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Background

Healthcare provision, with increasing complexity and patient load, is progressively experiencing the benefits of inter-professional collaboration. Since the late 1990s, pharmacists have been involved in medication management and titration at anticoagulation clinics. Over the years, this practice evolved to various other pharmacist-managed clinics and services e.g. heart failure, renal, diabetes management. Advanced Practice Nurses (APNs) undergo the Masters of Nursing programme and were certified from mid 2000s. Since then, APNs have been practicing in various settings and disciplines, being heavily involved in patient care, including medication management.

 

Practice Model

Collaborative prescribing aims to assist and facilitate care transformation in the community and hospitals, by providing a more holistic service with improved continuity for team-based care. The collaborative prescribing practitioner (CPP) is a member of a multidisciplinary clinical team led by a medical practitioner and his/her scope of practice is a set of services performed as part of a team. The scope and services are defined in a Collaborative Practice Agreement, under the governance of the institution, according to National standards and guidelines.

 

Programme Content

The National Collaborative Prescribing Programme prepares APNs and pharmacists to prescribe under a Collaborative Practice Agreement with a medical practitioner(s).  Collaborative prescribing involves assessing the patient, considering treatment options, reaching a shared decision, prescribing, providing patient education, monitoring and reviewing of the patient. Through this programme, the individual will acquire skills and competencies in history taking, data interpretation, diagnostic formulation, physical examination, clinical decision making, applied therapeutics, psychosocial aspects of prescribing, collaboration with multidisciplinary team, effective communication and documentation.

The programme is designed to build on the basic skills already acquired in the APNs’ and pharmacists’ training. The core components comprise of areas involving safe and professional prescribing, as well as improving prescribing practice and prescribing as part of a team. The core competencies required include inter-professional collaboration, understanding prescribing systems, and professional and ethical considerations of prescribing. Based on differences in baseline skillsets of APNs and pharmacists, a portion of the curriculum is conducted separately to strengthen areas requiring further skills development in the two professions to perform collaborative prescribing.

At the end of the programme, the CPP should be able to develop his/her own practice under a Collaborative Practice Agreement. The CPP should also be aware of his/her own strengths and limitations, scope of practice and practice framework that he/she should practice within.

One set of application form must be completed and submitted with a passport-sized photograph and a copy of each of the supporting documents listed below.

  • Singapore NRIC or Passport,
  • Advanced Practice Nurse Practising Certificate or Pharmacist Practising Certificate, and
  • Current Curriculum Vitae.

 

The completed application form, with all the supporting documents, should be mailed to the following address:

Department of Pharmacy
National University of Singapore
Block S4A, Level 3
18 Science Drive 4
Singapore 117543
Republic of Singapore
Attn: National Collaborative Prescribing Programme

 

For further enquiries, please contact the Collaborative Prescribing Programme curriculum committee secretariat at phaleow@nus.edu.sg.

 

Application Fee

A non-refundable fee of S$100 (inclusive of GST) is payable for each application submitted.

Advanced Practice Nurses (APNs):

  1. Candidates must be at least 1-year post-APN certification and working in current scope of practice for at least 1 year,
  2. Candidates must be working in an area with existing or potential need for Collaborative Prescribing service,
  3. Candidates must have identified a clinical supervisor who, together with his/her team, will provide supervision to the candidate during the clinical practicum, and
  4. Candidates must have met the minimum pass mark in the numeracy test conducted prior to entry of the programme.

 

Pharmacists:

  1. Candidates must be at least 3-year post-pharmacist registration with experience in direct patient care setting and working in multidisciplinary / team-based practice for at least 1 year,
  2. Candidates must be working in an area with existing potential need for Collaborative Prescribing service,
  3. Candidates must have identified a clinical supervisor who, together with his/her team, will provide supervision to the candidate during the clinical practicum, and
  4. Candidates must have met the minimum pass mark in the numeracy test conducted prior to entry of the programme.

The three-month programme is conducted over 13 weeks, with one full day a week (Mondays) in teaching sessions over 9 weeks, and an additional 80 hours of clinical practicum.

 

Teaching Sessions

Teaching methods include lectures, case-based discussions, clinical stimulations, role-play, hands-on practice, problem/team based learning, as well as self-directed and e-learning.

 

Clinical Practicum

An existing or potential collaborative prescribing practice with a clinical supervisor is required for the programme.  The clinical supervisor (together with his/her team) will oversee the clinical practicum to ensure opportunities for hands-on practice and the individual’s competency to practice independently as a CPP.

The clinical practicum would involve the following breakdown of hours:

  • 30 hours DIRECT supervision:
    • 12 hours with named clinical supervisor
    • 18 hours with Senior Resident and above
  • 10 hours INDIRECT supervision by above
  • 30 hours DIRECT supervision by peers i.e. Resident/Medical Officer, APN or pharmacist
  • 10 hours INDIRECT supervision by peers

 

Assessment

For successful completion of the CP Programme, the candidate must have achieved a minimum of 75% attendance score, and successfully completed the following assessments:

  • Portfolio reviews (which includes scope of practice, personal drug formulary, personal development plan, drug monograph and clinical application of drug use, learning log, clinical / prescribing logs, Mini-CEX, and case based discussions)
  • Oral presentations,
  • In-class quiz,
  • A final written examination, and
  • A formative and a summative OSCE.
Date Time Venue Session Code Topics (Time allocation) Assessment
19-Mar-18 0800-1000 NUS MD3-02-01 Tiered Seminar Room GEN01.1 Introduction and program overview (2h) Nil
1000-1300 NUS MD6-04-02L to Q PHA01 concurrent with NUR01 General approach to patient (role-play) (3h) OSCE         Mini-CEX
1000-1300 NUS MD3-02-01 Tiered Seminar Room NUR01 concurrent with PHA01 Overview of drug use in Singapore (3h) TBC In-class discussion
1400-1700 NUS MD3-02-01 Tiered Seminar Room GEN01.2 Principles of Prescribing 1 (3h) In-class discussion

Written exam

26-Mar-18 0900-1000 LKCMedicine CSB Seminar Room GEN02.1 Legislative aspects of prescribing (1h) In-class discussion

Written exam

1000-1200 LKCMedicine CSB Seminar Room GEN02.2 Scope of Practice and Personal Formulary (2h) In-class peer assessment
1300-1800 LKCMedicine CSB L6 Comms Suite GEN02.3 Consultation/History-taking skills (5h) OSCE        Mini-CEX
02-Apr-18 0900-1000 NUS MD3-02-01 Tiered Seminar Room GEN03.1 Presentation 1 (1h)
Presentation of drug monograph and clinical application from personal drug formulary
In-class peer assessment
1000-1100 NUS MD3-02-01 Tiered Seminar Room GEN03.2 Portfolio review 1 (1h) In-class peer assessment
1100-1300 NUS MD3-02-01 Tiered Seminar Room GEN03.3 Principles of Prescribing 2 (2h) In-class discussion

Written exam

1400-1800 NUS MD6-01-02 GEN03.4 Prescribing in a team context (4h) OSCE           Mini-CEX
09-Apr-18 0900-1100 TTSH SIMTAC GEN04.1 is contiguous with GEN04.3 Communication skills (role-play) (2h)

– Communication with patients

OSCE       Mini-CEX
1200-1600 TTSH SIMTAC GEN04.2 Principles of physical assessment and clinical examination (4h) OSCE             Mini-CEX
1600-1800 TTSH SIMTAC GEN04.3 contiguous with GEN04.1 Communication skills (role-play) (2h) – Communication in the interprofessional setting OSCE            Mini-CEX
16-Apr-18 0900-1300 NUS MD6-04-02K to Q PHA05.1 concurrent with NUR05 Physical assessment simulation/practice (I) (4h) OSCE
Mini-CEX
1400-1800 NUS MD6-04-02K to Q PHA05.2 concurrent with NUR05 Physical assessment simulation/practice (II) (4h) OSCE            Mini-CEX
0900-1300 NUS MD3-02-01 Tiered Seminar Room NUR05.1 concurrent with PHA05 Pharmacokinetics & pharmacodynamics (4h) Written exam
1400-1500 NUS MD6-01-02 NUR05.2 concurrent with PHA05 Pharmacotherapeutics (1h) – Respiratory Written exam
1500-1800 NUS MD6-01-02 NUR05.3 concurrent with PHA05 Pharmacotherapeutics (3h) – Infectious diseases Written exam
23-Apr-18 0800-1200 NUS MD6-04-02K to Q PHA06 concurrent with NUR06 Physical assessment simulation/practice (II) (4h) OSCE         Mini-CEX
0800-1200 NUS MD1-MPH1 NUR06 concurrent with PHA06 Pharmacotherapeutics (4h) – Cardiovascular Written exam
1300-1530 NUS MD1-MPH1 GEN06.1 Skin/dermatological conditions (2.5h) In-class quiz
1530-1630 NUS MD1-MPH1 GEN06.2 Portfolio review 2 (1h) In-class peer assessment
1630-1730 NUS MD1-MPH1 GEN06.3 OSCE briefing (1h) NA
30-Apr-18 0800-0900 NUS MD3-02-01 Tiered Seminar Room GEN07 Quiz (Skin/dermatological conditions) (1h) NA
0900-1400 NUS MD6-04-02K to Q PHA07.1 concurrent with NUR07 Revision I – History-taking and communication skills (5h) OSCE             Mini-CEX
1500-1700 NUS MD6-04-02K to Q PHA07.2 concurrent with NUR07 Obtaining history from special populations (2h) OSCE         Mini-CEX
0900-1200 NUS MD3-02-01 Tiered Seminar Room NUR07.1 concurrent with PHA07 Pharmacotherapeutics (3h) – Endocrine Written exam
1300-1530 NUS MD6-01-02 NUR07.2 concurrent with PHA07 Pharmacotherapeutics (2.5h) – Renal Written exam
1530-1800 NUS MD6-01-02 NUR07.3 concurrent with PHA07 Pharmacotherapeutics (2.5h) – Gastrointestinal Written exam
07-May-18 0800-1200 NUS MD6-04-02K to Q PHA08 concurrent with NUR08 Revision II – Physical assessment simulation/practice (4h) OSCE
Mini-CEX
0900-1030 NUS MD4-02-03E Seminar Room NUR08.1 concurrent with PHA08 Pharmacotherapeutics (1.5h) – Neurology Written exam
1030-1200 NUS MD4-02-03E Seminar Room NUR08.2 concurrent with PHA08 Pharmacotherapeutics (1.5h) – Psychiatry Written exam
1200-1300 NUS MD4-02-03E Seminar Room GEN08.1 Portfolio review 3 (1h) In-class peer assessment
1400-1800 NUS MD4-02-03E Seminar Room GEN08.2 Interpreting diagnostic tests and procedures (4h) Written exam
14-May-18 NA e-learning NUR09.1 e-learning Pharmacotherapeutics (1h) – Pain management Written exam
NA e-learning NUR09.2 e-learning Pharmacotherapeutics (2h) – Musculoskeletal Written exam
19-May-18 0800-1200 NUS MD6-04-02F to Q GEN09.1 Mock OSCE (4h) OSCE
Mini-CEX
1300-1700 NUS MD6-04-02F to Q EXA01 Formative OSCE (4h) NA
1700-1800 NUS MD6-03-01R GEN09.2 Debrief Formative OSCE (1h) NA
28-May-18 0900-1100 NUS MD4-02-03E Seminar Room EXA02 Final written exam (2h) NA
31-May-18 NA GEN10 Portfolio review 4 (Final portfolio submission) NA
09-Jun-18 0900-1300 NUS MD6-04-02A to R EXA03 Summative OSCE (4h) NA
1400-1600 NUS MD1-06-03M Seminar Room EXA04 Re-sit for final written exam (2h) NA

General

GEN01.2 Principles of Prescribing 1 (3h)

  1. International Clinical Quality Framework
    • Institute for Healthcare Improvement (IHI) Open School
  2. Patient Safety Module: Responding to Adverse Event
    • Case Study
    • Documentation of Adverse Event
  3. MOH National Quality Framework: Serious Reportable Events
    • Purpose
    • Implementation
    • Case Studies
  4. MOH Private Hospitals and Medical Clinics (PHMC) Act
    • Clinical Quality Assurance Framework
      • Purpose
      • Implementation
    • Changes in 2018 and the upcoming Heath Services Act
  5. Managing Feedback and Complaints in the Institution
    • Framework for Response
    • Working with Patient and NOK, Family Conference
    • Case Studies
  6. Institution versus Individual Malpractice Insurance
  7. Doctor’s Prescribing in Brief
    • Malpractice Insurance
    • Compliance with SMC Ethical Code and Ethical Guidelines
    • Case Studies

 

GEN02.1 Legislation and Regulation of Prescribing (1h)

  1. Legislative aspects of prescribing
  2. Regulatory controls of medicines
  3. Regulatory requirements and responsibilities of a prescriber

 

GEN03.3 Principles of Prescribing 2 (2h)

  1. Health Sciences Authority and regulatory oversight of health products
  2. Framework of pharmacovigilance including risk detection, risk assessment, risk management and risk communication
  3. Timeline of adverse drug reaction profile of a drug
  4. Prescriber’s responsibility in pharmacovigilance
  5. Adverse Drug Reactions reporting

 

GEN03.4 Prescribing in a Team Context (4h)

  1. Role of the doctor, pharmacist and nurse (and allied health professionals)
  2. Communication, collaboration and relationships with other healthcare providers
  3. Shared decision making in clinical practice

 

GEN06.1 Skin/Dermatological Conditions (2.5h)

  1. Common primary skin conditions
  2. Dermatological manifestations of systemic diseases
  3. Dermatological side effects of medications

 

GEN08.2 Interpreting diagnostic tests and procedures (4h)

ECGs, x-rays, scans, key laboratory tests

Consultations and Physical Assessments

PHA01 General Approach to Patient (role-play) (3h)

Calgary-Cambridge approach to medical interview and communication

    • Initiating the session
    • Gathering information: basic, understanding patient’s ideas, concerns and expectations (ICE)
    • Building relationship

 

GEN02.3 Consultation/History-Taking Skills (5h)

Calgary-Cambridge approach to medical interview Cognitive i.e. internal processing skills
Initiating the session Identify presenting complaint(s)

Identify the dominant emotion

Gathering information

  • Explore problems
  • Explore ICE aka health beliefs and behaviors
  • Encourage expression of feelings
Use a history template

Perform clinical reasoning during history taking:

  • Sort/Prioritise, analyse and group information into packages
  • Link packages of information

Decide patient’s readiness to negotiate ICE

Providing structure Formulate differential diagnoses by clarifying the links between packages of information
Building relationship Pace the patient
Closing the session Summarise and plan for next step
  • Documentation of plan and records: SOAP

 

GEN04.1 Communication Skills I (role-play) (2h)

Communications with patients

Calgary-Cambridge approach to communication Cognitive i.e. internal processing skills
Initiating the session Establish the reason for communication

Identify the dominant emotion

Providing structure Sequence the ENCOUNTER logically
Building relationship Pace the patient
Explanation and planning Provide clinical information

Sequence the INFORMATION logically

Closing the session Summarise and plan for next step

 

GEN04.2 Principles of Physical Assessment and Clinical Examination (4h)

  1. For APNs
    • Cardiovascular exam
    • Respiratory exam
    • Gastrointestinal exam
    • Neurological exam
    • Musculoskeletal exam
  2. For pharmacists
    • General assessment and vital signs (BP, pulse rate, SpO2, peak flow)
    • Cardiovascular exam
    • Respiratory exam
    • Gastrointestinal exam

 

GEN04.3 Communication Skills II (role-play) (2h)

Communication in the interprofessional setting

Modified SBAR for Ordinary Communication SBAR for Crisis Communication
Initiate the session

  • Introduce self
  • Identify reason for communication

Situation: What is going on with the patient OR What I have observed / heard / obtained information that puzzles me / is concerning

Situation: What is going on with the patient? E.g. “I am referring to Mdm Yeo in room 25. Chief complaint is shortness of breath of new onset.”
Background – What is the clinical background or context OR How I came to observe, hear or obtain the information Background – What is the clinical background or context?

E.g. “Patient is a 62-year-old female just returned from abdominal surgery. She was given IV Augmentin and Gentamicin in OT. No drug allergy”

Assessment and Assistance – What do I think the problem is? Can you help me to understand what is happening? Assessment – What do I think the problem is?

E.g. “She is now wheezing. Would like to rule out drug allergy.”

Recommendation and Request – What would I do to correct it OR What would I do differently?

Response – depending on the reply, consider whether negotiation, consultation, discussion or debate is best

Close the session

Recommendation and Request – What would I do to correct it?

E.g. “I feel strongly the patient should be assessed now. Can you come to room 25 now?”

 

PHA05 Physical Assessment Simulation/Practice I (8h)

  • General assessment and vital signs
  • Cardiovascular exam
  • Respiratory exam
  • Gastrointestinal exam
  • Neurological exam
  • Musculoskeletal exam

 

PHA06 Physical Assessment Simulation/Practice II (4h)

  • Neurological exam
  • Musculoskeletal exam

 

PHA07.1 Revision I – History-Taking and Communication Skills (5h)
More details will be provided at a later date

 

PHA07.2 Obtaining History from Special Populations (2h)

  • Patients with dementia/psychiatric disorders

 

PHA08 Revision II – Physical Assessment Simulation/Practice (4h)
More details will be provided at a later date

 

GEN09.1 Mock OSCE (4h)
More details will be provided at a later date

Pharmacotherapeutics

NUR01 Overview of Drug Use in Singapore (3h)

Drug Classification

  • Standard, non-standard drug lists
  • Non-formulary and exemption drugs
  • Drug costs and subsidies
  • OTC, P-meds, POM, controlled drugs

 

NUR05.1 Pharmacokinetics & Pharmacodynamics (4h)

Overview

Special populations

  • Geriatrics
  • Hepatic / renal impairment
  • Obesity
  • Pediatrics
  • Pregnancy/lactation

 

NUR05.2 Pharmacotherapeutics (Respiratory Disorders) (1h)

  • COPD
  • Asthma

 

NUR05.3 Pharmacotherapeutics (Infectious Diseases) (3h)

  • Antimicrobial stewardship
  • Upper respiratory tract infection (URTI)
  • Lower respiratory tract infection (LRTI)
  • Tuberculosis (TB)
  • Urinary tract infection (UTI)
  • Eye infections
  • Skin/soft tissue infections
  • Varicella/Herpes simplex virus (HSV) infections
  • Adult vaccinations (follow MOH recommendations)

 

NUR06 Pharmacotherapeutics (Cardiovascular Diseases) (4h)

  • Hypertension
  • Dyslipidaemia
  • Arrhythmias
  • Acute and chronic heart failure
  • Acute coronary syndrome (ACS) and Coronary artery disease (CAD)
  • Thromboembolic disorders
  • Endocarditis prophylaxis

 

NUR07.1 Pharmacotherapeutics (Endocrine Disorders) (3h)

  • Diabetes Mellitus (DM), including diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar nonketotic coma (HHNK)
  • Thyroid disorders

 

NUR07.2 Pharmacotherapeutics (Renal Diseases) (2.5h)

  • Chronic kidney disease (CKD)
  • Basics of haemodialysis (HD) and peritoneal dialysis (PD)
  • Drug-induced renal disease
  • Acute kidney injury (AKI)
  • Erythropoietin stimulating agents (ESA), iron, vitamin and folate

 

NUR07.3 Pharmacotherapeutics (Gastrointestinal Diseases) (2.5h)

  • Diarrhea/constipation
  • Peptic ulcer diseases (PUD)
  • Helicobacter pylori infection
  • Gastrointestinal (GI) bleed
  • Gastroenteritis

 

NUR08.1 Pharmacotherapeutics (Neurology) (1.5h)

  • Parkinson’s disease
  • Stroke
  • Epilepsy

 

NUR08.2 Pharmacotherapeutics (Psychiatry) (1.5h)

  • Depression
  • Anxiety

 

NUR09.1 Pharmacotherapeutics (Pain Management) (e-learning)

  • Use of analgesics for acute pain

 

NUR09.2 Pharmacotherapeutics (Musculoskeletal Disorders) (e-learning)

  • Osteoporosis
  • Calcium, bisphosphonates and vitamin D

Consultation and Physical Assessment

PHA01 General approach to patient (role-play)

Calgary Cambridge consultation model by RCSI Perdana JC1 Medical Humanities
How to get your FIRST MINUTE right in the CSA Exam by Aman Arora
How to use ‘ICE’ efficiently in the CSA Exam by Aman Arora

 

GEN02.3 Consultation/History-taking skills

CSA – 1st five minutes.m2ts by Matthew Smith
Clinical communication skills – verbal communication – version 2 of 2 by U of Nottingham

 

GEN04.1 Communication skills (role-play)

How to form a MANAGEMENT PLAN in the CSA Exam by Aman Arora

 

GEN04.2 Principles of physical assessment and clinical examination

New! Macleod’s Clinical examination 13th edition by Iain Hennessy

 

Suggested Reading

The patient history: an evidence-based approach to differential diagnosis (2012, 2nd ed.) by Henderson, Mark C; Tierney, Lawrence M., Jr; Smetana, Gerald W

History Taking – Authored by Dr Colin

History and Physical Examination – Authored by Dr Roger Henderson

Handbooks

Student handbook

Clinical supervisor handbook

 

Templates / Forms

Collaborative Practice Agreement Template v1.0

Drug Monograph Form v1.0

Mini-CEX Form v1.0

Case-Based Discussion Form v1.0

Learning Log Template v1.0

Prescribing Log Template v1.0

 

Assessment Rubrics

Portfolio Assessment Rubric

Presentation Assessment Rubric v1.0

 

Portfolio Checklist

Portfolio Checklist v1.0

What is a numeracy test?

The numeracy test consists of 10 questions on basic drug dosage calculations, to be completed in 30 minutes.

Please refer to attached sample of numeracy questions.

 

Can I use a calculator for the numeracy test?

Yes. Please bring along a calculator for the numeracy test.

Please note that mobile devices such as smartphones and tablets are not allowed.

 

When and where will the numeracy test be conducted?

The numeracy test will be conducted at National University of Singapore, MD1-06-03M Seminar Room, on the following dates:

  • 5 Mar 2018 @ 8am
  • 9 Mar 2018 @ 8am

You may select one of 2 dates provided.

 

What is the pass mark for the numeracy test?

The pass mark is decided using an evidence-based standard setting method and will be different for each test that is offered.

 

What if I do not pass the numeracy test?

Each candidate is allowed one re-take of the numeracy test, on the following dates:

  • 9 Mar 2018 @ 8am (MD1-06-03M Seminar Room)
  • 13 Mar 2018 @ 8am (MD1-06-02 Meeting Room)

 

When will the programme start?

The first cohort of the programme starts on 19 Mar 2018.

 

Where will the teaching sessions be held?

The teaching sessions will be held mostly in the National University of Singapore.

 

How should I select my clinical supervisor?

The following are key criteria in determining the suitability of a doctor to take on the role of clinical supervisor who will provide supervision, support and opportunities to develop your competence in prescribing practice:

The doctor must be a registered medical practitioner who:

  • Has been nominated by the Head of Department / Service (HOD),
  • Has at least 3 years of recent clinical experience in the field of practice related to your field / scope of practice, and
  • Has some training and experience in teaching and/or supervising in practice, and preferably acknowledged by HOD and/or peers as a good teacher/supervisor.

A principal consideration is the willingness, availability and skills of the doctor to supervise and facilitate your learning during the Clinical Practicum. You as an active learner together with the HOD should discuss and therefore identify the most suitable doctor to be nominated as the clinical supervisor.

 

Will there be any briefing for the clinical supervisors?

Details are found (a) in the Clinical Supervsior Guide that will be made available to all supervisors once their appointment is confirmed, and (b) on this website.

Please email us if further clarification is needed.