Introduction
This essay critically appraises the concept of accountability within my potential prescribing practice as a non-medical prescriber (NMP) studying the V150 course, with a specific focus on my role within a multidisciplinary team (MDT). Prescribing governance is a cornerstone of safe and ethical practice, and this piece will explore how professional, legal, and ethical frameworks guide prescribing decisions. Particular attention will be given to the application of Competency 7 from the Royal Pharmaceutical Society (RPS) Framework for Prescribing Governance, which relates to prescribing within the team context and ensuring accountability. Importantly, this discussion does not address pharmacology but instead focuses purely on the governance surrounding prescribing decisions. As I have not yet prescribed, this analysis is reflective and anticipatory, considering how I would apply these principles in future practice. The essay will outline key frameworks, evaluate their relevance to nursing prescribing practice, and consider the implications for accountability within an MDT setting.
Understanding Accountability in Prescribing Practice
Accountability is a fundamental principle in healthcare, particularly in prescribing, where practitioners are answerable for their decisions and actions. For NMPs, such as nurses undertaking the V150 course, accountability encompasses adhering to professional standards, legal regulations, and ethical obligations. The Nursing and Midwifery Council (NMC) Code (NMC, 2018) explicitly mandates that nurses must act in the best interests of patients, ensuring their practice is safe, effective, and evidence-based. This professional accountability is reinforced by the understanding that prescribing decisions impact patient outcomes and interprofessional collaboration within the MDT.
In my future role as an NMP, accountability will mean justifying my prescribing decisions, ensuring they align with clinical guidelines and are defensible under scrutiny. However, this is not merely an individual responsibility; it extends to working collaboratively with the MDT, including doctors, pharmacists, and allied health professionals. Indeed, accountability in this context requires clear communication and shared decision-making, ensuring that my actions complement the wider care plan. This collaborative approach is vital to mitigate risks and uphold patient safety, a priority that underpins all prescribing governance frameworks.
Professional, Legal, and Ethical Frameworks Guiding Prescribing
Several frameworks govern prescribing practice, each contributing to accountability. Professionally, the NMC Code (2018) serves as a foundational guide, emphasising the need for competence, transparency, and patient-centered care. Legally, NMPs operate under the Medicines Act 1968 and subsequent amendments, which delineate the scope of prescribing authority for non-medical professionals (Department of Health, 2006). Additionally, the Human Medicines Regulations 2012 outline the legal boundaries within which nurses can prescribe, ensuring accountability through strict adherence to designated formularies or patient group directions (PGDs).
Ethically, prescribing decisions must reflect principles such as beneficence and non-maleficence, ensuring that treatments do more good than harm. For instance, when considering a prescribing decision, I would weigh the potential benefits against risks, consulting with MDT colleagues to ensure an ethical balance. This process is not without challenges; ethical dilemmas may arise, such as when patient preferences conflict with clinical recommendations. Here, accountability demands that I document my rationale clearly, demonstrating how I have considered all perspectives in line with ethical guidelines like those from the General Medical Council (GMC), which, although primarily for doctors, offer valuable insights into shared decision-making (GMC, 2020).
These frameworks collectively underscore the importance of accountability, but their application in practice requires critical reflection. For example, legal compliance alone does not guarantee ethical practice, and professional standards may sometimes conflict with organisational policies. Therefore, as a future NMP, I must navigate these complexities with a clear understanding of how each framework applies to my role within the MDT.
Applying the RPS Framework: Competency 7 in Prescribing Governance
The RPS Competency Framework for All Prescribers (RPS, 2021) provides a structured approach to prescribing governance, with Competency 7 focusing specifically on prescribing within the team context. This competency emphasises the importance of collaboration, communication, and shared accountability within the MDT. It requires prescribers to understand their role within the team, contribute to team decisions, and ensure that prescribing aligns with agreed care plans. As a student on the V150 course, I have not yet prescribed, but reflecting on this competency allows me to anticipate how I would apply it in practice.
For instance, Competency 7 underscores the need to consult with colleagues before making prescribing decisions, particularly when managing complex cases. If I were to prescribe for a patient with multiple comorbidities, I would engage with the MDT—potentially including a pharmacist for advice on drug interactions or a specialist consultant for condition-specific guidance. This collaborative approach not only enhances patient safety but also distributes accountability across the team, reducing the risk of individual error. Furthermore, Competency 7 requires clear documentation of decisions, ensuring transparency and traceability—key aspects of accountable practice.
However, applying this competency is not without limitations. Within an MDT, differing professional opinions may create tension, and time constraints could hinder thorough consultation. To address these challenges, I would prioritise effective communication strategies, such as regular team meetings or shared electronic records, to maintain accountability. While the RPS Framework is comprehensive, its effectiveness depends on my ability to adapt it to real-world scenarios, a skill I am developing through my V150 studies.
Critical Evaluation of Accountability in MDT Settings
While accountability is essential, its practical application within an MDT can be complex. One strength of shared accountability is the pooling of expertise, which often leads to better patient outcomes. For example, a pharmacist’s input on dosage adjustments can complement my nursing assessment, creating a more holistic prescribing decision. However, this shared responsibility can also blur lines of accountability, making it unclear who is ultimately responsible if an adverse event occurs. Literature suggests that role ambiguity within MDTs is a common barrier to effective collaboration (Reeves et al., 2013), and I must therefore strive for clarity in my future practice by defining my responsibilities explicitly.
Additionally, power dynamics within MDTs can influence accountability. Historically, nurses may defer to medical professionals due to hierarchical structures, potentially undermining their autonomy as prescribers (Courtenay & Carey, 2008). As a future NMP, I must assert my professional accountability while respecting the expertise of others, striking a balance that prioritises patient care over professional egos. This critical awareness of team dynamics will be central to applying Competency 7 effectively.
Conclusion
In conclusion, accountability is a multifaceted concept central to safe and effective prescribing practice within an MDT. By drawing on professional standards (e.g., NMC Code), legal regulations (e.g., Human Medicines Regulations), and ethical principles, I can ensure that my future prescribing decisions as an NMP are defensible and patient-focused. The RPS Competency 7 provides a valuable framework for navigating team-based prescribing, encouraging collaboration and shared accountability. However, challenges such as role ambiguity and team dynamics highlight the need for critical reflection and adaptability. As I progress through the V150 course, developing these skills will be essential to uphold accountability, ultimately enhancing patient safety and trust in healthcare delivery. This anticipatory analysis not only prepares me for future practice but also underscores the broader implications of governance in sustaining high standards across multidisciplinary settings.
References
- Courtenay, M. and Carey, N. (2008) Preparing nurses to prescribe medicines for patients with diabetes: A national questionnaire survey. Journal of Advanced Nursing, 61(4), pp. 403-412.
- Department of Health. (2006) Improving Patients’ Access to Medicines: A Guide to Implementing Nurse and Pharmacist Independent Prescribing within the NHS in England. London: Department of Health.
- General Medical Council. (2020) Decision Making and Consent. GMC.
- Nursing and Midwifery Council. (2018) The Code: Professional Standards of Practice and Behaviour for Nurses, Midwives and Nursing Associates. NMC.
- Reeves, S., Lewin, S., Espin, S. and Zwarenstein, M. (2013) Interprofessional Teamwork for Health and Social Care. Wiley-Blackwell.
- Royal Pharmaceutical Society. (2021) A Competency Framework for All Prescribers. RPS.
