Clinical Governance in Independent Prescribing
Role of the employer in NHS organisations
70. Clinical governance is the system through which NHS organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care, by creating an environment in which clinical excellence will flourish.
71. Chief Executives and Independent Contractors are legally accountable for the quality of care that patients receive and for securing patient safety.
72. When properly implemented, clinical governance provides a framework for enabling nurses who have qualified as independent prescribers, to practice safely, competently and in the interests of patients.
73. The employing organisation must ensure that nurse independent prescribing is included within NHS Board strategic plans (see paragraph 27) and their overall clinical governance framework to ensure that nurses and pharmacists practise safely and competently. The clinical governance framework must include systems for:
- selection - all entrants to prescribing training must be selected according to criteria indicating their potential to prescribe safely in the area in which they will practise. This will usually include evidence that they have appropriate specialist knowledge and an opportunity to prescribe within their work (see para 34)
- completion of accredited education programmes - the regulatory bodies provide and assess the standards for training and education programmes. Employers also have a duty to ensure that those training to prescribe are supported through their programme (see paras 43 - 54)
- NMC register-checking procedures need to be in place for new employees, permanent staff required to maintain their registration, and nurse independent prescribers from other countries. Thus employers will ensure that the names of prescribers are annotated on their professional register before they begin to prescribe (see appendices 1 and 2)
- ensuring that arrangements are in place for assessment of practice, clinical supervision, audit, and continuing professional development for all nurse independent prescribers (see paras 53 - 59)
- developing a risk management plan - this will ensure potential risks associated with extending clinical practice are recognised and action taken to minimise the impact. Systems need to be set up by employers to ensure nurse prescriber details and changes are given to HIG / ISD, and prescription forms handled securely and safely (see Appendices 3 - 4 and 7 - 8)
- ensuring that the parameters of an individual's prescribing are agreed between the prescriber and their employer, and ensuring that Drug and Therapeutic Committees and Information Services Division ( ISD), are aware of the medicines being prescribed by the Nurse Independent Prescribers.
74. Nurses should use clinical supervision arrangements or equivalent as an opportunity for reflection on prescribing, as well as other aspects of practice (see paragraphs 56 - 58). The model of clinical supervision should be agreed at local level, taking account of other staff support mechanisms and resources.
75. A review of independent prescribing by nurses should be carried out as part of the overall prescribing monitoring arrangements and as a suitable area of practice for regular audit. This should include prescription and cost data (e.g. PRISMS). In hospital settings, nurse independent prescribers will come under the same systems of scrutiny and monitoring as other prescribers (see para 105).
Independent and the private sector
76. Nurse independent prescribers who work outside NHS settings where clinical governance systems may be different or may not be applied in the same way, must ensure they comply with requirements to demonstrate their competence to practise. For example, they must be able to show how they audit their practice, keep up-to-date with current guidance, and how they safeguard the patients in their care.
77. Appendices 10 - 13 provide useful websites and other helpful sources of information for nurse independent prescribers. Pharmacists (see appendix 6) are also a useful source of advice for all prescribers.