Enhancing Mental Health Services: NMP for Quality Care

1. Improving care quality through NMP in the delivery of mental health services Mike Caulfield MSc, PGCE, BSc, DipHE Advanced Nurse Practitioner for Acute Care/PICU (West) Cheshire and Wirral Partnership NHS Foundation Trust

2. Overview • National drivers • NMP Standards • Organisational level • Individual level

3. National Drivers • NHS Plan (2000) • Need for organisation and delivery of patient centred services • Remove boundaries • ‘Devolution of power’ • Increase information technology • Patient centred systems

4. The issue • NHS Plan (2000) • 1999 – 5500 patients over the age of 75 ready fro discharge from acute care but still occupying a bed • Nearly 25% were waiting for TTO medication to be prescribed by a ward doctor • More timely if prescribed by a nurse or pharmacist

5. Aims of NMP • Improve patient care without compromising patient safety • Make it easier for patients to get the medicines they need • Increase patient choice in accessing medicines • Make better use of the skills of health professionals • Contribute to the introduction of more flexible team working across the NHS. (DOH 2006)

6. Standards • Standard of safe and effective practice • Discharge their duty of care • Observe U.K. law • Operate within the limits of their professional competence • Maintain professional knowledge and competence • Obtain patient consent for treatment • Hold appropriate professional indemnity insurance.

7. Standards • Standard of care – prescribing practice • Being adequately prepared for the role • Attending approved prescribing training • Observing professional standards of care

8. Standards • Standard of care – communication • Maintaining accurate, contemporaneous patient records • Being accountable for any care delivery that is delegated • Ensuring that colleagues understand the boundaries of prescriber roles, and specifically, Non-Medical Prescriber roles.

9. The organisational perspective • Mental Health Trust • Undertakes the national guidance • MP16: Non medical prescribing policy • Endorsement • Deputy director of nursing and therapies • Chief Pharmacist • Line Manager

10. Organisational Quality Objectives • Adhere to NMP principles • Set out an accountability framework for practice • Outline the application process to become a non-medical prescriber • Psychopharmacology • Ensure that all staff follow standard polices and procedures when prescribing • Provide a standard for NMP within CWP that provides an auditable process • Inpatient Safety Metrics • Ensure that all non-medical prescribers within CWP are aware of their roles, responsibilities and limitations.

11. Example of Audit • Inpatient Safety Metrics • Medicines Management • Accurate demographic information • Legibility • Prescription Information • Omissions documented accurately • Discontinuation • Indication and Max Dose for PRN • Reason for PRN clearly documented

12. Individual Level • ANP and NMP within Acute Inpatient Care • Case load basis • Assessment • Holistic assessment • Formulation • Intervention • Nursing • Pharmacological • Evaluation • Discharge/Signposting

13. NMP within recovery • Collaborative working • Communication • Consultation • Assessment process • History taking • Patient Choice • Previous prescriptions • Information sharing

14. NMP within recovery • Insight • Concordance • Psychosocial approach • Regular review/evaluation • Efficacy • Side effects

15. NMP and the MHA • Engagement • Best Interest Prescribing • Safe prescribing • HDAT • MDT working • Open dialogue • Carer liaison

16. Case Study • 23 year old male • H/O low mood, alcohol and drug use • Previous admission 2014 • Diagnosis of mental and behavioural disorder due to alcohol – harmful use • CBT 2011 • Social stressors

17. Case study • Admitted March 2015 • Low mood • Anxiety • Suicidal ideation, intent and plans • Alcohol use

18. Case Study • History taking • Assessment • Mood • Alcohol Use • Formulation • Time line • Mood preceded alcohol use

19. Prescribing • Anti-depressant • Prescribed by GP • Non-effective • Psycho-edcuation • Evaluation • Amendments • Detoxification • SADQ • Chlordiazepoxide

20. Outcome • Abstinence • Efficacy of anti-depressant • Psycho-education • Medication • Alcohol use • Accommodation • Voluntary work • Recovery

21. Thank You