version control non... · web viewpoli c y independent p r es c r i b ing nurse indepe n d ent p...

Policy Number

LCH-92

This document has been reviewed in line with the Policy Alignment Process for Liverpool Community Health NHS Trust Services It is a valid Mersey Care document however due to organisational change this FRONT COVER has been added so the reader is aware of any changes to their role or to terminology which has now been superseded When reading this document please take account of the changes highlighted in Part B and C of this formPart A ndash Information about this DocumentPolicy Name Non Medical PrescribingPolicy Type Board Approved (Trust-wide) Trust-wide Divisional Team Locality

Action No Change Minor

Change MajorChange New

Policy No LongerNeeded

Approval

As Mersey Carersquos Executive Director Lead for this document I confirm that this documenta) complies with the latest statutory regulatory requirementsb) complies with the latest national guidancec) has been updated to reflect the requirements of clinicians and officers andd) has been updated to reflect any local contractual requirements

Signature DatePart B ndash Changes in Terminology (used with lsquoMinor Changersquo lsquoMajor Changesrsquo amp lsquoNew Policyrsquo only)

Terminology used in this Document New terminology when reading this Document

Part C ndash Additional Information Added (to be used with lsquoMajor Changesrsquo only)Section

Paragraph NoOutline of the information that has been added to this document ndash especially where it may

change what staff need to do

Part D ndash Rationale (to be used with lsquoNew Policyrsquo amp lsquoPolicy No Longer Requiredrsquo only)Please explain why this new document needs to be adopted or why this document is no longer required

Part E ndash Oversight Arrangements (to be used with lsquoNew Policyrsquo only)Accountable Director

Recommending Committee

Approving Committee

Next Review Date

LCH Policy Alignment Process ndash Form 1

SUPPORTING STATEMENTS This document should be read in conjunction with the following statements

SAFEGUARDING IS EVERYBODYrsquoS BUSINESSAll Mersey Care NHS Foundation Trust employees have a statutory duty to safeguard and promote the welfare of children and adults including being alert to the possibility of child adult abuse and neglect through their observation of

abuse or by professional judgement made as a result of information gathered about the child adult

knowing how to deal with a disclosure or allegation of child adult abuse undertaking training as appropriate for their role and keeping themselves updated being aware of and following the local policies and procedures they need to follow if they

have a child adult concern ensuring appropriate advice and support is accessed either from managers Safeguarding

Ambassadors or the trustrsquos safeguarding team participating in multi-agency working to safeguard the child or adult (if appropriate to your

role) ensuring contemporaneous records are kept at all times and record keeping is in strict

adherence to Mersey Care NHS Foundation Trust policy and procedures and professional guidelines Roles responsibilities and accountabilities will differ depending on the post you hold within the organisation

ensuring that all staff and their managers discuss and record any safeguarding issues that arise at each supervision session

EQUALITY AND HUMAN RIGHTSMersey Care NHS Foundation Trust recognises that some sections of society experience prejudice and discrimination The Equality Act 2010 specifically recognises the protected characteristics of age disability gender race religion or belief sexual orientation and transgender The Equality Act also requires regard to socio-economic factors including pregnancy maternity and marriagecivil partnership

The trust is committed to equality of opportunity and anti-discriminatory practice both in the provision of services and in our role as a major employer The trust believes that all people have the right to be treated with dignity and respect and is committed to the elimination of unfair and unlawful discriminatory practices

Mersey Care NHS Foundation Trust also is aware of its legal duties under the Human Rights Act 1998 Section 6 of the Human Rights Act requires all public authorities to uphold and promote Human Rights in everything they do It is unlawful for a public authority to perform any act which contravenes the Human Rights Act

Mersey Care NHS Foundation Trust is committed to carrying out its functions and service delivery in line the with a Human Rights based approach and the FREDA principles of Fairness Respect Equality Dignity and Autonomy

Liverpool Community Health NHS Trust

Non- Medical Prescribing Policy

Policy No 92

Title Non-Medical Prescribing Policy

Policy reference number

92

Aim andpurpose

This document sets out the principles on which non-medicalprescribing is based and individual roles and responsibilities in relation to non-medical prescribing

Author Non-Medical Prescribing Lead

TypeNew document

Reviewed document radic

Review Date April 2019

Persongroupaccountable for Review

Clinical Standards Group

Type ofEvidence base used

C Evidence which includes published andorunpublished studies and expert opinion and Department of Health Statutory Requirements and Department of Health Guidance

Issue date April 2017 ndash slight amendment approved at Clinical Standards Group meeting in January 2018

Authorised byClinical Policies Group

March 2019

Equality Analysis Assessment Undertaken

Yes X April 2017 Evidence radic

Non-Medical Prescribing Policy Liverpool Community Health NHS Trust

Page 2

Version Control

Version Number 9

Ratified by Clinical Standards Group

Date of ApprovalJanuary 2017

Name of originatorauthorNon-Medical Prescribing Lead

Approving Body Committee Clinical Standards Group

Date issued January 2018

Review date March 2019

Target audience Non-medical prescribers across LCH

Name of Lead Director Managing Director

Director of Nursing

Changes Alterations Made To Previous Version

64 Minor wording changes Clarification of the process for prescribers who are retiring and returning64 Minor wording changes Clarification of the process for prescribers who are retiring and returning71 ndash process has been clarified for adding WIC staff to EMIS72 ndash Clarify number of prescription pads kept in MDS Details for Princes street have been removed78 ndash Updated contact details85 ndash Remove prescribing on an inpatient chart9 - Clarification of bank and agency prescribing requirementsAppendices 1B 2 4 and 5 updated


Page 3

Contents Page

1 Introduction 6

2 Definition and Explanation of specialist terms roles used within 6

this policy

21 Independent Prescribing

22 Nurse Independent Prescribers (V300)

23 Pharmacist Independent Prescribers

24 Nurse Prescribersrsquo Formulary for Community Practitioners (NPFCP)

25 Community Practitioner (V100V150) Prescribers

26 Patient Group Direction

27 Patient Specific Direction

28 Supplementary Prescribers (V200)

29 Clinical Management Plan

3 Identifying the need for NMP within a Clinical Service 9

4 Independent Prescribing 9

41 Guidance for NMP on prescribing including

prescribing Controlled Drugs

42 Eligibility Criteria for Nurse (V300) or

Pharmacist Independent Prescribing

43 Designated Medical Practitioner

5 V150V200 Eligibility criteria 13

51 Community Nurse Prescriber (V150)

52 Supplementary Prescriber (V200)

6 NMP Registration 14

61 NMP Register


Page 4

62 Registering as a NMP

63 Amendment to registration information

64 Retrieval of prescription pads when leaving

LCH And destruction of pads

7 Security and Safe Handling of Prescriptions 16

71 Generation of Prescriptions

72 Receipt of Prescriptions

73 Storage of Prescriptions

74 Prescription Pad Security during working day

75 Process for lost or stolen prescriptions

76 Spoilt Prescriptions

77 Fraudulent Prescriptions

8 Prescribing and Assessment 21

81 Wound Dressing Initial Assessment Guidance

82 Prescribing on behalf of another practitioner

83 Repeat Prescribing

84 Emergency Supply

85 Prescribing for In-patients Prescription Chart

86 Medication Errors

87 Discontinuing Medication

88 Off labelOff license medicines

89 Guidance on the mixing of medicines

9 Bank Agency Prescribing 26

10 Professional Portfolio Continuing Professional

Development and Personal Development Review 27

101 Criteria for Continuing Professional Development

102 Continuing Professional Development Reflections

11 Legal Responsibilities Liability and Indemnity Insurance 27


Page 5

12 Consent 29

13 Audit and Governance 29

14 References and Associated Documentation 30

Appendices 32


Page 6

[1] Introduction

It is government policy to extend prescribing responsibilities to non-medical professions to

bull improve patient care without compromising patient safety

bull make it easier for patients to get the medicines they need

bull increase patient choice in accessing medicines

bull make better use of the skills of health professionals

bull contribute to the introduction of more flexible team working across the NHS

Liverpool Community Health NHS Trust (LCH) has developed this policy to fulfil the requirements to patients and service users receiving prescribed medications from staff employed by LCH LCH is committed to ensuring that all staff are trained and equipped to perform their role effectively and safely

2 Definitions and Explanation of specialist termsroles used within this policy are stated below


Prescribing by a practitioner responsible for the assessment of patients with undiagnosed and diagnosed conditions and for decisions about the clinical management required


Nurses who have successfully completed a nurse independent prescribing course or previously an extended formulary nurse prescribing c o u r s e a r e able to prescribe any medicine for any medical condition within their clinical competence including Controlled Drugs Schedule 2-5 except for diamorphine cocaine and dipipanone for treatment of addiction


Pharmacists who have successfully completed an independent prescribing course are able to prescribe any medicine for any medical condition within their clinical competence including Controlled Drugs Schedule 2-5 except for diamorphine cocaine and dipipanone for treatment of addiction


This is the formulary that the community practitioner prescriber is authorised to prescribe from The formulary contains 13 prescription only medicines


Page 7

(POMs some pharmacy only medicines (P) and medicines on sale to t h e general public general sales list (GSL) medicines and a list of dressings and appliances relevant to community nursing and health visiting practice


Page 8

25 Community Practitioner (V100V150) Prescriber

Community practitioner prescribers will have completed either the V100 or V150 qualification The V100 is completed as part of the Specialist Practitioner Qualification (SPQ) or the Specialist Community Public Health Nurse programme (SCPHN) whereas the V150 qualification focuses solely on prescribing Community practitioner prescribers consist of district nurses health visitors midwives and school nurses V100 and V150 Non-Medical Prescribers can prescribe only from the NPFCP

26 Patient Group Direction (PGD)

A Patient Group Direction (PGD) is a written instruction for the supply or administration of a licensed medicine (or medicines) in an identified clinical situation where the patient may not be individually i d e n t i f i e d b e f o r e presenting for treatment This should not be interpreted as indicating that the patient must not be identified patients may or may not be identified depending on the circumstances

Patient Group Directions can be used by the following registered healthcare professionals acting as named individuals n u r s e s health visitors paramedics optometrists chiropodists and podiatrists radiographers orthodontists physiotherapists dieticians occupational therapists prosthetics dental therapists dental hygienists and orthodontists and speech and language therapists Each PGD has a list of individual professions named as competent to supplyadminister under the PGD

PGD legislation enables dental therapists and dental hygienists to administer local anaesthetics and to sell or supply fluoride supplements and toothpastes with high fluoride content of 2800 and 5000 parts per million (ppm) However the legislation does not limit the medicines dental therapists and dental hygienists may sellsupply or administer

As long as the Health Care Professional is assessed as competent in the use of a medicine and there is agreement between all the signatories to the PGD any licensed Pharmacy Medicine (P) or Prescription Only Medicine (PoM) can be included in a PGD Particular caution should be exercised in any decision to draw up PGDs relating to antibiotics Microbial resistance is a public health matter of major importance and great care should be taken to ensure that their inclusion in a PGD is absolutely necessary and will not jeopardise strategies to combat increasing resistance A local microbiologist should be involved in drawing up any PGD which includes an antibiotic

27 Patient Specific Direction (PSD)

A patient specific direction is a written instruction from a doctor or a dentist or a non-medical prescriber for a medicine or an appliance to be supplied or administered to a named patient for example

In a Walk In Centre On a bed based unit on a patientrsquos ward drug chart When a dentist is providing a written prescription for treatment by


Page 9

a DCP(Dental Care Professional)


0

28 Supplementary Prescribers ( V 2 0 0 )

Supplementary prescribers may be nurses pharmacists or allied health professionals who have successfully completed a supplementary prescribing course and are able to prescribe against a patient-specific clinical management plan that has been agreed with the medical independent prescriber (doctor or dentist)

29 The Clinical Management Plan (CMP)

The clinical management plan applies to supplementary prescribers only BeforeSupplementary prescribing can take place there must be a written Clinical Management Plan (written or electronic) relating to a named patient and to that patientrsquos specific condition(s) to be managed by the supplementary prescriber Agreement to the plan must be recorded by both the independent and supplementary prescriber before supplementary prescribing begins This should be included in the patient record

Regulations specify that the CMP must include the following

The illness or conditions which may be treated by the supplementary prescribers

The date on which the plan is to take effect and when it is to be reviewed by a GP or Consultant from area of practice who is party to the plan (review date no longer than one year)

The name of the patient to whom the plan relates

Reference to the class or description of medicines or types of appliances which may be prescribed or administered under the plan

Any restrictions or limitations as to the strength or dose of any medicine which may be prescribed or administered under the plan and any period of administration or use of any medicine or appliance which may be prescribed or administered under the plan

Any CMP must reflect LCH andor national guidelines The CMP may include a reference to published national or local guidelines However these must clearly identify the range of relevant medicinal products to be used in the treatment of the patient and the CMP should draw attention to the relevant part of the guideline

Following diagnosis by the independent prescriber the independent and supplementary prescriber will probably need to discuss the CMP before the document itself is prepared Either the independent or supplementary prescriber may draft the CMP however both must formally agree to the CMP before supplementary prescribing can begin


Page 11

The CMP comes to an end At any time at the discretion of the independent prescriber GP or consultant At the request of the supplementary prescriber or the patient At the time specified for the review of the patient (unless it is renewed by

both prescribers at that time) Where there is a sole independent prescriber and he or she is replaced

for whatever reason In these circumstances the CMP must be reviewed by their successor The supplementary prescriber must never make amendments to the CMP without the agreement of the independent prescriber n a m e d o n the plan

3 Identifying the need for NMP within a Clinical ServiceThe need for NMP should be linked to the strategic plan for the service included in business plans and training need analysis for the service

4 Independent Prescribing (V300) Non-Medical Independent Prescribing (NMIP) is prescribing by a practitioner

(eg pharmacist nurse physiotherapist podiatrist) responsible and accountable for the assessment of patients with undiagnosed or diagnosed conditions and for decisions about the clinical management required They will have successfully completed a recognised independent prescribing course and have independent prescriber annotated as a qualification on the professional register

The patient must agree to any prescribing arrangements or decisions and the NMIP must work in partnership with the patient and doctor or consultant in charge of the patientrsquos overall care

Independent prescribing is only one element of the clinical management of the patient Patient history drug history allergies clinical assessment interpretation of that assessment a decision on safe and appropriate therapy and a process for on-going monitoring are necessary The independent prescriber is responsible for ensuring that all these elements are in place Where possible the NMIP must access the full clinical record

A NMIP can only prescribe a medicine for a patient whom heshe has assessed for care In the event of being requested to intervene for a patient under the case load of another prescriber the independent prescriber should undertake their own assessment

The NMIP may only prescribe according to hisher sphere of expertise competence and experience

41 Guidance for NMIP on prescribing including


Page 12

CDs

Declaration o f i n te n t to presc ri be c o ntrolled d r u g s Nurse or pharmacist independent prescribers intending to prescribe controlled drugs schedule 2- 5 need to discuss with their line manager and declare their intention using the electronic self-declaration format on an annual basis

T h e re g is t er o f n o n- m edical presc ri b ers w il l be u p d a ted The register of NMPs is updated with information regarding those who have declared their intention to prescribe CDs The Self Declaration email will contain information on which CDs and for what conditions they may be prescribed

It is good practice to review CD presc ri bing st at us as p a rt o f the P erso n al D e v elop m e n t R e v i e w (PD R ) This allows practitioner and line manager to discuss prescribing practise and any areas of development required If a CD has not been prescribed during the review period a discussion should be held around how the practitioner can demonstrate on-going competence to prescribe in this area

M onito r i ng o f the pre s c r i bing of C D s ( s c h e d u l e 2 - 5)Prescribing by non-medical prescribers including CDs is monitored monthly through ePact data by the NMP Prescribing Lead ePact data is available to prescribers and managers and can be found on SIRs

The appropriate prescribing of CDs will be monitored by the Medicines Safety and Optimisation Group Divisional Lead and the NMP P r e s c r i b i n g Lead on a bi-monthly basis

Any incidents or risks identified in relation to CDs prescribed by NMPs will be reported to the LCH CDAO (CD accountable officer) NMP Lead Medicines Optimisation Group and escalated further if required

In 2012 a single prescribing competency framework was published by the National Prescribing CentreNational Institute for Health and Clinical Excellence (NICE) to support all prescribers to prescribe effectively In 2016 the Royal Pharmaceutical society updated the framework with the backing of NICE and in collaboration with all prescribing professions in the UK including the NMC

This updated single framework is available atRPGSB Competency Framework

The non-medical prescribing policy should be used in conjunction with relevant supporting LCH policies and procedures including

Controlled Drugs Policy Overarching Medicines Policy Trust Antimicrobial Guidelines Wound Care Formulary


Page 13


Page 14

42 Eligibility Criteria for Nurse (V300) or Pharmacist Independent Prescribing

It is the responsibility of the non-medical prescribing lead or the Service Manager to ensure that practitioners who put themselves f o r w a r d to become NMPs meet both LCH and Higher Education Institution (HEI) pre-course criteria before nominating them to HEI

Those wishing to undertake prescribing training will need to demonstrate a professional qualification as outlined below

Pharmacists registered with the General Pharmaceutical Council should have at least two yearsrsquo a p p r o p r i a t e p a t i e n t o r i e n t a t e d experience i n a h o s p i t a l c o m m u n i t y o r p r i m a r y c a r e s e t t i n g following their post- registration year

AHPs registered with the Health Professionals Council should have a minimum of 3 years relevant post-qualification experience

First level nurses registered with the Nursing and Midwifery Council (NMC) Evidence of successful study at degree level and ability to study to

Masterrsquos level They will have sufficient opportunity to prescribe and maintain competence

and confidence after the training is complete Confirmation from NMP Lead that the entrant will have appropriate

supervised practice in the clinical area in which they are expected to prescribe and that there is an identified service need for this extension of role

Have successfully completed the numeracy assessment test They have the support of a GPConsultant from their area of practice that is

eligible and willing to act as the Designated Medical Practitioner and supervisor

Are willing to engage with the Trust Non-Medical Prescribing Sub Group once qualified

Their role is one in which independent prescribing is required

43[42] Designated Medical PractitionerA guide to help doctors prepare for and carry out the role of DMP is available on within the lsquoNMC Standard for Nurse and Midwife Prescribersrsquo guidance (page 59 ndash 60)

http w w wn m c - uk or gD o cu m ents St a ndards n m cStand a rd s o f Pro f ic i e n c y F o r N u rs e And M i d w i f ePre s c r i b e r s p df

The DMP must be a registered medical practitioner who

Has normally had at least three years recent clinical experience for a group of patientsclients in the relevant field of practice

Is within a GP practice and is either vocationally trained or is in the


Page 15

possession of a certificate of equivalent experience from the Joint Committee for Postgraduate Training in General Practice or is a specialist registrar clinical assistant or a consultant within an NHS Trust or other NHS employer

Has the support of the employing organisation or GP practice to act as the DMP who will provide supervision support and opportunities to develop competence in prescribing practice

Has some experience or training in teaching andor supervising in pract ice

Normally works with the trainee prescriber If this is not possible (such as in nurse led services or community pharmacy) arrangements can be agreed for another doctor to take on the role of the DMP provided the above criteria are met and the learning in practice related to the clinical area in which the trainee prescriber will ultimately be carrying out their prescribing


Page 16

5 V150V200 Eligibility Criteria51 Community Practitioner (V150) Prescriber

Prospective candidates must meet the following criteria

Have a practising experienced (at least 2 years) Community Nurse or Independent Prescriber mentor willing to supervise and assess 10 days of learning in practice for the course

Have the support of the Employer who will also need to confirm that The candidatersquos post is one in which there is a clinical need and opportunity

to prescribe The candidate is competent to take a history undertake a clinical

assessment and prescribe The candidate has a current (within the last three years) enhanced

disclosure from the Disclosure and Barring Scheme The candidate has access to continuing professional development

opportunities on completion of the course The applicant has access to a prescribing budget on completion of the

course The applicant has sufficient knowledge to apply prescribing principles

taught on the programme to their own field of practice The candidate is able to demonstrate appropriate numeracy and literacy

skills

52 Supplementary Prescribing (V200)

Physiotherapists radiographers and chiropodistspodiatrists may train to become Supplementary prescribers Also nurses and Pharmacists may undertake a supplementary prescribing course although usually they undertake either Community Nurse Prescribing or Independent Prescribing (which incorporates supplementary prescribing)

521 Professionals wishing to undertake supplementary prescribing must meet the following criteria Have a minimum of 3 years post registration experience of which at least one

year immediately preceding the application has been in the clinical area in which the applicant intends to prescribe on successful completion of the course

Be registered with the Health Professions Council in one of the relevant Allied Health Professions

Successful completion of a physical assessment course at Masterrsquos level Evidence of study at degree level and ability to study to Masters level Be willing eligible and able to undertake the training programme Their subsequent prescribing practice will provide maximum benefits to patients

in their local services Have sufficient opportunity to prescribe and maintain competence

and confidence after the training is complete Be willing to engage with the Trust Non-Medical Prescribing Group


Page 17

once qualified Have the support from their manager Clinical and Service Directors Have sufficient opportunity to prescribe and maintain competence and

confidence after training is complete Their role is one in which supplementary prescribing is required and

reflected in the job description

6 NMP Registration

61 NMP Register

A record of each Non-Medical Prescriber will be maintained and updated by the Trusts NMP team The record will include the names of the Non-Medical Prescribers their professional registration number their service their locality CD permissions mobile contact numbers scope of practice and the date they last completed appendix 4 (the self-declaration form)

62 Registering as a Non-Medical Prescriber If an NMP is new in post new to the trust or has successfully completed

an accredited non-medical prescribing course and has notified their respective registering body they must notify their line manager

They must provide to their line manager A copy of their registration number Proof of registration as a NMP from the Higher

Education Institution or with their relevant professional body

An LCH registration form (appendix 2) must be completed by the line manager a copy forwarded to the NMP team and a copy scanned by the Team Leader and sent to Business HR for allocation to the personnel file

The non-medical prescribing coordinator w i l l inform the NHS Business Services Authority (BSA) using the registration form which can be found on the PPD website

For the first supply of prescriptions the non-medical prescribing coordinator will order prescription pads (subsequent prescriptions will be ordered by Medicines Distribution Service)

The prescriptions for prescribers w i l l be p e r s o n a l i s e d with the prescriberrsquos details The pads contain 50 prescriptions with serial numbers printed at the bottom (Please note Serial numbers are not numbered consecutively however they are numbered in order in 9rsquos)

A record must be kept to trace the issue of pads and serial numbers of each prescription

Where electronic prescribing is used the NMP coordinator will


Page 18

send an email to the NMPrsquos line manager when the registration process is complete and the NMP can be added to the electronic prescribing system

Until this process is complete the NMP must not prescribe

63 Annual Self-declaration to remain on the register

The NMP and their line manager must ensure the annual self-declaration form is completed in order to maintain active registration

An NMP who does not complete their annual self-declaration form will be sent 3 reminders their line manager will also be copied in If after 3 reminders they have not completed their self-declaration the NMP will be marked as inactive and their line manager informed

The NMP coordinator will share the locality self-declaration performance on a monthly basis with the locality governance lead for escalation review and action within the locality

64 Amendments to the register

For amendments to prescribing status change of contact details change in name and or base

The prescriber must notify the Line Manager and complete appendix 3 (change in details form) to inform NMP coordinator

The non-medical prescribing coordinator must notify the BSA completing the relevant form on the BSA website and reorder prescription pads if necessary

65 Retrieval of Prescriptions on Leaving LCH and destruction of pads

It is the responsibility prescriber to return their prescription pads to MDS for destruction It is the responsibility of the line manager completing the exit interview process to ensure that

1 Prescription pads have been returned to MDS by prescribers who leave their employment with LCH

2 The unused prescriptions are to be t a k e n by the NMP to the MDS and remaining pads destroyed by shredding Signature to be obtained from MDS by NMP that process has been completed

3 The MDS also maintains a database of prescriptions destroyed which includes the first and last serial numbers of the pads destroyed

4 The prescriber or their line manager should complete appendix 5 (NMP leavers automated email) to advise pads have been destroyed and prescriber details have been deleted from the electronic prescribing system

5


Page 19

6 MDS must ensure no further prescription pads are ordered for a prescriber who h a s left LCH employment or who has been suspended from prescribing duties The register will be updated to reflect the change in status of the prescriber

7 Prescribers who intend to retire and return to the trust must complete the leavers automated email (see appendix 5) as this ends their current contract of employment There is an option on this form for retire and return Prescription pads must be returned to MDS for safe storage

8 On their return to the trust these prescribers must complete the process to register as an NMP as detailed in section 62


Page 20

7 Security and Safe Handling of Prescriptions


1 Practice based independent and supplementary prescribers can have their details added to a practice computer system to allow the printing of prescriptions with the correct relevant details Walk in centre (WIC) prescribers will generate prescriptions using the electronic prescribing system prescribers must not be added to the clinical system until confirmation of their registration has been received from the NHSBSA If information is added to Non LCH systems advice on what details must be added to the practice computer system can be found on the BSA website

htt p w ww n h s b s a nh s ukPresc ri pti o nServ i c e s 3974 a s px

a visible audit trail of prescribing actions must be maintained prescriptions should always be signed immediately

2 Non-medical prescribers must only generate prescriptions with their personal qualification and PIN number ie NMC pin number GPhC pin The NMP must ensure that the qualification is correct on the prescription before signing If details are not correct contact n m p a d m i n l i v erpoolchnh s u k

3 Prescribers working across different GP practices should only use one prescription pad with one code It is no longer essential to add the GP practice code to the prescription pad as the costs are attributed to an LCH cost centre

4 Where a prescriber works for more than one organisation for example for LCH and for a GP practice as a private contractor a separate prescription padelectronic code will be required for each organisation

5 Non-medical prescribers use specific types of prescription pads for prescribing which can be identified as different colours by the dispenser (Electronic will be green hand written purple)

6 Prescribers should ensure that their work contact phone number is written on the bottom of the prescription This should be legible

7 Detailed advice on prescription writing is contained in the British National Formulary w w w BNF org (BNF)

8 Blank prescriptions must NOT be pre-signed to reduce the risk of misuse should they fall into the wrong hands In addition prescriptions should only be produced when needed and never left unattended

9 Prescribers must never tamper with existing prescriberrsquos details on a prescription or add their own prescribing details whether that be handwritten or by stamp

10 If an electronic prescription is damaged and requires re-printing an


Page 21

indication for the reason for duplication must be stated on the patient record

11 NMPs should not issue emergency or repeat prescriptions without the reassessment examination and evaluation of the patient where they have


Page 22

access to the full clinical record The drugs prescribed must be within their sphere of competence and in accordance with the repeat prescribing policy

The security of prescriptions is the responsibility of the employing organisation service manager and the prescriber It is advisable to hold only minimal stocks of prescriptions More specifically NMPs must carry only one pad in person at all times (NMPs may collect a maximum of 2 pads from MDS but one must be stored at their LCH base in a locked cupboard) Failure to comply with this standard may result in a removal of prescribing rights Remaining pads must be either stored at designated base in a locked cupboardcabinet or within the MDS buildings


It is the responsibility of LCH to ensure that there is a system in place to record the serial numbers of prescriptions received and subsequently issued to an individual prescriber surgeries clinics etc

1 When new prescription pads are received by MDS they will advise the Prescriber they are in stock MDS wil l hold 1 pad for V100 V150 and LCH employed WIC staff For all other staff a maximum of 2 pads will be held in stock The staff member at the MDS must not issue more than two pads at any given time unless in exceptional circumstance and authorised by the NMP lead or Head of Medicines Management

2 The authorised person will enter the following details onto the electronic prescription record and paper copy for that prescriber

Prescribers name base and contact phone number Date of receipt of pads Number of pads received A running total of how many pads are in the file updated

on paper version only The record sheet and the prescription pad(s) are to be kept in

the prescriberrsquos folder at MDS

All Prescribers should call the MDS 24 hours in advance of collecting their prescription pad

Suite 3 Baylis Edge Lane L7 9NJ (01512953981)


Page 23

1 The initial process for collecting first prescription pads requires the following process to be followed

Show the authorised person their L C H identity badge containing a photograph

Demonstrate their signature Provide a copy of their PINRegistration number This must

match the number printed on the prescription pad2 Prescription pads are legal documents which are the responsibility of the

authorised prescriber and therefore must be collected by the authorised prescriber on each occasion

3 Generic prescriptions for use with electronic prescribing within walk in centres may be collected by a designated person from that centre


The security of prescription forms is the responsibility of both the organisation and the prescriber Action should be taken to prevent the theft and loss of prescription forms from occurring in the first instance by organisations and individuals being vigilant Prevention is the responsibility of everyone which includes all prescribing and dispensing staff and non-prescribing staff who manage or administer prescription forms

Prescribers are responsible for the security of prescription forms once issued to them (NHS Protect 2015) Prescriptions are classed as ldquocontrolled stationeryrdquo ie stationery that may be used to obtain medicines fraudulently Therefore it is best practice to return pads to the designated base at the end of each shift for storage within a locked cupboard or cabinet In circumstances where it may not be suitable to return prescriptions to base (agile working multiple bases) it is the responsibility of the prescriber to ensure that all remaining prescriptions are securely locked within their home in an area only the NMP has access to It is not permitted for NMPs to store more than one prescription pad at home at any given time

74 Prescription pad security during the working day

Prescriptions should not be left on a deskcomputer unattended but placed in a designated locked place for example the prescriberrsquos box drawer cabinet or cupboard

Prescriptions are less likely to be stolen from (locked) secure stationery cupboards than from desks bags or cars

1 When storing prescription pads at work the prescriber must store their prescription pad in a locked box drawer or cabinet designated for the prescriber within the work place This must be operationally managed and risk assessed on a case by case basis

2 They must not be left unattended eg in the car while the car is unattended When travelling between patients the prescription pad should not be visible ndash it should be locked in the boot While visiting patients prescribers should keep their prescription pad with them


Page 24

at all times ensuring pads are kept close to them at all times

3 As a minimum standard the NMP must record the serial number at the top of the pad at the end of the working day Furthermore a record should be kept of all lost stolen or spoilt prescriptions Such steps will help to identify any prescriptions that are either lost or stolen overnight

4 It is good practice for prescribers not to break up prescription padsPrescriptions are recommended only to be removed to issue a prescription or to destroy a spoilt prescription The prescription pad should normally be kept intact so that serial numbers can be traced Blank prescriptions should not be pre-signed

75 Process for Lost or Stolen Prescriptions(Emergency contact numbers are given at the end of this section)

Any loss of prescriptions must be reported by the NMP as soon as possible to the Senior Service Manager or On Call Manager during out of hours or at weekend There is a risk of safety to the public if the pads fall into the wrong hands

Process

1) The NMP should report any Lost or Stolen prescriptions immediately to the service manager or on call manager stating

name designation prescriber status V300 V100 Pharmacist Medic date and time of losstheft place where losstheft occurred type of prescription stationery if it was a blankfilled prescription approximate number of prescriptions missing serial numbers if available

The non- medical prescriber will be given advice from the Senior Service Manager regarding the course of action This advice depending on the circumstances of the loss or theft will be either to

Refrain from issuing further prescriptions until further notice or To ensure future prescriptions are written in red ink for a period of

two months

2) The NMP should then ring 101 and relay the information obtained in point 1 above and make a record of incident number provided by police


Page 25

3) The NMP should then complete the NHS England MissingLostStolen Prescription form on SIRSNHS England MissingLostStolen Prescription form and forward to m e dic i nes m a na g e m e n t l i v erpoolchn h s u k and nmpadminliverpoolchnhsuk and en g la n d cw w alerts nhs net This will ensure that community pharmacies are notified

The NMP should also complete the NHSBSA MissingLostStolen Prescription form on SIRSNHSBSA MissingLostStolen Prescription Form and forward to prescriptionnhsprotectgsigovuk and m e dic i nes m a na g e m e n t l i v erpoolchn h s u k and nmpadminliverpoolchnhsuk

4) The NMP should then complete a Datix stating steps taken above within 24 hours of the time of losstheft quoting the police incident number

Refer to the Incident Reporting Policy (including SUIrsquos) - Incident reporting policy

5) The NMP coordinator will pick up email and forward the completed NHSBSA form to h eal t ha n ds a f e t y l i v erpoolchnh s u k

6) The Health and Safety Teamrsquos Local Security Management Specialist or suitable alternative will complete the NHS Protect online report form For further information please see httpwwwnhsbsanhsukDocumentsSecurityManagementSecurity_of_Prescription_forms_Updated_August_2015pdf


All void prescriptions should be shredded A record should be made of the destroyed or void prescription pad in the prescribers work diary


The generation of fraudulent prescriptions or the knowing of fraudulent alterations to a prescription is a criminal and disciplinary offence The person identifying potential fraud should contact NHS Protect the NMP Lead and the Head of Medicines Management A Datix incident report should be completed

78 Contact Details


Page 26

Xerox on 0300 123 0849 or e-mail nhsor d ers x ero x c o m

Name Contact emailNMP Lead Trish Mattinson TrishmattinsonliverpoolchnhsukActing Joint Heads of Medicines Management

Kerrie BermudezCatherine Kitchen

KerrieBermudezliverpoolchnhsukCatherineKitchenliverpoolchnhsuk

CD Accountable officer

Dr David Webster DaveWebsterliverpoolchnhsuk

8 Prescribing and Assessment

In order to prescribe for a patient the NMP must ensure that they have undertaken a full c l in i ca l assessment of the patient including taking a thorough history minimal dataset and summary record and where possible access a full clinical record NMP are accountable for their prescribing decisions and must prescribe only when they have relevant knowledge of the patientrsquos health and medical history

All NMPs must contact the GP with details of any prescriptions issued within 48 hours (NMC 2006) or 2 working days (to address weekend working) of completing a script The method used to contact the GP will be different within each service (ie fax letter EMIS web) This should be operationally managed on a case by case basis The use of a SOP may be appropriate for certain clinical services


An instance when this will be unavoidable would be within a Walk In Centre Within a WIC there may be circumstances when activity levels are high and when a PGD does not address all the presentations and it is in the best interest of the patient for them to receive this medication The NMP remains accountable if they do decide to prescribe (NMC 2006) and must be satisfied with the clinical assessment skills of their colleague (staff within the WIC whose competencies are known to the NMP) and the findings of the clinical condition that the prescription is being written for

NMPs must review patients who have been assessed by agency staff before they issue a prescription The NMP will choose to undertake this role and will do so to support managing the shift safely A SOP has been developed for WIC staff to support this practice

In the case of influenza outbreak in a care home NMPs may be required to prescribe antiviral medicines in line with the Trust Influenza protocol Unwell patients identified by care home staff must be assessed by the NMP All other residents should receive prophylactic antiviral treatment NMPs will be


Page 27

supported with advice from the Medicines Management team with choosing appropriate doses based on the residentsrsquo renal function and weight


The type of dressing is chosen according to the patientsrsquo needs from the wound care formularyguidance A prescription is given using either the First Dress Initiative or Total Wound care purchasing facility An NMP will make an assessment within two weeks or sooner if thought more urgent


The NMC (2010) state you may issue a repeat prescription but you do so in the knowledge that you are responsible as the signatory of the prescr ip t ion and are accountable for your practice

Therefore before signing a repeat prescription you must be satisfied that it is safe and appropriate to do so and that secure procedures are in place to ensure

a) The patientclient is issued with the correct prescription b) Each prescription is regularly reviewed and only re-issued to meet clinical need c) A review must take place following a maximum of six prescriptions or six months d) The correct dose is prescribed e) Suitable provision for monitoring each patientclientrsquos condition is in place and for ensuring that patientclients who need a further examination or assessment do not receive repeat prescriptions without being seen by an appropriate prescriber

Where full medical records are not accessible for review the patient must be referred to appropriate medical support If the patient has presented with an acute episode or exacerbation of condition they must be treated appropriately for this immediate episode and then referred on for full repeat prescription to be sanctioned

84 Prescribing Emergency Supply

Prescriptions may be requested by patient to a NMP for either emergency management of an acute episode or for the prevention of complications in long term conditions such as hypertension diabetes COPD Asthma etc In such cases immediate treatment should be appropriately given and patient then referred to own medical practitioner or UC24 for full medical review prior to repeat prescription being dispensed

Contraception may be prescribed for longer but must include follow up by the appropriate professional (sexual health Family planningassessing practitioner) to ensure that they are receiving the appropriate assessments


Page 28


Page 29


Please refer to LCH Overarching Medicines Policy for further guidance on medication errors


NMPs may discontinue medication if they have assessed a patient and in their clinical judgement think this is the best course of action Non-medical prescribers should always consider themselves part of the team and not undertake actions without considering the care plan for the patient Details of any discontinued medicines should be recorded in the patients nursing and or medical notes stating the name and dose of medication discontinued and why the medicine was stopped The GP should be informed and a record made on the GP clinical system For inpatients this should be clearly evident on the IPC

87 Off-label off-licence medicinesNon-Medical Prescribers may in exceptional circumstances prescribe medicines outside of their license for use (off label) when they are absolutely clear this is clinically necessary and supported with an evidence base Their decision to prescribe off label must be clearly documented with a detailed rationale for the clinical decision and informed consent must be obtained from the patient or parent of a child

88 Guidance on the mixing of medicinesThe Medicines and Healthcare products Regulatory Agency (MHRA) has in place regulations to enable mixing of medicines prior to administration in clinical practice

These regulations enable

Doctors and dentists who can already mix medicines themselves to direct others to mix

Nurse and Pharmacist Independent Prescribers to mixmedicines themselves and to direct others to mix

Supplementary Prescribers to mix medicines themselves and to direct others to mix but only where that preparation forms part of the Clinical Management Plan for an individual patient

The regulations also define mixing as ldquothe combination of two or more medicinal products together for the purposes of administering them to meet the needs of a particular patientrdquo

This applies not only to palliative care but to all clinical areas where the mixing of medicines prior to administration is accepted practice and supported by the employerrsquos policies for the delivery of healthcare


Page 30

Medicines should only be mixed together in the same syringe (apart from normal diluents) for use in a syringe driver if

There is no available licensed preparation It is in the best interest of the patient (eg symptom control

avoiding multiple venous access etc) There is stability data for the drug combination being used

(check via Medicines Information Service)

Mixing of drugs to make a new combined product means that the product is outside the product licence however it is recognised as accepted practice within palliative care The prescriber of an unlicensed product or use of a product outside of the product license takes full clinical responsibility for the prescription

A PGD cannot be used for this purpose - other than dissolving or dispersing the product in or diluting or mixing it with some other substance used as a vehicle for the purpose of administering it

9 Bank and Agency Prescribing

All staff who work as prescribers in the trust must be included on the LCH NMP register and registered with the NHSBSA before they prescribe It is necessary for the manager NMP Lead and LCH to fully understand a NMPs competence to prescribe and as employees to understand their cover regarding vicarious liability Managers should ensure that the NMP is registered with the trust has fully completed the NMP annual electronic self-declaration and can provide evidence (Professional Portfolio) of CPD and professional development within scope of prescribing competency

Bank Staff

Staff with a current permanent clinical role in LCH may cover additional sessions within their area of clinical competence and are entitled to prescribe within this area using their LCH prescription pad Prescribers who work in a primarily non-clinical role will be treated as agency staff Prescribers with a bank only contract will be treated as agency staff

Agency StaffNMP will only be accepted within agency contracts within the Walkmdashin Centres to ensure continued service delivery This must be approved by the Clinical lead for the WICrsquos subject to

Regular working pattern as a bankagency nurse (minimum of 1 regular working day per week or block booking)

Evidence of competence verification by the Clinical nurse manager for the WIC where the Agency NMP will be working

Submission of the LCH NMP registration form (appendix 2) annual self-declaration form (appendix 4) and competence verification checklist to the


Page 31

NMP co-ordinator Electronic prescribing only will be supported individual pads will not be

ordered for agency staff Prescribers must not be given prescribing rights on the clinical system

until the NMP co-ordinator has confirmed they are included on the trust register and registered with the NHSBSA

An SOP exists in the WIC to support the use of agency staff as prescribers

10 Professional Portfolio Continuing Professional Development and Personal Development Review

All NMPs have a professional responsibility to keep themselves up to date with clinical and professional developments NMPs will be expected to implement best practice in the management of conditions for which they may prescribe Continuing Professional Development (CPD) needs may be met by a range of blended learning opportunities including clinical supervision learning reflections attendance at education events and shadowing colleagues Prescribing should be discussed at the Personal Development Review (PDR) and any training needs met through CPD The NMP will access on-going education offered and be self-directed in meeting learning and development needs

101 Criteria for CPD

The following is a list of acceptable forms of LCH NMP CPD

Attending NMP CPD session ndash either offered by the Trust or external to the organisation

ELearning in area of prescribing competency Attendance at NMP Steering GroupForum Individual study related to Management of Medicinestherapeutics Review of personal ePACT prescribing data Shadowing a prescribing colleague

Evidence of reading journals or articles directly linked to scope of practice with reflection

Work based Learning or reflecting on a patient journey

LCH NMPs should maintain a prescribing section within their professional portfolio NMPs need to be aware of the RPSGB Single Competency Framework for Prescribing and utilise this as a tool to benchmark any learning needs they may have in relation to their prescribing

Link to RPSGB Framework RPSGB Framework


Page 32

11 Legal Responsibilities Liability and Indemnity Insurance

NMPs are accountable for all aspects of their prescribing decisions The NMP is individually and professionally accountable for hisher prescribing decision action and omission and cannot delegate this accountability to another person This accountability extends to decisions taken to recommend lsquoover the counterrsquo items

The NMP must ensure that their prescribing activity is within their sphere of competence and nature of work is safe cost effective consistent with the clinical need of the patient and in line with National and local guidance

The role of other people in the delivery of health care to service users must be recognised and respected

The NMP must recognise and deal with pressures (eg from the pharmaceutical industry patients relatives or colleagues) that might inappropriately affect their prescribing decision and refuse to be influenced by such pressures Any prescription must be in the best interests of the patient only The NMP must report such pressure to the Head of Medicines Management and Non-medical Prescribing Lead

Where a NMP is appropriately trained and qualified and provided heshe prescribes with the consent of the employer as part of their professional duties and in accordance with the employerrsquos policies and the Law the employer is held vicariously liable for their actions (NHS Indemnity) In addition NMPs are a c c o u n t a b l e to their Professional Regulatory Body

Once qualified it is the responsibility of the clinical supervisor or designated medical practitioner (or line manager if suitably qualified) to mutually agree with the NMP the areas in which staff can prescribe as part of their professional duty

The NMP must complete an annual electronic self-declaration

If a prescriber wishes to prescribe following an absence of 12 months or longer the line manager will need to assess their competency to prescribe against the RPSGB Single Competency Framework for all Prescribers If this is necessary the NMP and Service manager will need to l i n k with the NMP Lead for further information


Page 33

12 Consent

Valid consent must be obtained before starting treatment which includes administration of medicines Refer to LCH Consent to Treatment Policy If a patient is unable to consent at the time the treatment decision is made due to lacking mental capacity as per the Mental Capacity Act 2007 a best interest decision will be required in order to undertake the most appropriate action for the patient at that time This must incorporate consideration of the known wishes feelings beliefs and values of the patient For further information please refer to the LCH Mental Capacity Act policy

13 Audit and Governance

The NMP and LCH are both responsible for ensuring safe systems of operation quality best practice and cost-effectiveness

The NMP Pharmacy Lead will ensure that ePACT data is scrutinised and prescribing activity is appropriate

The Head of Medicines Management will oversee the annual prescription pad safety audit This is done as part of the Medicines Storage Audit The findings will be shared with the Medicines Safety Optimisation Group and appropriate divisions


Page 34

14 References and Associated Documentation

Medicines Act 1968htt p w w w l e g i s lati o n g o v ukukp g a1 9 6 8 6 7 p d f su k p g a _ 1 968 0 06 7 _ en p d f

The Human Medicines Regulations 2012htt p w w w l e g i s lati o n g o v ukuksi2 0 12 19 1 6 p d f s uks i _ 2 0 1 2 19 1 6 _ e np d f

Improving Patientsrsquo Access to Medicines A Guide to Implementing Nurse and Pharmacist Independent Prescribing within the NHS in England Department of Health April 06 httpwebarchivenationalarchivesgovuk20130107105354httpwwwdhgovukprod_consum_dhgroupsdh_digitalassetsdhendocumentsdigitalassetdh_4133747pdf

Medicines Matter ndash A guide to mechanisms for the prescribing supply and administration of medicines July 2006 Department of Health httpwwwbasicsorgukDocument20vaultmedicines20matter

About Supplementary Prescribing httpwebarchivenationalarchivesgovuk20130107105354httpdhgovukprod_consum_dhgroupsdh_digitalassetsdhendocumentsdigitalassetdh_4110033pdf

General Pharmaceutical Council w w w pharma c y r e g ulationo rg

Nursing and Midwifery Council ww w n m c - uk o rg

NHS Executive Patient Group Directions (England Only) Department of Health 09 August 2000 [HCS 2000026]

RPSGB frameworkwwwrpharmscomunsecure-support-resourcesprescribing-competency-frameworkasp

NHSBSA Prescription SecurityhttpwwwnhsbsanhsukDocumentsSecurityManagementSecurity_of_Prescription_forms_Updated_August_2015pdf


Page 35

15 Associated Documentation

The policies below are available within LCH via SIRS

Policy for the Safer Management of Controlled Drugs -httpoperaliverpoolchnhsukSIRSPolicies-and-ProceduresClinical20PoliciesControlled20Drugs20Policypdf

bull Policy and guidance for joint working with Pharmaceutical Industry httpoperaliverpoolchnhsukSIRSPolicies-and-ProceduresClinical20PoliciesJoint20Working20with20Pharmacutical20Industrypdf

bull Policy for Consent to Examination or Treatment httpoperaliverpoolchnhsukSIRSPolicies-and-ProceduresClinical20PoliciesConsent20to20Treatment20Policypdf

bull Policy on Clinical SupervisionhttpoperaliverpoolchnhsukSIRSPolicies-and-ProceduresClinical20PoliciesClinical20Supervision20Policy20APRIL202016pdf

bull Records Manual Policy httpoperaliverpoolchnhsukSIRSPolicies-and-ProceduresCorporate20PoliciesRecords20Manual20Policypdf

bull Risk Assessment Policy httpoperaliverpoolchnhsukSIRSPolicies-and-ProceduresCorporate20PoliciesRisk20Management20Strategy20and20Policypdf

bull Policy for the Management of Incidents including Serious Untoward IncidentshttpoperaliverpoolchnhsukSIRSPolicies-and-ProceduresCorporate20PoliciesIncident20Reporting20Policypdf

Performance Appraisal Policy for A4C Staff httpoperaliverpoolchnhsukSIRSPolicies-and-ProceduresCorporate20PoliciesPerformance20Appraisal20Policypdf

Medicines Overarching PolicyhttpoperaliverpoolchnhsukSIRSPolicies-and-ProceduresClinical20PoliciesMEDICINES20OVERARCHING20POLICYpdf


Page 36

List of Appendices

Appendix 1AIdentification and Application Process Appendix 1B Accreditation and Registration ProcessAppendix 2Non-Medical Prescriber Registration Form for LCH UseAppendix 3Change in Details Automated EmailAppendix 4Self-Declaration Automated EmailAppendix 5Leavers Automated Email

Appendices can be found on the LCH NMP Intranet Page - httpnwwliverpoolchnhsukservice-directorynon-medical-prescribinghtm

Appendix 1A

Appendix 1B

Appendix 2

Appendix 3 Change in Details Automated Email Form

Appendix 4 Self-Declaration Automated Email Form

Appendix 5 NMP Leavers Automated Email Form

Version Control

Contents Page

1 Introduction 6

1 Introduction











3 Identifying the need for NMP within a Clinical Service

4 Independent Prescribing (V300)

41 Guidance for NMIP on prescribing including CDs


5 V150V200 Eligibility Criteria

51 Community Practitioner (V150) Prescriber


6 NMP Registration

61 NMP Register

62 Registering as a Non-Medical Prescriber















75 Process for Lost or Stolen Prescriptions


78 Contact Details








87 Off-label off-licence medicines







12 Consent




List of Appendices

SUPPORTING STATEMENTS This document should be read in conjunction with the following statements

SAFEGUARDING IS EVERYBODYrsquoS BUSINESSAll Mersey Care NHS Foundation Trust employees have a statutory duty to safeguard and promote the welfare of children and adults including being alert to the possibility of child adult abuse and neglect through their observation of

abuse or by professional judgement made as a result of information gathered about the child adult

knowing how to deal with a disclosure or allegation of child adult abuse undertaking training as appropriate for their role and keeping themselves updated being aware of and following the local policies and procedures they need to follow if they

have a child adult concern ensuring appropriate advice and support is accessed either from managers Safeguarding

Ambassadors or the trustrsquos safeguarding team participating in multi-agency working to safeguard the child or adult (if appropriate to your

role) ensuring contemporaneous records are kept at all times and record keeping is in strict

adherence to Mersey Care NHS Foundation Trust policy and procedures and professional guidelines Roles responsibilities and accountabilities will differ depending on the post you hold within the organisation

ensuring that all staff and their managers discuss and record any safeguarding issues that arise at each supervision session

EQUALITY AND HUMAN RIGHTSMersey Care NHS Foundation Trust recognises that some sections of society experience prejudice and discrimination The Equality Act 2010 specifically recognises the protected characteristics of age disability gender race religion or belief sexual orientation and transgender The Equality Act also requires regard to socio-economic factors including pregnancy maternity and marriagecivil partnership

The trust is committed to equality of opportunity and anti-discriminatory practice both in the provision of services and in our role as a major employer The trust believes that all people have the right to be treated with dignity and respect and is committed to the elimination of unfair and unlawful discriminatory practices

Mersey Care NHS Foundation Trust also is aware of its legal duties under the Human Rights Act 1998 Section 6 of the Human Rights Act requires all public authorities to uphold and promote Human Rights in everything they do It is unlawful for a public authority to perform any act which contravenes the Human Rights Act

Mersey Care NHS Foundation Trust is committed to carrying out its functions and service delivery in line the with a Human Rights based approach and the FREDA principles of Fairness Respect Equality Dignity and Autonomy



Policy No 92



92

Aim andpurpose



TypeNew document









March 2019




Version Control

Version Number 9









Director of Nursing




Page 3

Contents Page

1 Introduction 6


this policy





















61 NMP Register


Page 4

















84 Emergency Supply













Page 5

12 Consent 29



Appendices 32


Page 6

[1] Introduction


















Page 7



Page 8












Page 9



Page 10














Page 11













Page 12

CDs












Page 13


Page 14




















Page 15






Page 16











skills










Page 17




6 NMP Registration

61 NMP Register













Page 18

















5


Page 19





Page 20
















Page 21




Page 22













Page 23
















Page 24






Process





two months



Page 25











78 Contact Details


Page 26















Page 27













Page 28


Page 29














Page 30









Bank Staff







Page 31
















Page 32











Page 33

12 Consent







Page 34













Page 35













Page 36

List of Appendices



Appendix 1A

Appendix 1B

Appendix 2




Version Control

Contents Page

1 Introduction 6

1 Introduction


















6 NMP Registration

61 NMP Register


















78 Contact Details















12 Consent




List of Appendices



Policy No 92



92

Aim andpurpose



TypeNew document









March 2019




Page 2

Version Control

Version Number 9









Director of Nursing




Contents Page

1 Introduction 6


this policy





















61 NMP Register


Page 4

















84 Emergency Supply













Page 5

12 Consent 29



Appendices 32


Page 6

[1] Introduction


















Page 7



Page 8












Page 9



Page 10














Page 11













Page 12

CDs












Page 13


Page 14




















Page 15






Page 16











skills










Page 17




6 NMP Registration

61 NMP Register













Page 18

















5


Page 19





Page 20
















Page 21




Page 22













Page 23
















Page 24






Process





two months



Page 25











78 Contact Details


Page 26















Page 27













Page 28


Page 29














Page 30









Bank Staff







Page 31
















Page 32











Page 33

12 Consent







Page 34













Page 35













Page 36

List of Appendices



Appendix 1A

Appendix 1B

Appendix 2




Version Control

Contents Page

1 Introduction 6

1 Introduction


















6 NMP Registration

61 NMP Register


















78 Contact Details















12 Consent




List of Appendices



92

Aim andpurpose



TypeNew document









March 2019




Page 2

Version Control

Version Number 9









Director of Nursing




Page 3

Contents Page

1 Introduction 6


this policy





















61 NMP Register


















84 Emergency Supply













Page 5

12 Consent 29



Appendices 32


Page 6

[1] Introduction


















Page 7



Page 8












Page 9



Page 10














Page 11













Page 12

CDs












Page 13


Page 14




















Page 15






Page 16











skills










Page 17




6 NMP Registration

61 NMP Register













Page 18

















5


Page 19





Page 20
















Page 21




Page 22













Page 23
















Page 24






Process





two months



Page 25











78 Contact Details


Page 26















Page 27













Page 28


Page 29














Page 30









Bank Staff







Page 31
















Page 32











Page 33

12 Consent







Page 34













Page 35













Page 36

List of Appendices



Appendix 1A

Appendix 1B

Appendix 2




Version Control

Contents Page

1 Introduction 6

1 Introduction


















6 NMP Registration

61 NMP Register


















78 Contact Details















12 Consent




List of Appendices


Page 2

Version Control

Version Number 9









Director of Nursing




Page 3

Contents Page

1 Introduction 6


this policy





















61 NMP Register


Page 4

















84 Emergency Supply













12 Consent 29



Appendices 32


Page 6

[1] Introduction


















Page 7



Page 8












Page 9



Page 10














Page 11













Page 12

CDs












Page 13


Page 14




















Page 15






Page 16











skills










Page 17




6 NMP Registration

61 NMP Register













Page 18

















5


Page 19





Page 20
















Page 21




Page 22













Page 23
















Page 24






Process





two months



Page 25











78 Contact Details


Page 26















Page 27













Page 28


Page 29














Page 30









Bank Staff







Page 31
















Page 32











Page 33

12 Consent







Page 34













Page 35













Page 36

List of Appendices



Appendix 1A

Appendix 1B

Appendix 2




Version Control

Contents Page

1 Introduction 6

1 Introduction


















6 NMP Registration

61 NMP Register


















78 Contact Details















12 Consent




List of Appendices


Page 3

Contents Page

1 Introduction 6


this policy





















61 NMP Register


Page 4

















84 Emergency Supply













Page 5

12 Consent 29



Appendices 32


[1] Introduction


















Page 7



Page 8












Page 9



Page 10














Page 11













Page 12

CDs












Page 13


Page 14




















Page 15






Page 16











skills










Page 17




6 NMP Registration

61 NMP Register













Page 18

















5


Page 19





Page 20
















Page 21




Page 22













Page 23
















Page 24






Process





two months



Page 25











78 Contact Details


Page 26















Page 27













Page 28


Page 29














Page 30









Bank Staff







Page 31
















Page 32











Page 33

12 Consent







Page 34













Page 35













Page 36

List of Appendices



Appendix 1A

Appendix 1B

Appendix 2




Version Control

Contents Page

1 Introduction 6

1 Introduction


















6 NMP Registration

61 NMP Register


















78 Contact Details















12 Consent




List of Appendices


Page 4

















84 Emergency Supply













Page 5

12 Consent 29



Appendices 32


Page 6

[1] Introduction




















Page 8












Page 9



Page 10














Page 11













Page 12

CDs












Page 13


Page 14




















Page 15






Page 16











skills










Page 17




6 NMP Registration

61 NMP Register













Page 18

















5


Page 19





Page 20
















Page 21




Page 22













Page 23
















Page 24






Process





two months



Page 25











78 Contact Details


Page 26















Page 27













Page 28


Page 29














Page 30









Bank Staff







Page 31
















Page 32











Page 33

12 Consent







Page 34













Page 35













Page 36

List of Appendices



Appendix 1A

Appendix 1B

Appendix 2




Version Control

Contents Page

1 Introduction 6

1 Introduction


















6 NMP Registration

61 NMP Register


















78 Contact Details















12 Consent




List of Appendices


Page 5

12 Consent 29



Appendices 32


Page 6

[1] Introduction


















Page 7














Page 9



Page 10














Page 11













Page 12

CDs












Page 13


Page 14




















Page 15






Page 16











skills










Page 17




6 NMP Registration

61 NMP Register













Page 18

















5


Page 19





Page 20
















Page 21




Page 22













Page 23
















Page 24






Process





two months



Page 25











78 Contact Details


Page 26















Page 27













Page 28


Page 29














Page 30









Bank Staff







Page 31
















Page 32











Page 33

12 Consent







Page 34













Page 35













Page 36

List of Appendices



Appendix 1A

Appendix 1B

Appendix 2




Version Control

Contents Page

1 Introduction 6

1 Introduction


















6 NMP Registration

61 NMP Register


















78 Contact Details















12 Consent




List of Appendices


Page 6

[1] Introduction


















Page 7



Page 8














Page 10














Page 11













Page 12

CDs












Page 13


Page 14




















Page 15






Page 16











skills










Page 17




6 NMP Registration

61 NMP Register













Page 18

















5


Page 19





Page 20
















Page 21




Page 22













Page 23
















Page 24






Process





two months



Page 25











78 Contact Details


Page 26















Page 27













Page 28


Page 29














Page 30









Bank Staff







Page 31
















Page 32











Page 33

12 Consent







Page 34













Page 35













Page 36

List of Appendices



Appendix 1A

Appendix 1B

Appendix 2




Version Control

Contents Page

1 Introduction 6

1 Introduction


















6 NMP Registration

61 NMP Register


















78 Contact Details















12 Consent




List of Appendices


Page 7



Page 8












Page 9
















Page 11













Page 12

CDs












Page 13


Page 14




















Page 15






Page 16











skills










Page 17




6 NMP Registration

61 NMP Register













Page 18

















5


Page 19





Page 20
















Page 21




Page 22













Page 23
















Page 24






Process





two months



Page 25











78 Contact Details


Page 26















Page 27













Page 28


Page 29














Page 30









Bank Staff







Page 31
















Page 32











Page 33

12 Consent







Page 34













Page 35













Page 36

List of Appendices



Appendix 1A

Appendix 1B

Appendix 2




Version Control

Contents Page

1 Introduction 6

1 Introduction


















6 NMP Registration

61 NMP Register


















78 Contact Details















12 Consent




List of Appendices


Page 8












Page 9



Page 10


























Page 12

CDs












Page 13


Page 14




















Page 15






Page 16











skills










Page 17




6 NMP Registration

61 NMP Register













Page 18

















5


Page 19





Page 20
















Page 21




Page 22













Page 23
















Page 24






Process





two months



Page 25











78 Contact Details


Page 26















Page 27













Page 28


Page 29














Page 30









Bank Staff







Page 31
















Page 32











Page 33

12 Consent







Page 34













Page 35













Page 36

List of Appendices



Appendix 1A

Appendix 1B

Appendix 2




Version Control

Contents Page

1 Introduction 6

1 Introduction


















6 NMP Registration

61 NMP Register


















78 Contact Details















12 Consent




List of Appendices


Page 9



Page 10














Page 11













CDs












Page 13


Page 14




















Page 15






Page 16











skills










Page 17




6 NMP Registration

61 NMP Register













Page 18

















5


Page 19





Page 20
















Page 21




Page 22













Page 23
















Page 24






Process





two months



Page 25











78 Contact Details


Page 26















Page 27













Page 28


Page 29














Page 30









Bank Staff







Page 31
















Page 32











Page 33

12 Consent







Page 34













Page 35













Page 36

List of Appendices



Appendix 1A

Appendix 1B

Appendix 2




Version Control

Contents Page

1 Introduction 6

1 Introduction


















6 NMP Registration

61 NMP Register


















78 Contact Details















12 Consent




List of Appendices


Page 10














Page 11













Page 12

CDs













Page 14




















Page 15






Page 16











skills










Page 17




6 NMP Registration

61 NMP Register













Page 18

















5


Page 19





Page 20
















Page 21




Page 22













Page 23
















Page 24






Process





two months



Page 25











78 Contact Details


Page 26















Page 27













Page 28


Page 29














Page 30









Bank Staff







Page 31
















Page 32











Page 33

12 Consent







Page 34













Page 35













Page 36

List of Appendices



Appendix 1A

Appendix 1B

Appendix 2




Version Control

Contents Page

1 Introduction 6

1 Introduction


















6 NMP Registration

61 NMP Register


















78 Contact Details















12 Consent




List of Appendices


Page 11













Page 12

CDs












Page 13





















Page 15






Page 16











skills










Page 17




6 NMP Registration

61 NMP Register













Page 18

















5


Page 19





Page 20
















Page 21




Page 22













Page 23
















Page 24






Process





two months



Page 25











78 Contact Details


Page 26















Page 27













Page 28


Page 29














Page 30









Bank Staff







Page 31
















Page 32











Page 33

12 Consent







Page 34













Page 35













Page 36

List of Appendices



Appendix 1A

Appendix 1B

Appendix 2




Version Control

Contents Page

1 Introduction 6

1 Introduction


















6 NMP Registration

61 NMP Register


















78 Contact Details















12 Consent




List of Appendices


Page 12

CDs












Page 13


Page 14

























Page 16











skills










Page 17




6 NMP Registration

61 NMP Register













Page 18

















5


Page 19





Page 20
















Page 21




Page 22













Page 23
















Page 24






Process





two months



Page 25











78 Contact Details


Page 26















Page 27













Page 28


Page 29














Page 30









Bank Staff







Page 31
















Page 32











Page 33

12 Consent







Page 34













Page 35













Page 36

List of Appendices



Appendix 1A

Appendix 1B

Appendix 2




Version Control

Contents Page

1 Introduction 6

1 Introduction


















6 NMP Registration

61 NMP Register


















78 Contact Details















12 Consent




List of Appendices


Page 13


Page 14




















Page 15
















skills










Page 17




6 NMP Registration

61 NMP Register













Page 18

















5


Page 19





Page 20
















Page 21




Page 22













Page 23
















Page 24






Process





two months



Page 25











78 Contact Details


Page 26















Page 27













Page 28


Page 29














Page 30









Bank Staff







Page 31
















Page 32











Page 33

12 Consent







Page 34













Page 35













Page 36

List of Appendices



Appendix 1A

Appendix 1B

Appendix 2




Version Control

Contents Page

1 Introduction 6

1 Introduction


















6 NMP Registration

61 NMP Register


















78 Contact Details















12 Consent




List of Appendices


Page 14




















Page 15






Page 16











skills













6 NMP Registration

61 NMP Register













Page 18

















5


Page 19





Page 20
















Page 21




Page 22













Page 23
















Page 24






Process





two months



Page 25











78 Contact Details


Page 26















Page 27













Page 28


Page 29














Page 30









Bank Staff







Page 31
















Page 32











Page 33

12 Consent







Page 34













Page 35













Page 36

List of Appendices



Appendix 1A

Appendix 1B

Appendix 2




Version Control

Contents Page

1 Introduction 6

1 Introduction


















6 NMP Registration

61 NMP Register


















78 Contact Details















12 Consent




List of Appendices


Page 15






Page 16











skills










Page 17




6 NMP Registration

61 NMP Register





























5


Page 19





Page 20
















Page 21




Page 22













Page 23
















Page 24






Process





two months



Page 25











78 Contact Details


Page 26















Page 27













Page 28


Page 29














Page 30









Bank Staff







Page 31
















Page 32











Page 33

12 Consent







Page 34













Page 35













Page 36

List of Appendices



Appendix 1A

Appendix 1B

Appendix 2




Version Control

Contents Page

1 Introduction 6

1 Introduction


















6 NMP Registration

61 NMP Register


















78 Contact Details















12 Consent




List of Appendices


Page 16











skills










Page 17




6 NMP Registration

61 NMP Register













Page 18

















5






Page 20
















Page 21




Page 22













Page 23
















Page 24






Process





two months



Page 25











78 Contact Details


Page 26















Page 27













Page 28


Page 29














Page 30









Bank Staff







Page 31
















Page 32











Page 33

12 Consent







Page 34













Page 35













Page 36

List of Appendices



Appendix 1A

Appendix 1B

Appendix 2




Version Control

Contents Page

1 Introduction 6

1 Introduction


















6 NMP Registration

61 NMP Register


















78 Contact Details















12 Consent




List of Appendices


Page 17




6 NMP Registration

61 NMP Register













Page 18

















5


Page 19




















Page 21




Page 22













Page 23
















Page 24






Process





two months



Page 25











78 Contact Details


Page 26















Page 27













Page 28


Page 29














Page 30









Bank Staff







Page 31
















Page 32











Page 33

12 Consent







Page 34













Page 35













Page 36

List of Appendices



Appendix 1A

Appendix 1B

Appendix 2




Version Control

Contents Page

1 Introduction 6

1 Introduction


















6 NMP Registration

61 NMP Register


















78 Contact Details















12 Consent




List of Appendices


Page 18

















5


Page 19





Page 20



















Page 22













Page 23
















Page 24






Process





two months



Page 25











78 Contact Details


Page 26















Page 27













Page 28


Page 29














Page 30









Bank Staff







Page 31
















Page 32











Page 33

12 Consent







Page 34













Page 35













Page 36

List of Appendices



Appendix 1A

Appendix 1B

Appendix 2




Version Control

Contents Page

1 Introduction 6

1 Introduction


















6 NMP Registration

61 NMP Register


















78 Contact Details















12 Consent




List of Appendices


Page 19





Page 20
















Page 21
















Page 23
















Page 24






Process





two months



Page 25











78 Contact Details


Page 26















Page 27













Page 28


Page 29














Page 30









Bank Staff







Page 31
















Page 32











Page 33

12 Consent







Page 34













Page 35













Page 36

List of Appendices



Appendix 1A

Appendix 1B

Appendix 2




Version Control

Contents Page

1 Introduction 6

1 Introduction


















6 NMP Registration

61 NMP Register


















78 Contact Details















12 Consent




List of Appendices


Page 20
















Page 21




Page 22




























Page 24






Process





two months



Page 25











78 Contact Details


Page 26















Page 27













Page 28


Page 29














Page 30









Bank Staff







Page 31
















Page 32











Page 33

12 Consent







Page 34













Page 35













Page 36

List of Appendices



Appendix 1A

Appendix 1B

Appendix 2




Version Control

Contents Page

1 Introduction 6

1 Introduction


















6 NMP Registration

61 NMP Register


















78 Contact Details















12 Consent




List of Appendices


Page 21




Page 22













Page 23





















Process





two months



Page 25











78 Contact Details


Page 26















Page 27













Page 28


Page 29














Page 30









Bank Staff







Page 31
















Page 32











Page 33

12 Consent







Page 34













Page 35













Page 36

List of Appendices



Appendix 1A

Appendix 1B

Appendix 2




Version Control

Contents Page

1 Introduction 6

1 Introduction


















6 NMP Registration

61 NMP Register


















78 Contact Details















12 Consent




List of Appendices


Page 22













Page 23
















Page 24






Process





two months













78 Contact Details


Page 26















Page 27













Page 28


Page 29














Page 30









Bank Staff







Page 31
















Page 32











Page 33

12 Consent







Page 34













Page 35













Page 36

List of Appendices



Appendix 1A

Appendix 1B

Appendix 2




Version Control

Contents Page

1 Introduction 6

1 Introduction


















6 NMP Registration

61 NMP Register


















78 Contact Details















12 Consent




List of Appendices


Page 23
















Page 24






Process





two months



Page 25











78 Contact Details
















Page 27













Page 28


Page 29














Page 30









Bank Staff







Page 31
















Page 32











Page 33

12 Consent







Page 34













Page 35













Page 36

List of Appendices



Appendix 1A

Appendix 1B

Appendix 2




Version Control

Contents Page

1 Introduction 6

1 Introduction


















6 NMP Registration

61 NMP Register


















78 Contact Details















12 Consent




List of Appendices


Page 24






Process





two months



Page 25











78 Contact Details


Page 26



























Page 28


Page 29














Page 30









Bank Staff







Page 31
















Page 32











Page 33

12 Consent







Page 34













Page 35













Page 36

List of Appendices



Appendix 1A

Appendix 1B

Appendix 2




Version Control

Contents Page

1 Introduction 6

1 Introduction


















6 NMP Registration

61 NMP Register


















78 Contact Details















12 Consent




List of Appendices


Page 25











78 Contact Details


Page 26















Page 27














Page 29














Page 30









Bank Staff







Page 31
















Page 32











Page 33

12 Consent







Page 34













Page 35













Page 36

List of Appendices



Appendix 1A

Appendix 1B

Appendix 2




Version Control

Contents Page

1 Introduction 6

1 Introduction


















6 NMP Registration

61 NMP Register


















78 Contact Details















12 Consent




List of Appendices


Page 26















Page 27













Page 28















Page 30









Bank Staff







Page 31
















Page 32











Page 33

12 Consent







Page 34













Page 35













Page 36

List of Appendices



Appendix 1A

Appendix 1B

Appendix 2




Version Control

Contents Page

1 Introduction 6

1 Introduction


















6 NMP Registration

61 NMP Register


















78 Contact Details















12 Consent




List of Appendices


Page 27













Page 28


Page 29






















Bank Staff







Page 31
















Page 32











Page 33

12 Consent







Page 34













Page 35













Page 36

List of Appendices



Appendix 1A

Appendix 1B

Appendix 2




Version Control

Contents Page

1 Introduction 6

1 Introduction


















6 NMP Registration

61 NMP Register


















78 Contact Details















12 Consent




List of Appendices


Page 28


Page 29














Page 30









Bank Staff






















Page 32











Page 33

12 Consent







Page 34













Page 35













Page 36

List of Appendices



Appendix 1A

Appendix 1B

Appendix 2




Version Control

Contents Page

1 Introduction 6

1 Introduction


















6 NMP Registration

61 NMP Register


















78 Contact Details















12 Consent




List of Appendices


Page 29














Page 30









Bank Staff







Page 31


























Page 33

12 Consent







Page 34













Page 35













Page 36

List of Appendices



Appendix 1A

Appendix 1B

Appendix 2




Version Control

Contents Page

1 Introduction 6

1 Introduction


















6 NMP Registration

61 NMP Register


















78 Contact Details















12 Consent




List of Appendices


Page 30









Bank Staff







Page 31
















Page 32











12 Consent







Page 34













Page 35













Page 36

List of Appendices



Appendix 1A

Appendix 1B

Appendix 2




Version Control

Contents Page

1 Introduction 6

1 Introduction


















6 NMP Registration

61 NMP Register


















78 Contact Details















12 Consent




List of Appendices


Page 31
















Page 32











Page 33

12 Consent



















Page 35













Page 36

List of Appendices



Appendix 1A

Appendix 1B

Appendix 2




Version Control

Contents Page

1 Introduction 6

1 Introduction


















6 NMP Registration

61 NMP Register


















78 Contact Details















12 Consent




List of Appendices


Page 32











Page 33

12 Consent







Page 34

























Page 36

List of Appendices



Appendix 1A

Appendix 1B

Appendix 2




Version Control

Contents Page

1 Introduction 6

1 Introduction


















6 NMP Registration

61 NMP Register


















78 Contact Details















12 Consent




List of Appendices


Page 33

12 Consent







Page 34













Page 35













List of Appendices



Appendix 1A

Appendix 1B

Appendix 2




Version Control

Contents Page

1 Introduction 6

1 Introduction


















6 NMP Registration

61 NMP Register


















78 Contact Details















12 Consent




List of Appendices


Page 34













Page 35













Page 36

List of Appendices



Appendix 1A

Appendix 1B

Appendix 2




Version Control

Contents Page

1 Introduction 6

1 Introduction


















6 NMP Registration

61 NMP Register


















78 Contact Details















12 Consent




List of Appendices


Page 35













Page 36

List of Appendices



Appendix 1A

Appendix 1B

Appendix 2




Version Control

Contents Page

1 Introduction 6

1 Introduction


















6 NMP Registration

61 NMP Register


















78 Contact Details















12 Consent




List of Appendices


Page 36

List of Appendices



Appendix 1A

Appendix 1B

Appendix 2




Version Control

Contents Page

1 Introduction 6

1 Introduction


















6 NMP Registration

61 NMP Register


















78 Contact Details















12 Consent




List of Appendices

Appendix 1A

Appendix 1B

Appendix 2




Version Control

Contents Page

1 Introduction 6

1 Introduction


















6 NMP Registration

61 NMP Register


















78 Contact Details















12 Consent




List of Appendices

Appendix 1B

Appendix 2




Version Control

Contents Page

1 Introduction 6

1 Introduction


















6 NMP Registration

61 NMP Register


















78 Contact Details















12 Consent




List of Appendices

Appendix 2




Version Control

Contents Page

1 Introduction 6

1 Introduction


















6 NMP Registration

61 NMP Register


















78 Contact Details















12 Consent




List of Appendices




Version Control

Contents Page

1 Introduction 6

1 Introduction


















6 NMP Registration

61 NMP Register


















78 Contact Details















12 Consent




List of Appendices