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PEER REVIEW: PRESCRIBING
Nurse Prescribing in A Private Cardiology Outpatient Setting Written by Padraig Denn, Introducing Nurse Prescribing to Private Cardiology Practice
Introduction I am going to investigate the processes involved in the development of a nurse prescriber role in a cariology out-patient setting in a private facility in Munster. I will initially look at defining the nurse prescriber role in order to have a clear view of the role requirements. I will then look at the specific area for the new role and how the Irish Legal and Regulatory framework will impact on the role’s development. I will finally look at how accountability and ethical considerations will impact on the role and what skills and guidelines a nurse/midwife prescriber could use to ensure that the care they provide is not only effective but appropriate for each individual patient. Definition In order to investigate the development of nurse prescriber role in an outpatient setting we should first identify the definition of the role. I will review the development of nurse prescribing in Ireland later but in short nurse prescribing is built on both a legal framework and associated regulations and rules. The prescriber must be registered on the appropriate prescribers register and only prescribe medications that are commonly used in their specific area of expertise. Despite a thorough search of relevant literature, I was unable to identify a specific definition for the nurse prescriber role. Therefore, I
propose the below definition of the role for the purposes of this article. “Nurse/Midwife prescribing is a comprehensive process of amending an individual’s medical product regime by an appropriately educated and registered nurse/midwife prescriber within their scope of practice and area of expertise. This process encompasses effective assessment of the individual and their problem whilst adhering to local and national laws/ regulations/policies/guidelines as part of a patient centred care approach. The resultant prescription should adhere to best practice documentation guidelines and should be subject to comprehensive auditing to ensure consistency and accuracy.”
role to encompass the assessment and management of non-acute cardiology presentations, in conjunction with the lead cardiologist, to improve the throughput in out-patient clinics. A significant component of this role would be the active management of patient’s conditions which would involve effective prescribing of medicinal products.
Scope of Nursing for Prescribing
The out-patient services are based in a private healthcare facility in the Munster region and will be the first private clinic in Munster to have an Advanced Nurse Practitioner (ANP) role as part of the day-to-day management of the broad spectrum of non-urgent out-patients.
Based on the recommendations of theses report a review was commissioned in 2001 into the possibility of extending the role of nursing to include prescribing. The review was carried by a team from An Bord Altranais and the National Council for the Professional development of Nursing and Midwifery. There review was published after three and a half years of assessment in 2005. This review recommended that prescriptive authority should be extended to nurses and midwives (Drennan et al., 2009).
The implementation process for nurse prescribing in Ireland had its infancy in two reports that were published in the late 1990’s early 2000. The commission of Nursing (Government of Ireland, 1998) and the Review of scope of Practice for Nursing and Midwifery (Final Report) (An Bord Altranais, 2000).
In this article I will look at the important components of effectively integrating this new advanced nurse role into a preexisting clinical setting whilst ensuring that national legal and registration guidelines are adhered too. I will also consider the personal considerations of taking on this new role in the Appendix 1 above setting.
The National Nursing and Midwifery board (NMBI) (registration authority in Ireland for Nurse Prescribers) and the Health Services Executive have laid out the rules and regulations for the nurse/midwife prescribing role in numerous publications. I will explore these in more detail later. Clinical Setting I am currently the manager of an outpatient cardiology department which includes a nurse lead Acute Cardiology assessment unit, heart failure clinic, cardiac rehabilitation nurse led service and we are in the process of developing a cardiology nurse research post. It is planned to expand my current
AUGUST 2022 • HPN | HOSPITALPROFESSIONALNEWS.IE
Appendix 2 Practice Standards and Guidelines
Appendix 1
