VOL: 102, ISSUE: 17, PAGE NO: 54
Three-yearly PREP requirements mean that nurses are accustomed to the idea of continuing professional development (CPD). Most are also able to identify their own learning needs on the basis of either the demands of their current job or future aspirations, and to select appropriate methods of achieving their minimum five days in each registration period.
While CPD is important in all areas of nursing practice, in prescribing it is crucial. The wrong drug, dose or combination can have catastrophic effects on patients and, in the worst cases, these can occur almost instantaneously and inflict irreparable damage, as Trudy Granby, assistant director, National Prescribing Centre Plus programme points out.
‘Prescribing is a complex procedure. It requires a range of competencies that nurses need to maintain since it is such a regular intervention and we have to safeguard patients - particularly as the opening up of the British National Formulary means we will be able to prescribe just about anything. Prescribing has the potential to do great good, but it also has the potential to do great harm.’
It is also vital for prescribers to keep up to date with current practice and the latest evidence related to prescribing. Again, this requires regular CPD.
‘CPD for nurse prescribers is absolutely essential to keep them up to date and ensure patient safety, and to ensure patients get the most up-to-date treatments,’ says Matt Griffiths, the RCN’s joint prescribing adviser. ‘This isn’t just in terms of new drugs, but also new protocols. For example, uncomplicated urinary tract infections are now treated with a three-day course of antibiotics, whereas previously it would have been five to seven days.’
The incidence of prescribing errors
If adverse events are the result of prescribing errors the prescriber is accountable - and errors are all too common, even among doctors with years of prescribing experience. In a study of the incidence and clinical significance of prescribing errors among obstetric hospital inpatients, Dean et al (2002) identified errors in 1.5% of medication orders written by doctors from junior house officers up to consultant level. Of these, 26% were potentially serious; this is equivalent to 0.4% of all orders written. The drugs most commonly involved in the identified errors were paracetamol, morphine, diamorphine, metoclopramide, and beclomethasone, while most of the errors concerned dosage selection. Most potentially serious errors occurred either in deciding whether or not drug treatment was required or in dosage selection.
Although nurse prescribers are expected to maintain their prescribing competence through appropriate CPD, there is currently no regulated standard relating specifically to prescribing - the onus is on individual prescribers to maintain their competence.
The NMC is consulting on whether a standard should be introduced. Fiona Peniston-Bird, non-medical prescribing facilitator at Surrey and Sussex Strategic Health Authority, believes this is necessary and that it will become particularly important if funding for non-medical prescribing is no longer separately identified in the future.
‘I hope this does not happen too soon, but I would like to see CPD for non-medical prescribing firmly embedded in practice before it does,’ she says. ‘My feeling is that there should be a mandatory CPD requirement for prescribers that is over and above PREP requirements.’
Although they have no formal standards for CPD, nurse prescribers do take the issue seriously and appear to have clear ideas on what they need. The National Prescribing Centre (NPC) recently undertook a survey of its non-medical prescribers’ network, to find out what sort of CPD members want.
‘The responses suggest that people want information on the therapeutic topics you might expect, such as CHD, diabetes and hypertension,’ says Ms Granby. ‘They also asked for face-to-face contact and a newsletter - which the NPC now provides - and cited pharmacology as an important topic - although by this they tended to mean therapeutics.’
What is available?
A relatively small number of organisations provide formal CPD for non-medical prescribers. Some pharmaceutical companies offer free courses and study days, but while Mr Griffiths says many of these are excellent, he believes they should be validated by organisations such as the RCN, the Association for Nurse Prescribing or educational institutions to ensure they are of appropriate quality and are not promotional.
The NPC offers a range of CPD, including therapeutic workshops on a range of topics. These can be accessed in two ways - employers can purchase them on an ad hoc basis, or they can have a dedicated NPC trainer to deliver them as needed. The NPC also offers face-to-face events, which tend to offer information on prescribing in general, covering a range of topics including the Department of Health perspective, the role of the Medicines and Healthcare products Regulatory Agency and the National Patient Safety Agency, how prescribing is monitored at a national level, clinical epidemiology and achieving concordance through a medicines partnership with patients. The Association for Nurse Prescribing conference tends to involve more sharing of good practice, looking at what is happening in different areas.
But while formal events can be useful in maintaining competency, more ad hoc CPD can be invaluable to ensure prescribers are up to date with current evidence and practice. In addition to journals, technology offers up-to-the minute information that takes only minutes a day to check for material that is relevant to individual prescribers’ practice (see Box).
Selecting the right CPD content depends on individual prescribers’ learning needs and preferences and the areas in which they prescribe.
In order to maintain their competence and keep up to date on current practice they need to be able to recognise their current learning needs or identify potential new areas of practice, and evaluate the CPD on offer.
It is also advisable to use a mix of formats, including formal taught events, journals and free updates to meet the whole spectrum of their needs.