How safe is our prescribing practice?

The Prescribing Competency Framework sets out standards for non-medical prescribing that apply to patient assessment, treatment selection and the procedures for safe and effective prescribing that include record-keeping, clinical governance and continuing professional development. Non-medical prescribers should be applying it in every aspect of their prescribing but, according to a recent article by nurse Steve Turner, it appears to be missing from some important parts of practice.

Steve Turner is a nurse prescriber and an educator with roles in Care Right Now CIC, MedicineGov, Plymouth University and community pharmacy. His commentary, posted in the hub (www.pslhub.org, an online forum for patient safety issues hosted by the charity Patient Safety Learning), lists six questions on which non-medical prescribers should reflect about how they utilise the Framework in day-to-day practice:

1. Do the prescribers in your team use the competency framework?
2. Is the competency framework part of the prescribing CPD in your organisation?
3. Is the competency framework used as part of prescribers’ annual appraisals?
4. How is prescribing competency monitored in your organisation, and is the competency framework included in clinical supervision?
5. Does your organisation use the prescribing competency framework in clinical governance sessions?
6. Is the prescribing competency framework referred to in incident investigation reports?

There are, he says, many published examples showing that points 1 – 5 are being implemented to the benefit of patient safety. That’s not true of point 6 and he lists three examples of deaths in which prescribing competency was a key issue but the Framework received no mention.

He makes three points.

• It is ‘surprising that the art and science of prescribing medicines receives so little attention in investigation reports, and from public bodies’.
• ‘The public and healthcare practitioners need to be aware of the Prescribing Competency Framework and why the framework must be applied in practice, used in clinical supervision and CPD, and why we must all speak out if we believe it is not being followed.’
• ‘… since the demise of the National Prescribing Centre, no national body is picking up on this need for more awareness, training and education specifically related to prescribing’.

The final point, he concludes, is leading to ‘patients are being harmed and lives may be being lost as a direct result of this gap in learning’.

Reflection on Steve’s comments raises some important issues for haemophilia nurses. How many of us are explicit when we record our prescribing decisions? Can we demonstrate good practice from our documentation? Do we refer to the Prescribing Competency Framework or do we rely on years of custom and practice in our decision making? Are we able to demonstrate safe and effective practice if we aren’t using a validated decision-making tool?

Is the Framework suitable for use in everyday practice or is it something that’s better suited to coursework for trainee non-medical prescribers? We should be honest about this. I can remember having to learn the components of the Activities of Daily Living as a student nurse. I’d struggle to remember them all now but that does not affect my competence as a nurse.

The Framework is intended for non-medical prescribers, regardless of their profession. Does it work equally well for us all? Do the various professions approach the process of prescribing differently? And is a one-size-fits-all approach realistic for modern practice? Does the Framework succeed in trying to be all things to all prescribers?

It’s disturbing that the Framework is not part of the process of learning from fatal incidents in which medication played a role. Either it is core to prescribing competence, in which case it should be central to our interpretation of incidents and the lessons to be learned, or it should be recognised as an educational tool. To claim the former while practising the latter is unsafe.

 

Sarah Johns will be presenting Haemnet’s forthcoming Prescribing Update meeting. Details will be released shortly