Evidence for Competency 1

Evidence for competency 1.3: Works and communicates as part of a multidisciplinary workforce

Evidence for competency 1.6: Understands the principles behind supplementary prescribing and how they are applied in practice.

Evidence for competency 1.7: Reviews diagnosis and generates treatment options within the treatment plan

Evidence for competence 2.2 Works with patients and clients as partners in treatment

Evidence for competence 2.7: Refers back to a medical practitioner when appropriate.

Evidence for competence 3.5: Communicates effectively with patients, clients and professional colleagues

Précis from case study:

Appropriately qualified nurses may prescribe in the following manner: Patient Group Directions (PGDs), independent nurse prescribing, and supplementary nurse prescribing. As Citalopram is not on the list of approved medications within the nurse prescriber extended formulary (NPEF), nor depression one of the treatable conditions (BNF, 2005), clearly neither of the first two options is appropriate. Below is an example of how, when and why each aspect of prescribing may be appropriate, in this instance pertaining to asthma care (National Prescribing Centre, 2004).

Extrapolating these principles to Bob’s care would indicate a straightforward decision to use supplementary prescribing within a Clinical Management Plan. Bob’s Clinical Management Plan is below, and defines the dosage range prescribable by the nurse, and also the conditions pertaining to medication review, in this case low mood and/or presence of side effects.

The Clinical Management Plan is therefore the most significant aspect of Bob’s care in relation to supplementary nurse prescribing. The plan would be discussed at length with the independent prescriber, given Bob’s complex history, paying particular attention to potential drug interactions. The discussion would be informed by the BNF (2005) and Bob’s personal drug history. For example, he appears to be particularly sensitive to oversedation by psychotropic medication, making therapeutic dosage historically difficult.

With regard to the prescription itself, the Scottish Executive (2005) offer the following advice in respect of supplementary prescribers such as myself who work across more than one practice:

EFNP/Supplementary prescribers who prescribe across more than one GP practice will be supplied with 2 different types of GP10N prescription pads. Pads issued in respect of the "principal prescribing practice" i.e. the practice for whose patients the greatest number of prescriptions will be written, will be pre-printed with all the details described above (the prescriber's name, nurse prescriber code, Nursing and Midwifery Council (NMC) number, practice address and contact telephone number.). See http://www.scotland.gov.uk/library5/health/spbn-09.asp

Prescription pads used for patients registered with any other GP practice will be printed with the prescriber's name, NHS Organisation address, NMC number and contact telephone number. Prescribers will need to write the appropriate nurse prescriber code on each prescription form. See http://www.scotland.gov.uk/library5/health/spbn-10.asp

Name of Patient: Patient medication sensitivities/allergies:

Bob Hoskins None Known Patient identification e.g. ID number, date of birth: 04.04.24 Independent Prescriber(s): Supplementary Prescriber(s)

Dr Consultant CaseStudy presenter Condition(s) to be treated Aim of treatment

Low Mood Elevate Mood Medicines that may be prescribed by SP: Citalopram Preparation Indication Dose schedule Specific indications for referral back to the IP

. Drowsiness Inefficacy Citalopram Depression 20mg-40mg daily Renal complications Postural Drop (BP) Guidelines or protocols supporting Clinical Management Plan: Argyll and Clyde (2005) Guidelines for Nurse Prescribing Scottish Exec (2005) Supplementary Prescribing by Nurses within NHSScotland: A Guide for Implementation NICE (2004) Depression: management of depression in primary and secondary care BNF (2005, p201) Citalopram

Frequency of review and monitoring by: Supplementary prescriber Supplementary prescriber and independent prescriber

Weekly 3 monthly Process for reporting ADRs:

BNF yellow card

Shared record to be used by IP and SP:

Psychiatric Notes

Agreed by independent Date Agreed by supplementary Date Date agreed with prescriber(s) prescriber(s) patient/carer

Dr Consultant My signature Today