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: admin@nursingboard.ie 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.