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Decision-Making Framework for Nurse and Midwife Prescribing
Is there a local written policy1 to support nurse/midwife prescribing?
Is there a collaborative practice agreement2 thatsupports the nurse/midwife prescribing?
Is prescribing within thenurse/midwife’s scope of
practice and competency3?
The nurse/midwifeshould NOT
prescribe
Has there been anassessment4/5 of the
patient/service-user’s needs?
Has the nurse/midwife sufficientinformation/skill to determine atreatment plan for the individual
patient/service-user care plan?
The nurse/midwife is able to determinethe required pharmacological/non-
pharmacological treatment option(s)6
for the patient/service-user
The appropriatetreatment for the
patient/service-useris outside the
parameters agreedwith the CPA
The nurse/midwife isresponsible for the
consulting with and/orreferring the
patient/service-user toan appropriate
registered medicalpractitioner for further
treatment within atimely manner
ensuring appropriatecontinuity of care
The nurse/midwifedocuments7 the treatment
plan including theprescribed medication,
monitoring /evaluation &follow up care & ensurses acontinuing care/dischargeplan8 is completed for the
patient/client &communicated to the
appropriate health careprofessional
The nurse/midwife initiates the treatmentdecision in discussion with and agreement by
the patient/service-user (and/or carer ifapplicable) providing a comprehensive
description of the treatment prescribed includingexpectations of treatment and side effects if any
The prescription for the medication is written
Yes
Yes
Yes
Yes
Yes
Yes
No
No
No
No
An Bord Altranais, 18/20 Carysfort Avenue, Blackrock, Co. Dublin.Telephone: 01 639 8500. Email: [email protected] Web: www.nursingboard.ie
Explanatory Notes1 Policy identifies the structures that authorise
and provide a framework for the practice ofnurse/midwife prescribing in theorganisation. This may include reference tothe involvement of Drugs and Therapeutics,Risk Management and Clinical GovernanceCommittees.
2 The collaborative practice agreement (CPA)is drawn up with the agreement of thenurse/midwife, the registered medicalpractitioner, and the employer outlining theparameters of the nurse/midwife’sprescribing authority (his/her scope ofpractice). Refer to the An Bord Altranaispublication Collaborative PracticeAgreement for Nurses and Midwives withPrescriptive Authority (2007).
3 Scope of practice and competency – Doesthe nurse/midwife meet the requirementsand standards set by An Bord Altranaisthrough completion of the educationprogramme for nurse/midwife prescribing?Is he/she on the Division of the Register ofNurse Prescribers as maintained by An BordAltranais? Is the registered nurse prescriberundergoing continuing professionaldevelopment in prescribing practice toenable competency assessment?
4 Assessment includes: • Physical examination• History taking (including medications)• Clinical diagnostic decision*
(diagnosis, hypothesis)
5 Orders and interprets laboratory and otherdiagnostic tests – e.g. bloods andspirometry.
6 If the patient/service-user’s assessed needsexceed the nurse/midwife’s scope ofpractice, the patient/service-user is referredto the appropriate registered medicalpractitioner.
7 Documentation and record keeping forregistered nurse prescribers should beoutlined in local policy e.g. prescriptionwriting including prescription padresponsibilities, medication administrationrecord and patient/service-user’s individualcase notes; supporting material for clinicalaudit of the registered nurse prescriber’sprescribing practice.
8 Continuing care/Discharge plan –Monitoring of therapeutic effect of theprescribed treatment by the registeredmedical practitioner/registered nurseprescriber and other team members.
* An example: a nurse with prescriptiveauthority is working in the diabetic day carecentre. Her patient population includesindividuals with known diagnoses of insulindependent diabetes. A patient presents witha pattern of hyperglycemia. The nursethrough her assessment skills checks forketones in the urine and for any source ofinfection. She also enquires about anyrecent changes in the patient’s diet. Basedon this information the nurse make a clinicaldiagnostic decision regarding the elevatedblood sugars and the insulin dose isadjusted appropriately.
An Bord Altranais has published supportinginformation for the regulatory framework andprofessional guidance.
• Requirements and Standards for EducationProgrammes for Nurses and Midwives withPrescriptive Authority (2007)
• Practice Standards for Nurses and Midwives withPrescriptive Authority (2007)
• Collaborative Practice Agreement for Nurses andMidwives with Prescriptive Authority (2007)
Please refer to these publications in associationwith this Decision-Making Framework.