.) 2005. Independent and Supplementary Prescribing: an Essential Guide. Cambridge: Cambridge Press.
Courtenay, M. & Griffiths, M (eds) 2010. Medication safety: an essential guide. Cambridge University press.
Dale, M.M. & Haylett, D.G. 2009 Pharmacology Condensed 2nd ed.Churchill Livingstone; Elsevier.
Department of Health. 2006. Improving Patients’ Access to Medicines: A Guide to Implementing Nurse and Pharmacist Independent Prescribing within the NHS in England. London: DOH.
Department of Health. 2005. Supplementary Prescribing by Nurses, Pharmacists, Chiropodists/Podiatrists, Physiotherapists and Radiographers within the NHS in England. London: DOH.
Dimond, B. 2008. Legal Aspects of Nursing. 5th ed. Harlow: Longman.
Dimond, B. 2005. Legal Aspects of Medicines. Quay.
Dodds L.J. (ed) 2010 Drugs in use: clinical case studies for pharmacists 4th ed. Pharmaceutical Press.
Edwards, C. & Stillman, P. 2006 Minor illness or major disease?:the clinical pharmacist in the community. Pharmaceutical Press.
Galbraith A. et al 2007 Fundamentals of Pharmacology 2nd ed. Pearson Prentice Hall.
Greene, R.J. & Harris, N.D. 2008 Pathology and therapeutics for pharmacists: a basis for clinical pharmacy practice. Pharmaceutical Press.
Jones, M. & Guatam, N. 2004 The hands-on guide to practical prescribing. Blackwell.
Jones, A. 2009 Nurse Prescribing in mental health. Wiley-Blackwell.
Kumar, P. & Clark, M. (eds). 2009. Clinical Medicine. 7th ed. Saunders Elsevier.
Jevon, P. Et al (eds). 2010 Medicines Management; a guide for nurses. Wiley-Blackwell.
Jones, R.M. & Rospond, R.M. 2009 Patient assessment in pharmacy practice 2nd ed. Lippincott Williams & Wilkins.
Lymn, J., Bowskill, D., Bath-Hextall, F., Knaggs, R. (eds) 2010 the new Prescriber. An integrated approach to medical and non-medical prescribing. Wiley-Blackwell.
Merrills, J. & Fisher, J. 2006 Pharmacy law and practice. Elsevier.
Neal, M.J. 2005 Medical Pharmacology at a glance. 5th ed. London: Blackwell
Porth, C.M. & Matfin, G. 2009. Pathophysiology: concepts of altered health states. 7th ed. Lippincott, Williams & Wilkins
Rang, H.P., Dale, M.M., Ritter, J.M. & Flower, R.J. 2007. Rand and Dale’sPharmacology. 6th ed. Churchill Livingstone Elsevier
Robinson, D. 2002. Clinical Decision-Making, a case study approach 2nd ed. Lippincott
Royal Pharmaceutical Society of Great Britain 2010 Medicines, ethics & practice: a guide for pharmacists & pharmacy technicians’ 34th ed. RPSGB.
Rutter, P. 2005 Symptoms, diagnosis and treatment: a guide for pharmacists and nurses. Elsevier Churchill Livingstone
Swage, T. 2004. Clinical Governance in Health Care Practice. 2nd ed. Butterworth-Heinemann
Tingle J. & McHale, J. 2007 Law and Nursing. 3rd ed. Elsevier.
Waller, D.G., Renwick, A.G., Hillier, K. 2010Medical Pharmacology and Therapeutics 3rd ed. Saunders Elsevier.
Assessment tasks / The assessment regulations will conform to the University of Brighton General Examination and Assessment Regulations and the rules and regulations of the GPHSS / Post Graduate Continuing Professional Development (PGCPE) / Graduate Programme in Health and Social Sciences (GPHSS) Framework. Competence will be demonstrated through assessment of both theory and practice. To facilitate this, each student will maintain a portfolio of assessment and achievement of the stated learning outcomes. A range of assessment strategies will be employed to test knowledge, decision-making and the application of theory to practice. These are dictated by the DOH/NMC/ GPhC (General Pharmaceutical Council) and are listed in the 4 parts as follows:
Examination
(Part A)Objective Structured Clinical Examination (OSCE), a systematic examination of practice within a simulated clinical environment, including a pass/fail calculation element.
(Part B)Final examination consisting of 30 multiple choice questions and an unseen written paper to test pharmacological knowledge, application to practice and analytical reasoning (nurses must achieve a minimum 80% pass for the multiple choice paper, a statutory body requirement):
Coursework
(Part C)Clinical Management Plans for the students’ specific client group
(Part D)Review of portfolio (to include reflection, critical incident analysis, case studies etc., including a pass/fail calculation element) will include a record of the satisfactory completion of a minimum of 12 days or the equivalent (90 hours) of learning experience. The assessment of practice will be the responsibility of the prescribing medical practitioner providing support, teaching and supervision of the student. This portfolio is designed to provide evidence of the NPC’s Competencies for Supplementary / Independent Prescribers.
Each part of the above examination and coursework elements of the assessment strategies carries an equal weighting and students must achieve the identified minimum pass mark in each of the components, except in circumstances where individual statutory body’s requirements apply, in which case the statutory body’s requirements are paramount.
The final mark will be the arithmetic mean of the mark from the four components. All 4 parts of the assessments are marked in accordance to the level 7 marking criteria.
All four parts (OSCE, Portfolio, Clinical management Plan (CMP), and Unseen examination) of the module assessment must be passed in order to achieve an overall module pass.
Please note that it is ONLY after successful completion of all elements of the module and it has been annotated on the professional register with the relevant regulatory body that the individual will have the authority to prescribe within their scope of prescribing practice.
Brief description of module content and/or aims / This module will enable Independent Prescribers to prescribe all General Sales List and Pharmacy medicines currently prescribable by GPs, together with Prescription Only Medicines and a limited number of Controlled Drugs. It will also allow Supplementary Prescribers to prescribe Prescription Only Medicines including Controlled Drugs and off-label use in accordance with an individual patient’s Clinical Management Plan and the agreement of the medical practitioner and with the patient’s consent
Area examination board to which module relates / Community Combined AEB/CEB
Module team / Stevan Monkley-Poole: Module Leader: Nurses and Pharmacists
Claire May: Pharmacist / Pharmacology coordination
Penny Lindley: Assistant Head - Continuing Professional Education, School of Nursing & Midwifery
Kate Barnham: Former Student March 2010 cohort Independent Prescriber (Respiratory Nurse Specialist)
Inge Bateman: Non-Medical Prescribing Lead & Clinical Nurse Specialist in Acute Pain Management
Joanne Burgess: Former Student Sept 2006 cohort, Independent Prescriber (Mental Health Nurse)
Peter Coyne: Information Adviser
Sharon De Goeas: Senior Lecturer (Ethics)
Dr. Les Ellam: Learning Technologies Adviser
Mary Elliott: Independent prescriber, Lead Fracture Liaison Nurse Specialist,
Visiting Lecturer for Physical Assessment Elements
Sue Oliver: Former Student March 2010 cohort, Independent Pharmacist Prescriber
Mike Pettit: Principal Pharmacist / Senior Lecturer, Brighton and Sussex University Hospitals NHS Trust / Practice Director, Clinical Studies, School of Pharmacy & Biomolecular Sciences
Jenny Kam: Programme Administrator
Simon Otter: Physiotherapist (Module Leader: Allied Health Professions)
Paula Rabin, Director of Radiography, Brighton and Sussex University Hospitals NHS Trust
Semesters offered / 2 only
Site / Falmer
Date of approval of this version / Feb 2012
Version number
Field for which module is accepted and status / Nursing, Midwifery and Health Visiting / Pharmacy
Course(s) for which module is acceptable / MSc Advanced Nurse Practitioner
MSc Diabetes
MSc Cardiology
MSc Nephrology
MSc Public Health
MSc Professional Development in Health and Social Care
Departmental home / School of Nursing and Midwifery
External examiners / Louise Hales (Nurses: 2012 to 2015)
Professor Jane Portlock (Pharmacists: 2012 to 2015)

[1] NMC Standards of Proficiency for Nursing and Midwifery Prescribers May 2006