Wednesday, 12 January 2011

Being Left Alone

I work with a number of senior, experienced specialist practitioners who, in addition to the perk of getting to pay the NMC a little more each year, also are non-medical prescribers.

Like every Trust, we have a large number of policies, strategies, frameworks, pathways and protocols that are seen as telling staff what to do. Who likes this? I know of no clinical colleague who embraces such policy documentation with joy and enthusiasm. Some colleagues vociferously oppose it as curtailing clinical freedom and, in maveric piques, go against it all.

People don't generally like being told what to do, how to do it, when to do it and what format they have to use.

There's no policy documentation on how non-medical prescribers have to document their prescribing activity. As part of medicines management within our corner, I reviewed it. All of it. There was rather a lot of it. They'd extensive documentation of their Continuing Professional Development, tidily presented in a folder, with the activity and supervision and time taken. They'd evidenced letters to the GP and referrer for all prescriptions, with copies of all of these. They'd detailed the discussions before prescribing, with every case I picked up specifically detailing what had been discussed between them, the patient/carer and a Consultant Psychiatrist. Letters had details of all prescribing, including the specific prescription number of the script. They'd a photocopy of all prescriptions.

I thought it'd be a lot of work for them. It looked fantastic. It wasn't a lot of work, or time, they'd been incredibly efficiant. They simply detailed a one line record of CPD in their folder as it happened. They succinctly summarised prescribing in a couple paragraphs to the GP for each script. They used the copier in the office to keep a copy of all prescriptions, so it was just a few moments to do that. There was little time invested in to it, yet their audit trail of non-medical prescribing activity wasn't just okay, it was flawless.

It's good to see.

It supports what I believe, so is something that stuck in my mind. If folk are told what to do, it's oft times seen as a nuisance and hassle. Leave a nurse (all the non-medical prescribers were nurses) to just crack on and do it herself, without any direction, without any manager, without any Modern Matron, and they're utterly brilliant at sorting stuff themselves.

Now, if I can just persuade folk to leave clinicians alone more of the time . . .

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