OSCE used to train and assess potential prescribers

How can a nurse’s competency to prescribe be assessed and what options are there to supplement the generic course and provide subject-specific training? These and other questions are addressed in this study, in which an Objective Structured Clinical Examination (OSCE) for potential nurse prescribers in dementia was validated, comparing the performance of nurses after 12 days of dementia prescribing training with that of small numbers of doctors of different grades. Not all the doctors taking the exam had done the course, and not all the course participants took the exam.

The Oxford Advanced Dementia Course was one day a week for 12 weeks and at the end, participants could, if they wanted to, take the OSCE. The purpose of the course was to help participants feel confident enough to attend the independent prescribing course.

Interestingly, the performance of nurses was not correlated with their years of experience working in old age psychiatry, but that of doctors was, with the competency of staff grades and junior doctors varying considerably. Almost all memory clinic nurses passed the exam, along with all specialist registrars and consultants; however, only a third of community psychiatric nurses (CPNs) performed at the level thought necessary to become a supplementary prescriber even though they had considerable experience of managing patients with dementia. The authors point out that experienced CPNs are likely to make up any extended cadre of  supplementary prescribers in dementia.

The authors conclude that the OSCE provides useful evidence to employers of the competency of potential prescribers. They point out that most forms of continuing professional development appraisal are based on course attendance, not performance, and suggest that a practical exam such this could provide invaluable information about which nurses can safely prescribe, complementing the assessment of the designated medical practitioner and the results of the generic prescribing course. It could make a significant contribution to maintaining high standards of patient safety with nurse prescribing.

Cubbin S et al. Training and assessing independent nurse prescribers: a model for old age psychiatry. Psychiatric Bull 2009; 33: 350-353