District Health Board (NMDHB)

Supplementary and independent nurse prescribing has taken some years to materialise; this movement was facilitated by Department of Health (DoH), nursing regulators, nursing professional bodies, and general practice (GP) supporters (RCN, 2012). Following the Medicines Act (1992) where only Health Visitors and District Nurses were allowed to prescribe from a limited formulary, over time legislations were subsequently amended allowing non community nurses to prescribe from an extended formulary. In 2003, supplementary prescribing was being recognised and by 2012 The Misuse of Drugs Regulations allowed the nursing formulary to access all of the British National Formulary including controlled drugs. In line with these changes and to ensure that

The Medicines Acts 1968 and various amendments cover the legal management of medication. While care staff are not expected to have detailed knowledge of the legislation, they do need to be aware of the legal difference between types of drugs and the legal framework that allows them to handle medicines on behalf of the service user.

Treatment without consent - Charlotte, the nurse on duty, had forced James into getting the injections therefore causing him emotional distress. Treating a competent patient who has validly refused treatment could constitute an assault or battery. The legal provisions supporting a competent patients’ right to refuse treatment in Australia can be found in both legislation throughout all the States and common law. The Australian Charter of Healthcare Rights is also a helpful source of guidance as it reinforces the common law position that is based upon the principle of patient autonomy. The High Court of Australia first articulated the principle or refusal of treatment in Marion’s case, stating that a legally competent person has a right “to choose what occurs with respect to his or her own person.” Under the NSW Health Patient Charter, consent in regard to an operation, procedure or treatment is both a specific legal requirement and an accepted part of good medical practice. Medical practitioners are also expected to clearly explain proposed treatment, and adequately inform their patients on significant risks and alternatives associated with the treatment.Failure to do this could result in legal action for assault and battery against a practitioner who performs the procedure. Charlotte made no effort to explain or gain a consent from James.

The aim of this assignment is to demonstrate the use of safe and effective prescribing in practice. I will achieve this by presenting and analysing a prescribing scenario which I have encountered in my current area of practice within a District Nursing Team. During the case study the patient I have chosen will be referred to as Jean. This is to maintain her anonymity in line with the Nursing and Midwifery Council (2008) guidelines of confidentiality.

Every health professional has a legal obligation to patients. Nurses as part of the health care team share an important role in the quality and safe delivery of patient care. They have the major responsibility for the development, implementation and continuous practice of policies and procedures of an organisation. It is therefore essential that every organization offer unwavering encouragement and resources to support their staff to perform their duty of care in every patient. On the other hand, high incidences of risk in the health care settings have created great concerns for healthcare organizations. Not only they have effects on patients, but also they project threat to the socioeconomic status. For this reason, it is expected that all health care professionals will engage with all elements of risk management to ensure quality and safe patient delivery. This paper will critically discuss three (3) episodes of care from the case study Health Care Complaints Commission [HCCC] v Jarrett [2013] Nursing and Midwifery Professional Standards Committee of New South Wales [NSWNMPSC] 3 in relation to Registered Nurse’s [RN] role as a leader in the health care team, application of clinical risk management [CRM] in health care domains, accountability in relation to clinical governance [CG], quality improvement and change management practices and the importance of continuing professional development in preparation for transition to the role of RN.

The scope of practice for non-medical prescribers (NMP) has expanded greatly over the last 2 decades, with legislation now allowing NMP’s to prescribe from the whole BNF (with the exception of treatment in addiction and within the prescribers competency). Since the introduction of the Medicines Act in 1986 there have been over 15 different governmental reports and legislative changes (see Appendix 1 timeline) that have allowed for the development and growth of the NMP role. Initiated by The Cumberledge report of 1986 and followed by advisory group report in 1989 legislation was introduced with the Medicinal products: Prescription by nurses act of 1992 which allowed primary care nurses to prescribe from a limited formulary (V100 & V200). This advancement in legislation recognised previous recommendations and placed the improvement of patient care and effective use of resources at the core of its practice. However these acts did not reflect on other areas like secondary care or pharmacist and it wasn’t until 1998 The Crown Report and its second report published a year later that led to supplementary and independent prescribing (V300). In 2003 legislation was passed allowing some prescribing of controlled drugs in palliative care with restricted circumstances (amendment to Misuse of drugs Act 1971). In May 2006 nurses were empowered to prescribe from the whole BNF with the exception of some controlled drugs, and in 2009 further legislative changes were made to include the

Medication must be stored in a secure locked cupboard or area as this is part of the role of a Support Practitioner. It is my duty to ensure that the risks to the health of others are properly controlled.

There are several current legislation, guidelines, policies and protocols relevant to the administration of medication. These are The medicines Act (1968), Misuse of Drugs Act (1971), Misuse of Drugs Regulations (2007), Health Act (2000) The Care Standards Act (2000), Domiciliary Care Agencies Regulations (2002) Control of Substances Hazards to Health (2002), Hazard Waste Regulations, Controlled Waste Regulations (1992), The Handling of Medic9ines in Social Care and The Safe and Secure Handling of Medicines; a Team Approach.

rights, health, and safety of the patient.” This provision, identifying patients, medication safety are related because it is a nurse’s responsibility to protect the patient from harm and promote safety. Nurses are taught to use multiple checks before administering a drug and use two identifiers. These checks include checking the medication against the order when obtaining it, checking again when preparing the medication and the last check is done at the patient’s bedside prior to giving the medication. Also it is imperative to question any medication order that does not seem fit. The order should include a date, time, name of the medication, dosage strength, the route for

Non care setting - Medications are often stored and administered in a variety of non-health care settings. These settings include: primary and secondary schools, Child day care centres, Board and care homes, Jails and prisons. In all these settings, employees frequently are responsible for handling and administering prescription and over-the-counter medications to clients or residents. Some organizations may employ licensed health professionals to directly manage the medication administration process. However, many of these settings have no licensed health professionals involved. Where medications are stored and administered to individuals, written policies and procedures should address the following: Acquisition of medications (e.g., from parents, caregivers, pharmacies), Specification of which personnel are allowed access to medications and allowed to administer medications to students, clients or residents, Labelling and packaging of medications managed for students, clients

This paper aims to explore the role of the V100 nurse prescriber. The development of nurse prescribing will be outlined, followed by a reflective case study in which ethical and legal implications will be discussed and finally a reflective conclusion will be drawn. Where appropriate the paper will be written in the first person (Webb 1992).

There are several legislations in place with protocols for the administration of medication which I have listed below. The main policy re admin of drugs and storing of drugs and medicines is the Control Of Substances Hazardous to Health or COSHH but along with this there are other policies in place as per the list below.

The nurse must verify the physician’s medication order, including the dose and time, and then the pharmacy is responsible for their own checks and balances via the BCMA system in order to complete the dispensing phase of the medication (Gooder, 2011). The nurse enters the BCMA system with a login and password and is able then to see a list of the virtual due list for a specific patient. The computer on wheels is then taken to that patient’s room and the five rights of medication administration begin. As nurses, we are taught to use the five rights of drug administration are (1) right patient (2) right medication (3) right dose (4) right route and (5) right time. By scanning the barcode on the patient’s hospital identification band, the nurse then asks for the patient to verbally state their name and date of birth, which can be verified by the nurse on the virtual due list and then choses the medication that are due for administration at that time. The medication is dispensed and the nurse is able to scan the barcode on the medication, the scanning triggers the automatic documentation of the medication given (Kelly, 2012).

During my clinical placements I have witnessed IV therapy being administered to patients who require prescribed analgesia, antibiotics or anti-emetics as well as observing patients’ reactions to the treatment. IV therapy can be very effective (Hyde 2002 p42) but it also carries the greatest risk of any administration route. Amoore & Adamson (2003 p45) maintain that the safe administration of IV therapy requires the nurse to be skilled and knowledgeable in the use of the equipment, and to prevent any adverse incidents nurses must have up-to-date knowledge of the associated risks. As a student nurse I am not considered professionally accountable and I must work within my level of understanding and competence, under the direct supervision of a registered nurse (NMC guide for students 2006 p4). Nurses “must have the knowledge and skills for safe and effective practice when working without direct supervision” (NMC The Code 2007 p7). The Royal College of Nursing (RCN 2003 p7) states that IV therapy is a central part of a nurse’s professional practice. I realise that as a final year student I am not authorised to give IV therapy without supervision, so as a newly registered nurse this is an ideal opportunity to learn about IV therapy.

Guidelines and protocols are used throughout the health and social care sector. The Open University (2014) defines protocol as 'a set of formal rules or guidelines for practice '. This essay looks at whether guidelines and protocols are effective in ensuring care is safe, compassionate, caring and responsive. A way of providing care that helps, and not harms an individual. This essay is divided into three main sections. It will first consider evidence-based protocols and guidelines, who writes them, and how they are received. It will also look at possible implementation barriers. Secondly it will look at the lack of individuality within guidelines and