rn prescribing in nova scotia - nanb · model developed in janu a ry 2019 x education design...
Post on 31-May-2020
2 Views
Preview:
TRANSCRIPT
RN Prescribing in Nova Scotia
Presented by
Tim Guest RN, BScN, MBA
Vice President Health Services & Chief Nurse Executive
Objectives
1. What is RN Prescribing?
2. How is Nova Scotia moving forward:
• Why?
• How?
• Where?
• When?
RN Prescribing
• In place for over 20 years
• Implemented in the UK in 1992 initially with community-based
nurses
• Evolving roles of interdisciplinary team members
• Growing expectation workforce should be maximized
• Increase in trend for non physician prescribers
(pharmacist, nurse, dietician)
• Public demand for efficient and effective care
• Nurses are ready for additional opportunity to care for the
public
RN Prescribing
Common models:
• Independent
• Prescriber is accountable for the assessment and decisions
regarding clinical management
• Supplementary
• Physician or NP makes initial assessment, diagnosis, and creates a
clinical management plan
• Plan includes list of drugs RN prescriber can use
• Patient group directive
• clinical decision-making tools illness, patient population or
situation specific
• Authorized list of drugs that can be prescribed
RN Prescribing
Safely and Effectively implemented in areas such as:
• Primary Health Care
• Home Care
• Long Term Care
• Community and Public Health
• Mental Health & Addictions
• Wound Care
• Women’s Health
• Diabetes Health
• Communicable Diseases
RN Prescribing Outcomes
• Improved patient access to care
• Increased flexibility
• Point of care access 24/7
• Improved patient satisfaction with holistic/caring consultations
• Improved adherence to prescribed health care
• Safe
• More seamless RN care provision
• Increased RN satisfaction
• Increased teamwork
• Improved efficiency in care delivery
RN Prescribing in Nova Scotia - Why
• Access to primary care a provincial government priority.
• Significant public demand in the media for increased access to care,
high public confidence in knowledge, skills and abilities of RNs.
• The Canadian Nurses Association (2015) suggests optimizing the RN
role to include prescribing as one way to improve access to care in the
spirit of the right provider at the right time and right place.
• The Provincial Nursing Network identified the opportunity to explore
RN prescribing in Nova Scotia when updating the Nursing Strategy in
2015.
• Nurses in Nova Scotia recognize the benefit RN Prescribing would
have and are willing to take on the role.
Provincial Nursing Network
• Brings together a network of nurse leaders
representing direct care, employers, regulators,
educators, unions and government.
• Purpose is to engage in strategic dialogue to
advise the Department of Health and Wellness on
how nurses can contribute to health innovation
and key strategies to address overall population
health through a nursing lens.
• Applying the best available evidence, advises on
strategies to ensure an adequate number, mix and
distribution of nurses in the province.
• Advance broad system opportunities to optimize
the contribution of the profession to improve the
health of Nova Scotians.
• The diverse membership gives the network the
strength and credibility to carry out its important
function.
• Success is a direct result of the ongoing
collaboration of the network’s membership and its
relationships with key stakeholders in Nova Scotia
and across Canada.
CNA RN Prescribing Framework
1. RN PROFESSIONAL PRACTICE
• Entering into professional and interprofessional practice in a new way.
• Understanding how we work with our patients, families, communities and each other.
• Utilizing explicit leadership capabilities in the evolution and expansion of the role.
2. STRUCTURES
• Project Steering
Committee formalized
in March 2018
• Engagement of Key
Stakeholders-Ongoing
• Initial
Communications Plan
in April 2018
• Project Charter & High
Level Work Plan in
April 2018
• New Nursing Act,
proclaimed in June
2019, enables the
College’s Board to
approve particular
registrants to practice
in an expanded scope
of practice where they
have the appropriate
education and
competencies. RN
prescribing is one
example.
3. COMPETENCE
• RN Scope of practice
and definition of
competence
• Provincial RN
Prescribing Education
Model developed in
January 2019
• Education design
underway in April 2019
• Competencies, practice
education, supervision,
learner assessment and
qualifications
components
• First Cohort of RN
Prescriber candidates
to begin education in
2020
4. PRACTICE
• Population
idenitification for
program/service
selection
• Initial implementation
sites determined as
Primary Care, Sexual
Assault Nurse
Examiner Team,
Mental Health &
Addications, Wound
Care & Fracture
Liaison in May 2019
• First RN Prescriber
Cohort (10-12
individuals)
identification
• Process identification
and improvement
action plans
• Evaluation metrics
2020Today
2017 2018 2019 2020
Exploration of RN Prescribing in NS Start
4/2017
Project Management Start
11/2017
Provincial RN Prescribing Education Model Approved
Mar 2019
RN Prescribing Sites Determined
Apr 2019
New Nursing Act proclaimed in force
June 2019
RN Prescriber Cohort Education Program Start
Sep 2019
RN Prescriber Practice Start
May 2020
RN Prescribing in Nova Scotia: How
• Initial funding for project management was made available by the
Department of Health and Wellness for 2 years as part of the
provincial Nursing Strategy. $300K
• In-kind support is provided by the same system partners that make up
the Provincial Nursing Network:
• Employers – Leadership of the initiative and allocation of professional
practice staff resources
• Educator – Dalhousie University through research expertise and course
development
• Regulator – The Nova Scotia College of Nursing through development of
RN Prescribing standards and guidelines and enabling legislation
• Government – Ongoing support through targeted Nursing Strategy
funding allocations
RN Prescribing in Nova Scotia: How
Stakeholder Engagement
• Public
• NSHA & IWK Registered Nurses
• Family Practice Nurses of Nova Scotia
• NS College of Physicians & Surgeons
• NS College of Pharmacists
• NS Nurse Practitioners Association
• NS Clinical Nurse Specialists Association
• NS Dieticians Association
• Doctors Nova Scotia
• NSHA Continuing Care NS
• Victorian Order of Nurses
• Provincial Nursing Network – DHW, Educators, Employer Leaders, Unions
• Health Association Nova Scotia Continuing Care Council (LTC Leaders)
Initial Site Selection - Criteria
• Identified need for timely access with optimization of all
interprofessional roles, enhanced continuity, and quality of care
provision.
• Align with DHW, IWK, and NSHA strategic priorities.
• Participation of interprofessional teams and support of all
leadership levels (physician or NP mentorship, change
management transitions to practice, role support and
development).
• Practice Infrastructure Capacity: access to provincial clinical
portal(s), health information systems, Drug Information System
(DIS), laboratory services and reporting, diagnostic imaging,
auditing and evaluation (see Evaluative Measures) etc.
Next Steps
• Communication of initial implementation sites to stakeholders
• Finalize and put in place supports for the initial cohort of RNs
• Finalize access to systems (NS Pharmacare/Medavie Blue Cross,
insurer approval, Drug Information System access, Laboratory and
Diagnostic Imaging system access) that support RN prescribers
• Finalize materials and orientation needed to provide practice support
for RN prescribers
• Finalize the metrics required pre and post implementation to evaluate
the initial implementation of RN prescribers in the Province of Nova
Scotia
Questions?
May we hope that, when we are all dead and gone, leaders
will arise who have been personally experienced in the
hard, practical work, the difficulties, and the joys of
organizing nursing reforms, and who will lead far beyond
anything we have done!
-Florence Nightingale
top related