Non medical prescribing in Scotland: implementation guide

Appendix 13: Glossary

Approved Education Institution:

An education institution that has been approved to deliver a NMC approved programme.

Clinical Governance:

Quality assurance activities that ensure predetermined clinical standards that have been set are seen to be maintained by practitioners and are evident within health care settings.

Clinical Management Plan ( CMP):

The CMP is the foundation stone of supplementary prescribing. Before supplementary prescribing can take place, it is obligatory for an agreed CMP to be in place (written or electronic) relating to a named patient and to that patient's specific condition(s) to be managed by the supplementary prescriber. The clinical management plan is required to include details of the illness or conditions that may be treated, the class or description of medical products that can be prescribed or administered and the circumstances in which the supplementary prescriber should refer to, or seek advice from the independent prescriber. Supplementary prescribers must have access to the same patient health records as the independent prescriber. Since April 2005, nurse supplementary prescribers can prescribe controlled drugs, provided the independent prescriber (doctor/dentist) has agreed to this within the clinical management plan.

Competence:

Relates to the need for the student to demonstrate their 'capability' in certain skill areas to a required standard at a point in time.

Competencies:

Component skills which contribute to being competent and achieving the standards of proficiency for registration. Competencies might include skills arising from learning outcomes or other requirements.

Designated Medical Practitioner ( DMP):

Identified named medical practitioner who provides supervision and support to nurse/midwife prescribers, assesses their application of theory to practice and signs off satisfactory completion of the period of learning and assessment in practice.

Dispensing:

To label from stock and supply a clinically appropriate medicine to a patient/client/carer, usually against a written prescription, for self-administration or administration by another professional, and to advise on safe and effective use.

General Sale List Medicine ( GSL):

See Appendix 11.

Independent Prescribing:

A prescriber who is legally permitted and qualified to prescribe and takes the responsibility for the clinical assessment of the patient/client, establishing a diagnosis and the clinical management required, as well as the responsibility for prescribing and the appropriateness of any prescribing.

Learning Outcomes:

Developed by programme providers (approved educational institutions and their service partners), and which contribute towards and demonstrate the meeting of all NMC standards of proficiency by the end of the programme. Learning outcomes can be grouped together to form module outcomes and each module can then be assessed individually. Each module builds on the next towards meeting overall professional programme requirements.

Licensed Medication:

The Medicines and Healthcare products Regulatory Agency ( MHRA) operates a system of licensing before medicines are marketed (see marketing authorisation). However, the Medicines Act allows certain exemptions from licensing which include:

• The manufacture and supply of unlicensed relevant medicinal products for individual patients (commonly known as 'specials')
• The importation and supply of unlicensed relevant medicinal products for individual patients
• Herbal remedies exemption

Marketing Authorisation:

Previously known as a 'product licence'. This normally has to be granted by the MHRA before a medicine can be prescribed or sold. This authorisation, which confirms that medicines have met standards for safety, quality and efficacy, considers all of the activities associated with marketing medicinal products.

Medicines Act Exemptions:

Allow certain groups of healthcare professionals including occupational health schemes and midwives to sell, supply and administer particular items directly to patients/clients. Provided the requirements of any conditions attached to those exemptions are met, a Patient Group Direction is not required.

Nurse Independent Prescribers:

Nurses and midwives who are on the relevant parts of the Nursing and Midwifery Council ( NMC) register may train to prescribe any medicine for any medical condition within their competence including some controlled drugs.

Nurse Prescribers Formulary for Community Practitioners ( CPF):

The formulary from which nurses who have successfully completed the integrated prescribing component of the SPQ/ SCPHN programme, may prescribe independently.

Objective Structured Clinical Examination ( OSCE):

The OSCE is an examination that focuses on outcomes that contribute to clinical competence. The student's practice is assessed in a number of simulated clinical scenarios.

Over the Counter Medicine ( OTC):

See Appendix 11 (same as General Sale List)

Parts of the Register:

The NMC register, which opened on 1 August 2004, has three parts: nurses, midwives and specialist community public health nurses. A record of prescribing qualifications on the register identifies the registrant as competent to prescribe as a community practitioner nurse prescriber or a nurse independent/supplementary prescriber.

Patient Group Direction ( PGD):

A Patient Group Direction is a written instruction for the supply or administration of named medicines to specific groups of patients who may not be individually identified before presenting for treatment. Guidance on the use of PGDs can be found in the NES website. It is vital that anyone involved in the delivery of care within a PGD is aware of the legal requirements. It is not a form of prescribing.

Patient Specific Direction:

Are written instructions from a doctor, dentist or nurse prescriber for a medicine to be supplied and/or administered to a named person. This could be demonstrated by a simple request in the patient/client's notes or an entry on the patient's drug chart

Pharmacy Medicine (P):

See Appendix 11.

Prescription only medicines ( POM):

See Appendix 11.

Register of interests:

Prescribers are required to keep a 'register of interests' that could impact on their prescribing practice, such as links with pharmaceutical companies, use of pharmaceutical companies to sponsor events, any gifts received, etc.

Registrants:

Nurses, midwives and specialist community public health nurses currently entered in the NMC register.

Repeat Prescribing:

A partnership between patient/client and prescriber that allows the prescriber to authorise a prescription so it can be repeatedly issued at agreed intervals, without the patient/client having to consult the prescriber at each issue.

Requirements:

These include the rules, standards and principles relating to a programme.

Rules:

Rules are established through legislation and they provide the legal strategic framework from which the NMC develops standards, e.g. Education, Registration and Registration Appeals Rules 2004 (Sl 2004/1767). 'Standards' support the rules. Standards are mandatory and gain their authority from the legislation, in this case the order and the Rules.

Specialist Community Public Health Nurse:

A nurse who aims to reduce health inequalities by working with individuals, families, and communities promoting health, preventing ill health and in the protection of health. The emphasis is on partnership working that cuts across disciplinary, professional and organisational boundaries that impact on organised social and political policy to influence the determinants of health and promote the health of whole populations

Specialist Practitioner Qualification:

The Qualification awarded to registrants on successful completion of a programme of preparation leading to specialist practice. Specialist practice is the exercising of higher levels of judgement, discretion and decision making in clinical care.

Stakeholders:

Those who have a major interest in ensuring an effective programme outcome, including programme providers, placement providers, students, mentors, practice teachers, external examiners, external agencies, service users and carers.

Standards:

The NMC is required by the Nursing and Midwifery Order 2001 to establish standards of proficiency to be met by applicants to different parts of the register. The standards are considered to be necessary for safe and effective practice [Article 5(2)(a)]. These are set out within the Standards of proficiency for each of the three parts of the register and for the recorded qualification of nurse/midwife prescriber.

Supplementary prescribing:

A voluntary partnership between an independent prescriber (doctor/dentist) and a supplementary prescriber, to implement an agreed patient/client-specific Clinical Management Plan with the patient's agreement.

Unlicensed medicines:

This term refers to medicines that are not licensed for any indication or age group (also see appendix 11). Reasons why a drug may not be licensed include:

• The drug is undergoing a clinical trial, has been imported, or has been prepared extemporaneously or under a special manufacturing licence
• The product is not a medicine but is being used to treat a rare condition

V100, V200, V300:

Codes used by Approved Education Institutions to notify a registrant's successful completion of a programme to the NMC

Video consultation:

An examination to focus on outcomes which contribute to clinical competence. The student's practice is assessed as a live consultation and competency to consult, assess, diagnose and provide rationalisation for prescribing decision is assessed.

Yellow Card Scheme:

If a patient/client experiences an adverse drug reaction to a medication, the nurse should record this in the patient/client's notes, notify the prescriber (if they did not prescribe the drug) and notify via the Yellow Card Scheme immediately. Yellow cards are found in the back of the British National Formulary and online on: www.yellowcard.gov.uk. For further information read the BNF or access the MHRA website: www.mhra.gov.uk