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Prescribing for children and young people

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I learned today that the NMC have provided more guidance regarding prescribing for children and young people.

An NMC circular outlines that:

The NMC recognise that many registrants will be working in services where treatment would be provided across the age spectrum. As a result they (the NMC) have consulted with a number of bodies representing children and the other regulatory bodies in order to further strengthen the NMC ‘Standards of proficiency for nurse and midwife prescribers’ (May 2006) in relation to prescribing for children.

The Standards state that: ‘Only nurses with relevant knowledge, competence, skills and experience in nursing children should prescribe for children. This is particularly important in primary care (eg out of hours, walk-in-clinics and general practice settings). Anyone prescribing for a child in these situations must be able to demonstrate competence to prescribe for children and refer to another prescriber when working outside their area of expertise or level of competence.’ (NMC Standards, page 7) ‘It is the responsibility of the employer to ensure that the registrant is able to apply the prescribing principles to their own area of practice’ (NMC Standards, page 6).

It has been agreed that all nurse / midwife independent / supplementary prescribing programmes from this point forward, must incorporate an additional learning outcome to ensure that on successful completion of the programme, they can take an appropriate history, undertake a clinical assessment and make an appropriate diagnosis, having considered the legal, cognitive, emotional and physical differences between children and adults.

In addition the assessment must demonstrate the registrant’s ‘recognition of the unique implications and developmental context of the anatomical and physiological differences between neonates, children and young people.’ (NMC Standards, page 6).

In keeping with the existing standards of proficiency for nurse / midwife prescribers any assessment should take place within the context of their work setting, wherever that might be. If there is any doubt about the ability of the registrant to demonstrate knowledge, skill and competence in the areas described above, further training in relevant aspects of the legal, cognitive, emotional and physical differences between children and adults and in taking an appropriate history, undertaking a clinical assessment and making an appropriate diagnosis for a child, should be undertaken prior to completing a prescribing course.

A medical practitioner who is experienced and competent in prescribing for children should confirm the demonstration of competence.

If a registrant who is already a prescriber moves into a new role which requires them to prescribe for children for the first time, or after a break in practice, it would be considered good practice for them to have a period of preceptorship and they may require additional education and supervision in relation to assessment, diagnosis and prescribing for children.

Copies of the circular can be downloaded from the NMC website at: http://www.nmc-uk.org/circulars

Clarity is required on whether the additional learning outcome must apply to all nurses undertaking the programme, for example would a nurse specialising in the care and treatment of Alzheimer’s be exempt from this addition?

Organisations will now have to consider and decide to what degree a period of preceptorship for those who are either moving to a new role, or prescribing for children for the first time, is required.

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