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Inaugural Cohort of the National Collaborative Prescribing Programme on Day 1

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Inaugural Cohort of National Collaborative Prescribing Practitioners Graduates

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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 is co-hosted by Alice Lee Centre for Nursing Studies and Department of Pharmacy. The 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 recent passport-sized photograph, together with 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.

 

Softcopies of your application documents must be submitted to the NCPP secretariat, and at the same time, hardcopies of all the application documents must be submitted in time to reach the following address by the application deadline: 18 January 2019

Department of Pharmacy
National University of Singapore
Block S4A, Level 3
18 Science Drive 4
Singapore 117543
Attn: A/Prof Priscilla How (National Collaborative Prescribing Programme)

 

Click here to download the application form.

 

For further enquiries, please contact A/Prof Priscilla How (Pharmacy Lead) at priscillahow@nus.edu.sg

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, and
  3. Candidates must have identified a clinical supervisor who, together with his/her team, will provide supervision to the candidate during the clinical practicum.

 

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, and
  3. Candidates must have identified a clinical supervisor who, together with his/her team, will provide supervision to the candidate during the clinical practicum.

The three-month programme is conducted over 12-14 weeks, with one full day a week of teaching sessions over 9-11 weeks, and an additional 80 hours of clinical practicum.

 

Teaching Sessions

Teaching methods include lectures, case-based discussions, clinical simulations, 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 quizzes,
  • A final written examination,
  • A formative OSCE, and
  • A summative OSCE.

This timetable may be subjected to changes

Date Time Venue Session Code Topics Assessment
14-Aug-18 0800-0930 MD1-09-03E Tutorial Room 3 2GEN01.1 Introduction and program overview Nil
1000-1200 MD1-09-01A Tutorial room 1 2NUR01.1 concurrent with 2PHA01.1 Overview of drug use in Singapore Written exam
1000-1200 MD1-09-03E Tutorial Room 3 2PHA01.1 concurrent with 2NUR01.1 Basic ECG interpretation Written exam
1230-1530 MD6 04-02J-W 2NUR01.2 concurrent with 2PHA01.2 History taking – Revision for APNs OSCE / Mini-CEX
1230-1530 MD6 04-02J-W 2PHA01.2 concurrent with 2NUR01.2 History taking – Basic for Pharmacists OSCE / Mini-CEX
1530-1730 MD1-09-01B Tutorial room 2 2GEN01.2 Principles of Prescribing 1 Written exam
21-Aug-18 0900-1100 MD1-09-03E Tutorial Room 3 2GEN02.1 Scope of Practice and Personal Formulary In-class peer assessment
1100-1200 MD1-09-03E Tutorial Room 3 2GEN02.3 Summarising and Presenting to Assessor OSCE / Mini-CEX
1300-1700 MD6 04-04A-F and 04-05A-F 2GEN02.4 History Taking (Inter-professional Groups) OSCE / Mini-CEX
28-Aug-18 0915-1015 MD1-09-03E Tutorial room 3 2GEN03.1 Presentation 1 In-class peer assessment
1030-1230 MD1-09-03E Tutorial room 3 2NUR03.1 concurrent with 2PHA03.1 Pharmacotherapy for Special Populations Written exam
1030-1230 MD6 04-04A-F, 04-05A-F 2PHA03.1 concurrent with 2NUR03.1 Physical Examination for Pharmacists 1 OSCE / Mini-CEX
1300-1500 MD1-03-01B MPH3 2GEN03.2 Principles of Prescribing 2 Written exam
1500-1600 MD1-03-01B MPH3 2GEN03.3 ABG interpretation Written exam
1600-1700 MD1-03-01B MPH3 2GEN03.4 Portfolio review 1 In-class peer assessment
04-Sep-18 0900-1030 MD1-09-03E Tutorial Room 3 2NUR04.1 concurrent with 2PHA04.1 Pharmacotherapeutics – Endocrine (DM) Written exam
0900-1030 MD6 04-01K-W 2PHA04.1 concurrent with 2NUR04.1 Physical Examination for Pharmacists – Revision 1 OSCE / Mini-CEX
1100-1300 MD6 04-01K-W 2NUR04.2 concurrent with 2PHA04.2 Physical Examination for APNs 1 OSCE / Mini-CEX
1100-1300 MD6 04-01K-W 2PHA04.2 concurrent with 2NUR04.2 History Taking for Pharmacists OSCE / Mini-CEX
1330-1500 MD1-03-01B MPH3 2GEN04.1 Prescribing in a Team Context (Inter-professional Groups) OSCE / Mini-CEX
1500-1700 MD1-03-01B MPH3 2GEN04.2 Communication Skills – SBAR Phone Call (Inter-professional Groups) OSCE / Mini-CEX
11-Sep-18 0830-1100 MD1-09-03E Tutorial Room 3 2GEN05.1 Skin/Dermatological Conditions In-class discussion/ quiz
1100-1130 MD1-09-03E Tutorial Room 3 Briefing for Communication Skills cum Lunch
1130-1410 MD6 04-02FM-W 2GEN05.2 Communication Skills (Inter-professional Groups) OSCE / Mini-CEX
1430-1700 MD1-03-01B MPH3 2NUR05.1 concurrent with 2PHA05.1 Pharmacotherapeutics – Infectious diseases Written exam
1430-1700 MD6 04-02FM-W 2PHA05.1 concurrent with 2NUR05.1 Physical Examination for Pharmacists 2 OSCE / Mini-CEX
18-Sep-18 0900-1130 MD1-03-01D MPH1 2NUR06.1 concurrent with 2PHA06.1 Pharmacotherapeutics – Cardiovascular Written exam
0900-1130 MD6 04-05A-F, 04-06, 07, 08 2PHA06.1 concurrent with 2NUR06.1 Physical Examination for Pharmacists – Revision 2 OSCE / Mini-CEX
1230-1400 MD6 04-05A-F, 04-06, 07, 08 2NUR06.2 concurrent with 2PHA06.2 Physical Examination for APNs 2 OSCE / Mini-CEX
1230-1400 MD6 04-05A-F, 04-06, 07, 08 2PHA06.2 concurrent with 2NUR06.2 Physical Examination for Pharmacists 3 OSCE / Mini-CEX
1400-1600 MD6 04-05A-F, 04-06, 07, 08 2GEN06.1 Communication Skills (Inter-Professional Groups) OSCE / Mini-CEX
1600-1700 MD1-09-01B Tutorial room 2 2GEN06.2 Portfolio Review 2 In-class peer assessment
1700-1730 MD1-09-01B Tutorial room 2 2GEN06.3 OSCE Briefing N.A.
25-Sep-18 0900-1000 MD1-08-03E Seminar Room 2 2GEN07.1 Quiz (Skin/Dermatological Conditions) N.A.
1000-1130 MD1-09-01A Tutorial room 1 2NUR07.1 concurrent with 2PHA07.1 Pharmacotherapeutics – Gastrointestinal Written exam
1000-1130 MD6-04-01K-W 2PHA07.1 concurrent with 2NUR07.1 Physical Examination for Pharmacists – Revision 3 OSCE / Mini-CEX
1130-1230 MD1-09-01A Tutorial room 1 2NUR07.2 concurrent with 2PHA07.2 Pharmacotherapeutics – Psychiatry Written exam
1130-1300 MD6-04-01K-W 2PHA07.2 concurrent with 2NUR07.2 Communication Skills for Pharmacists OSCE / Mini-CEX
1300-1400 MD1-09-01A Tutorial room 1 2NUR07.3 concurrent with 2PHA07.3 Pharmacotherapeutics – Neurology Written exam
1400-1600 MD1-09-01A Tutorial room 1 2NUR07.4 concurrent with 2PHA07.3 Pharmacotherapeutics – Renal Written exam
1330-1600 MD6-04-01K-W 2PHA07.3 concurrent with 2NUR07.3-4 Mock OSCE I for Pharmacists OSCE / Mini-CEX
1600-1730 MD6 04-01K-W 2NUR07.5 Physical Examination for APNs 3 OSCE / Mini-CEX
02-Oct-18 0800-1130 MD1-09-03E Tutorial Room 3 2GEN08.1 Interpreting Diagnostic Tests and Procedures Written exam
1130-1230 MD1-09-03E Tutorial Room 3 2GEN08.2 Portfolio Review 3 cum Lunch In-class peer assessment
1230-1730 MD6 04-02X, 04-04A-F, 04-05A-F, 04-06, 07, 08 2GEN08.3 Mock OSCE II OSCE / Mini-CEX
09-Oct-18 0800-0900 MD6-01-02 2NUR09.1 Pharmacotherapeutics – Endocrine (thyroid disorders) Written exam
0900-1230 MD6 04-04A-F; 04-05A-F 2GEN09.1 Obtaining History from Special Populations (Inter-Professional Groups) OSCE / Mini-CEX
1300-1430 MD6-01-02 2GEN09.2 Basic X-ray Interpretation Written exam
13-Oct-18 0800-1300
MD6 04-02A-W; assemble at Seminar room: MD6 02-01D, E, F
2EXA01 Formative OSCE N.A.
23-Oct-18 0900-1100 MD1-09-03E/F Tutorial room 3/4 2EXA02 Final Written Exam N.A.
23-Oct-18 0900-1100 MD1-06-02 Meeting room 2GEN10 Portfolio Review 4 (Final portfolio submission) N.A.
03-Nov-18 0800-1300 TTSH SIMTAC; assemble at Conference Rooms 1 and 2, Level 1 Ward Block 2EXA03 Summative OSCE N.A.
1400-1600 TTSH Main Block Level 1 Conference Room 1 2EXA04 Re-sit for final written exam N.A.

General

Principles of Prescribing 1

  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

 

Principles of Prescribing 2

  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

 

Prescribing in a Team Context

  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

 

Skin/Dermatological Conditions

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

 

Basic ECG Interpretation

More details will be provided at a later date

 

ABG Interpretation

More details will be provided at a later date

 

Basic X-ray Interpretation

More details will be provided at a later date

 

Interpreting diagnostic tests and procedures

ECGs, x-rays, scans, key laboratory tests

Consultations and Physical Assessments

General Approach to Patient

Calgary-Cambridge approach to medical interview and communication

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

 

History-Taking Skills

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

 

Communication Skills (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

 

Communication Skills – SBAR

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?”

 

Physical Examination

  1. General assessment and vital signs (BP, pulse rate, SpO2, peak flow
  2. Cardiovascular exam
  3. Respiratory exam
  4. Abdominal exam
  5. Neurological exam
    • Upper limb
    • Lower limb
  6. Musculoskeletal exam
    • Back
    • Shoulder
    • Knee
  7. Summarising and presenting to assessor

 

Obtaining History from Special Populations

  • Patients with dementia/psychiatric disorders

 

Mock, Formative and Summative OSCE
More details will be provided at a later date

Pharmacy Topics and Pharmacotherapeutics

Overview of Drug Use in Singapore

Drug Classification

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

 

Pharmacotherapy for Special Populations

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

 

Pharmacotherapeutics (Respiratory Disorders)

  • COPD
  • Asthma

 

Pharmacotherapeutics (Infectious Diseases)

  • 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)

 

Pharmacotherapeutics (Cardiovascular Diseases)

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

 

Pharmacotherapeutics (Endocrine Disorders)

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

 

Pharmacotherapeutics (Renal Diseases)

  • 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

 

Pharmacotherapeutics (Gastrointestinal Diseases)

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

 

Pharmacotherapeutics (Neurology)

  • Parkinson’s disease
  • Stroke
  • Epilepsy

 

Pharmacotherapeutics (Psychiatry)

  • Depression
  • Anxiety

 

Pharmacotherapeutics (Pain Management)

  • Use of analgesics for acute pain

 

Pharmacotherapeutics (Musculoskeletal Disorders)

  • Osteoporosis
  • Calcium, bisphosphonates and vitamin D

General

When will the next cohort of the programme start?

The next cohort of the programme will start on 11 Feb 2019.

 

When will application for the next cohort of the programme open?

Application for the next cohort will open on 8 Jan 2019, and close on 18 Jan 2019.

 

How much are the fees for the programme?

The following is the fee structure, which may be subjected to changes:

International Participants Singapore Citizens Singapore PRs
39 years old or younger1 40 years old or older1
Full Programme Fee

$12,429.91

$12,429.91 $12,429.91

$12,429.91

Less: SSG Grant Amount

$0.00

$8,700.94 $8,700.94

$8,700.94

Nett Programme Fee

$12,429.91

$3,728.97 $3,728.97

$3,728.97

7% GST on Nett Programme Fee

$870.09

$261.03 $261.03

$261.03

Total Nett Programme Fee Payable, Including GST

$13,300.00

$3,990.00 $3,990.00

$3,990.00

Less Additional Funding if Eligible

$0.00

$0.00 $2,485.98

$0.00

Total Nett Programme Fee Payable, Including GST, after additional funding

$13,300.00

$3,990.00

$1,504.02

$3,990.00

1 Age as of 31 Dec of the year of enrolment

 

How many runs of the programme are there in a year?

There will be 2 runs, one starting in Feb, and the other starting in Aug.

 

Where will the teaching sessions be held?

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

 

Which day of the week will the teaching sessions be held?

The teaching sessions may vary for different cohorts. For the next cohort (Feb-May 2019), teaching sessions will be on Mondays.

Numeracy Test

The numeracy test will no longer be administered prior to the start of the program. Instead, it may be conducted as part of the course. More information will be provided during the course.

Clinical Practicum

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.

 

What is the percentage of supervision hours that should be spent on specialist’s and generalist’s competencies?

There is no fixed percentage recommended. They can be included in both direct and indirect supervision. How you distribute the hours is a decision between you and your clinical supervisor, and should be aimed to maximise your learning and satisfactory performance for the entire CP Programme.

Similarly, your prescribing log, mini-CEX and case-based discussions can be cases drawn from both competencies.

Portfolio Requirement

Where can I get templates and forms for the portfolio requirement?

All templates and forms for the portfolio requirement can be found in the CP website at the “handbook/template” tab.

 

Do I need to use the templates provided for the various section of the portfolio?

The templates are for reference only. You may present your portfolio in your own format as long as it complies with requirement provided in the trainee’s handbook.

However, the mini-CEX and case-based discussion should be completed using the forms provided.

 

What forms do my named clinical supervisor have to sign?

Do I need to get my named clinical supervisor to sign all my prescribing logs, mini-CEX and case-based discussion?

All the mini-CEX and case-based discussion forms need to be signed by an assessor. However, only one mini-CEX and case-based discussion needs to be endorsed by your named clinical supervisor, and it can be generalist or specialist case. The other mini-CEX and case-based discussion can be endorsed by another doctor or a peer, which can also be generalist or specialist case.

Each of the prescribing logs needs to be endorsed by your named clinical supervisor.

The learning log needs to be endorsed by your named clnical supervisor at the end of the clinical practicum.

Your named clinical supervisor must also sign the “Clinical Supervisor Final Report” form.