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Improving care quality through NMP in the delivery of mental health services
Mike Caulfield MSc, PGCE, BSc, DipHE Advanced Nurse Practitioner for Acute Care/PICU (West) Cheshire and Wirral Partnership NHS Foundation Trust Introduction: Personal Background: RMN – Qualified 2003 LJMU Staff Nurse/CPN Windsor House Liverpool HTT then Lecturer Practitioner University of Chester Since 2010 ANP for PICU and more recently Acute Care Chester
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Overview National drivers NMP Standards Organisational level
Individual level
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National Drivers NHS Plan (2000)
Need for organisation and delivery of patient centred services Remove boundaries ‘Devolution of power’ Increase information technology Patient centred systems
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The issue NHS Plan (2000) 1999 – 5500 patients over the age of 75 ready fro discharge from acute care but still occupying a bed Nearly 25% were waiting for TTO medication to be prescribed by a ward doctor More timely if prescribed by a nurse or pharmacist
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Aims of NMP Improve patient care without compromising patient safety
Make it easier for patients to get the medicines they need Increase patient choice in accessing medicines Make better use of the skills of health professionals Contribute to the introduction of more flexible team working across the NHS. (DOH 2006)
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Standards Standard of safe and effective practice
Discharge their duty of care Observe U.K. law Operate within the limits of their professional competence Maintain professional knowledge and competence Obtain patient consent for treatment Hold appropriate professional indemnity insurance.
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Standards Standard of care – prescribing practice
Being adequately prepared for the role Attending approved prescribing training Observing professional standards of care
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Standards Standard of care – communication
Maintaining accurate, contemporaneous patient records Being accountable for any care delivery that is delegated Ensuring that colleagues understand the boundaries of prescriber roles, and specifically, Non-Medical Prescriber roles.
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The organisational perspective
Mental Health Trust Undertakes the national guidance MP16: Non medical prescribing policy Endorsement Deputy director of nursing and therapies Chief Pharmacist Line Manager
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Organisational Quality Objectives
Adhere to NMP principles Set out an accountability framework for practice Outline the application process to become a non-medical prescriber Psychopharmacology Ensure that all staff follow standard polices and procedures when prescribing Provide a standard for NMP within CWP that provides an auditable process Inpatient Safety Metrics Ensure that all non-medical prescribers within CWP are aware of their roles, responsibilities and limitations.
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Example of Audit Inpatient Safety Metrics Medicines Management
Accurate demographic information Legibility Prescription Information Omissions documented accurately Discontinuation Indication and Max Dose for PRN Reason for PRN clearly documented
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Individual Level ANP and NMP within Acute Inpatient Care
Case load basis Assessment Holistic assessment Formulation Intervention Nursing Pharmacological Evaluation Discharge/Signposting
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NMP within recovery Collaborative working Communication Consultation
Assessment process History taking Patient Choice Previous prescriptions Information sharing
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NMP within recovery Insight Concordance Psychosocial approach
Regular review/evaluation Efficacy Side effects
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NMP and the MHA Engagement Best Interest Prescribing Safe prescribing
HDAT MDT working Open dialogue Carer liaison
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Case Study 23 year old male H/O low mood, alcohol and drug use
Previous admission 2014 Diagnosis of mental and behavioural disorder due to alcohol – harmful use CBT 2011 Social stressors
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Case study Admitted March 2015 Low mood Anxiety
Suicidal ideation, intent and plans Alcohol use
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Case Study History taking Assessment Formulation Mood Alcohol Use
Time line Mood preceded alcohol use
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Prescribing Anti-depressant Prescribed by GP Non-effective
Psycho-edcuation Evaluation Amendments Detoxification SADQ Chlordiazepoxide
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Outcome Abstinence Efficacy of anti-depressant Psycho-education
Medication Alcohol use Accommodation Voluntary work Recovery
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Thank You
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