202-1216 / Nurse Midwife Medicinal Product Prescribing

GOP Information
Organisation sharing the GOP
Related practices from PaSQ database
Office of Nursing and Midwifery Services, Health Service Executive


Quality improvement project

GOP Description
Implementation level
Clinical settings
Nurse Midwife Medicinal Product Prescribing has been implemented in diverse clinical settings in the acute and primary care services (n = 112). See Appendix 1 for complete list.
To enhance the health system’s capacity to respond to service need by maximising nurse and midwife prescribing as a key competency in collaboration with the multidisciplinary team.
All registered nurse and midwives, any grade, who fulfil specific criteria; NQAI Level 8 competence; CPD evidence; support from employer; nominated medical practitioner mentor.
• This is a national initiative encompassing legislation and professional nursing regulations
• In 2006, the Department of Health established a Resource and Implementation Group on Nurse and Midwife Prescribing. The role of this group was to advise on the regulations to be drafted, and to oversee the roll-out of nurse and midwife prescribing on a national basis.
• A standardised education programme was developed specific to nurse midwife medicinal product prescribing. This was reviewed and approved by the Nursing and Midwifery Board of Ireland (Regulatory Body).
• The HSE appointed a national team to develop and implement a plan for the roll out of nurse midwife prescribing. The role of the team was to:
– Identify clinical governance structures within service delivery. Develop an overarching mechanism for the evaluation of nurse midwife medicinal product prescribing from a service perspective.
– In partnership with the DoH, to develop and implement an inclusive communication strategy.
• A standardise approach was adopted for the national implementation of this initiative. A framework was developed to support the evolution of nurse and midwife medicinal product prescribing in a systematic, cohesive and sustainable manner.
Timeframe implementation
Since 2007, this initiative has been implemented in 180 health service providers across acute and primary
and community services. The initiative is evolving and adapting in response to health service reconfiguration and restructuring currently underway in Ireland. Building capacity is an ongoing objective.
Implementation tools available
• Application Guidelines for the Nurse Midwife Prescribing Education programmes
• Development of a Site Declaration Form, identifying required governance arrangements
• National Policy for Nurse Midwife Medicinal Product prescribing
• Toolkit for Implementation of Nurse Midwife Prescribing: one-two page fact/information sheets
• A national monitoring system
• A Patient Information Leaflet (adult and children)
• Indemnity statements from the State Claims Agency
• Guidance for prescribing of off-label medications by RNPs
• Guidance for the introduction of nurse midwife prescribing in GP practices
• A suite of regulatory documents developed by the Nursing and Midwifery Board of Ireland
Implementation cost
• Salaries of 1 Director of Nursing and Midwifery and 4 Assistant Directors of Nursing (Band 1)
• A total of 1192 nurses and midwives have been funded by the Health Service Executive to undertake the education programme. Cost of the programme:
– 2007-2009: €5500.00
– 2009–2014: €5000.00
– 2014–present: €3000.00
Method used to measure the results
• An independent external evaluation was undertaken in 2009 incorporating a 360 degree process. The purpose of the evaluation was to examine the effectiveness in practice of the introduction of independent nurse midwife prescribing and to establish if the model adopted for implementation had achieved the stated objectives in terms of quality, patient safety, communication and patient/client benefits and satisfaction.
• Currently a review of nurse midwife medicinal product prescribing systems and processes (regulation and implementation) is underway. The aim of the review is to provide a less rigorous and leaner process for registered nurse prescribers in Ireland.
• Independent External Evaluation: Overall, the conclusive findings from the Evaluation found that overall the initiative for independent nurse midwife prescribing in Ireland has been safely developed and implemented on a national basis. The Evaluation recommended that the national rollout of independent nurse midwife prescribing continue to be further supported and strengthened.
•Current Review: Underway, no results as yet.
Analysis of the results
• The Independent External Evaluation identified 10 recommendations, all but two of which have been implemented. The two outstanding recommendations are part of the Review currently underway.
Implementation barriers
Did you find implementation barriers?
Please describe implementation barriers
1. The public service moratorium on staff recruitment in place since 2008 resulting in no or limited recruitment, or replacement of retired/resigned staff. Staff training was predominantly limited to mandatory training.
2. Regulatory requirements related to the Collaborative Practice Agreement arrangements, including:
a. Requirement for annual and biannual review
b. Access to and role and function of Drugs and Therapeutics (D&T;) committee for authorisation of Attachment B of CPA
3. Requirements for inputting prescriptions to Nurse Midwife Prescribing Data Collection System (HSE)
Describe the strategies used to overcome the barriers (If needed)
As a consequence of these factors, a collaborative approach was established between the NMBI and the ONMSD to review the regulatory and implementation systems and processes.
Other information
Other information about the GOP that you would like to add (Link or attached document)

201511240205238527_248_GOP_Appendix 1 & 2.docx